Summary

Over the last year (September 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 September 2011, particularly over the last two years for social care.

Total figures

  • In September 2016, the number of delayed days were 196,246, for September 2015 there were 147,738 days. This represents a 33% increase over the last year. This is the highest number of total delayed days reported in a month since monthly data was first collected for August 2010. The previous highest month was last month.

Social care

  • In September 2015, the number of delayed days for social care reasons was 45,570. This rose to 67,594 in September 2016 (highest on record), which represents a 48% increase over the last year. (In August 2016 there were 62,807 days).

Health

  • In September 2016, the number of delayed days for health causes was 113,354 (highest on record) individual days, whereas, in September 2015 it was 91,492 which represents a 24% increase over the last year.

Both health and social care

  • In September 2015, there were 10,676 days which increased to 15,298 in September 2016. This represented 43% increase.

Attributable to social care

  • 34.4% were attributable to social care in September 2016, which is up from 30.8% compared to September 2015. In August 2016, 33.3% of delays were attributable to social care. See attached document which shows further trends (tabs 3-4).

Peak

  • This month’s DToC figures are the highest on record for total delays, and delays attributable to social care and health.

The next figures are due out on 8th December 2016 which will be for October 2016.

Reasons for the delay

  • Social care - The main reason for social care delays was patients awaiting care package in their own home. This accounted for 24,800 delayed days (36.7% of all social care delays), compared to 15,900 in September 2015.

Trends over the last five years

Total

  • Over the last five years (September 2011 – September 2016) the total number of individual days has risen from 117,194 to 196,246. This represents a 67% increase.
  • There have been particularly pressures over the last three years, in September 2013 there were 118,864 days.

Social Care

  • A similar trend for social care. Over the last five years (September 2011 - September 2016) the total number of individual days has risen from 36,948 to 67,594. This represents an 83 % increase. See attached document which shows further trends (tabs 1-2, 5-6).

Attributable to social care

  • 34.4% were attributable to social care in September 2016, which is up from 25.8% in September 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 (September 2011 – September 2016) the total number of individual days has risen from 72,291 to 113,354. This represents a 57% increase.

A&E attendance and emergency admissions

  • The total number of attendances in September 2016 was 1,952,000 an increase of 4.9% on the same month last year.
  • There were 476,000 emergency admissions in the month, 2.6% higher than the same month last year.
  • Emergency admissions via type 1 A&E departments increased by 3.7% 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 3.7% 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. There are five interventions. The intervention of most relevance to SC is mandating ‘Discharge to Assess’ and ‘trusted assessor’ type models. This doesn’t mean social care paying and it isn’t mandatory.
  • 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: Following the Spending Review the government claimed an above-inflation rise in care budgets by allowing local authorities to raise council tax by 2% for social care and increasing the amount of money available for the BCF. 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 to help address some of the financial challenges.

The Government’s own figures show that the potential benefit of the new 2% precept flexibility is £1.8 billion. The new social care precept flexibility (used by 93% of councils) raised a total of £380m. This does, however, raise much more in some areas than others and raises least in areas with the greatest need for social care and local councils might not use the precept in the future. We estimate the funding gap for social care to reach £4.3 billion by 2020.

The Budget Survey showed cost pressures relating to the increased numbers of older and disabled people needing care and support continue to run at just below 3% per year. This equates to £413m additional pressure in 2016/17. To maintain care at the same level as last year would require more than an extra £1.1bn.

The full benefit of the new money will not be felt until the end of the decade, but services supporting older and disabled people to get safely home after hospital are at breaking point right now in many areas.