Summary

Over the last year (September 2014-15) DToCs have increased considerably. For health the figures have marginally reduced, but for social care they have increased significantly.    

Total figures

In September 2014, it was 138,237 individual days compared to September 2015, it was 147,738 individual days. This represents a 7% increase over the last year and a 28% increase since September 2010.

Health

In September 2014, the number of delayed days for health causes was 93,123 individual days, whereas, in September 2015 this was 91,492, which represents a 2% reduction over the last year.

Social care

In September 2014, the number of days delays for social care reasons was 35,664. This rose to 45,570 in September 2015, which represents a 28% increase.

Both health and social care

In September 2014, there were 9,480 days which increased to 10,676 in September 2015.  This represented a 13% increase.

Peak

DToC peaked in January 2015, with 150,392 individual days.

A&E
  • A&E departments had their worst September performance against the four hour target in five years as more patients were admitted than in any other September.
  • Only 90% of patients at major A&Es were seen, treated, admitted or discharged within four hours, against the 95% target.
  • There were 458,510 patients admitted in September, a 3% increase on last September and an 8% increase since September 2010.
The next figures are due out on 10th December which will be for October.
 

Reasons for the delay

  • Health - The main reason for NHS delays in September 2015 was patients awaiting further non-acute NHS care (including intermediate care, rehabilitation services etc.). This accounted for 27,700 delayed days (30.2% of all NHS delays).
  • The other major reasons for delays are patient or family choice, 16,457 days and awaiting completion of assessment, 13,838 days.
  • Social care - The main reason for social care delays in September 2015 was patients awaiting care package in their own home. This accounted for 15,900 delayed days (34.9% of all social care delays), compared to 10,200 in September 2014.
  • The other major reasons for delays are awaiting residential home placement or availability 9,925 days and awaiting completion of assessment 7,825 days.
  • For both health and social care there were 35,366 days due to delays awaiting nursing and residential home placement or availability.

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.

The funding that councils received for winter pressures in the last financial year was in no way proportionate to the scale of the task or the level of support needed for vulnerable people. Councils must be funded adequately if they are to continue reducing pressures and costs for NHS during times of increased demand. According to the ADASS Budget Survey, councils received only 5.9 per cent (£41 million) of the £700 million allocated to the NHS to respond to winter pressures in 2014/15. This money, even with the additional £37 million councils received directly to help tackle delayed transfers of care, was in no way proportionate to the scale of the task.

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.

Role Council’s play in managing DToC - Earlier this year councils demonstrated the vital role they play in helping the NHS to manage seasonal demand pressures. Councils prioritise hospital discharge and are engaged in a range of activities to help combat delayed transfers of care, such as through six and seven day working, reallocating social work capacity to hospitals to support discharge nurses, increasing reablement support services, commissioning additional ‘step-down’ care home beds to get people out of hospital, and purchasing additional home care capacity.

Challenges facing providers – From the ADASS Budget Survey, 56% of directors believe that providers are facing financial difficulties now (rising to 62% considering what the situation will be like in two years), 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.

Mark Hill 

ADASS Policy Officer