Summary

Over the last year (November 2015-16) DToCs have increased considerably. For health the figures have increased, but for social care they have increased significantly. This follows a similar upward trend since November 2011, particularly over the last two years for social care.

 

Total figures

  • In November 2016, the number of delayed days were 193,680 for November 2015 there were 153,191 days. This represents a 26% increase over the last year.

 

Social care

  • In November 2015, the number of delayed days for social care reasons was 47,573. This rose to 67,478 in November 2016, which represents a 42% increase over the last year.

 

Health

  • In November 2016, the number of delayed days for health causes was 110,579 individual days, whereas, in November 2015 it was 95,124 which represents a 16% increase over the last year.

 

Both health and social care

  • In November 2015, there were 10,494 days which increased to 15,443 in November 2016.

 

Attributable to social care

  • 8% were attributable to social care in November 2016, which is up from 31.1% compared to November 2015. In October 2016, 34.9% of delays were attributable to social care. See attached document which shows further trends (tabs 3-4).

 

Peak

  • DToC peaked in November 2016 with 200,008 individual days, for social care with 69,798 days and for health 114,586 days. November’s days are just below these figures.

 

The next figures are due out on 9th February 2017 which will be for December 2016.

 

Reasons for the delay

 

  • Social care - The main reason for social care delays in November 2016 was patients awaiting care package in their own home. This accounted for 24,500 delayed days (36.3% of all social care delays), compared to 16,300 in November 2015. The number of delays attributable to this reason has been steadily increasing since February 2015.

 

  • Health - The main reason for health delays in November 2016 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 29,900 delayed days (27.0% of all NHS delays).

 

Trends over the last five years

 

Total

  • Over the last five years (November 2011 – November 2016) the total number of individual days has risen from 114,705 to 193,680. This represents a 69%
  • There have been particularly pressures over the last two years, in November 2014 there were 140,949 days.

 

Social Care

  • A similar trend for social care. Over the last five years (November 2011 - November 2016) the total number of individual days has risen from 35,280 to 67,478. This represents a 91% increase.
  • There have been particularly pressures over the last two years, November 2014 there were 37,610 days. See attached document which shows further trends (tabs 1-2, 5-6).

 

Attributable to social care

  • 8% were attributable to social care in November 2016, which is up from 26.7% in November 2014. Historically over the last five years, the delays attributable to social care was mid-late twenties. However, over the last year this has risen to early thirties.

 

Health

  • Over the last five years (November 2011 – November 2016) the total number of individual days has risen from 71,099 to 110,759. This represents a 56% increase.

 

A&E attendance and emergency admissions

  • The total number of attendances in November 2016 was 1,907,000, an increase of 1.7% on

the same month last year.

  • There were 489,000 emergency admissions in the month, 2.9% higher than the same

month last year.

  • Emergency admissions via type 1 A&E departments increased by 3.2% over the same period. (Type 1 - A large hospital department which provides a consultant-led, 24 hour service with full resuscitation facilities and designated accommodation for the reception of emergency patients).
  • Emergency admissions over the last twelve months are up 3.5% on the preceding twelve month period.
  • The chart below shows the volume of emergency admissions per day in each month. Further statistical analysis can be found on the accompanying spreadsheet - tabs 7 to 8.

 

Key messages

 

  • DToCs have increased significantly, particularly for social services. ADASS has signalled the fragility of the social care market, the considerable workforce recruitment and retention issues and funding on many occasions. This is impacting on putting together packages of care for people to enable them to avoid hospital admission in the first place or to be supported home well after admission.

 

  • Knock on impact to patients, and health and social care - DToC can harm patients and create massive increased and avoidable costs for both the NHS and social services. Councils give a priority to helping people home from hospital even in these difficult financial times when fewer people are getting services. Work is underway to promote earlier discharge planning and increased use of reablement and intermediate care. For example, the A&E Improvement Plans aim to help A&E waiting time performance. Support will be targeted at systems with the greatest need. Local A&E Delivery Boards will focus solely on urgent and emergency care.

 

  • Challenges facing providers – From the ADASS Budget Survey, four out of five directors believe that providers are facing financial difficulties now, there is continued evidence from our survey of actual failure within the provider market in the last 6 months, affecting at least 65% of councils and thousands of individuals as a consequence. This is fuelling wider concerns about provider viability and sustainability and the quality, quantity and duration of commissioned care. A proportion of providers are leaving the market or restricting supply to people who pay for their own care placing the most vulnerable at further risk.

 

Funding:  The Autumn Statement didn’t provide the desperately needed extra funding for adult social care. This means we will inevitably see more older and disabled people not getting the care and support they rely upon to survive each day, an even greater toll being placed on the 6.5 million family members and other carers, increasing delays in the NHS, and even more care homes closing and growing gaps and failures in the care market. We estimate the funding gap for social care to reach £4.3 billion by 2020.

 

The Local Government Finance Settlement has allowed councils to raise council tax by 3% for social care. Whilst we welcome the Government’s acknowledgement of the need to address the crisis in social care funding, but the amount brought forward for 2017/18 is woefully inadequate and the precept raises less in areas with the greatest need.

 

The BCF funding gradually increases during this Parliament, but only by any significance in 2019/20. The £700 million in the BCF should be brought forward now as services supporting older and disabled people are at breaking point right now in many areas.