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Delayed Transfers of Care

Volume 626: debated on Monday 3 July 2017

I would like to update the House about action we are taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up 24.5% from 1.81 million in the previous year. The Government are clear that no-one should stay in a hospital bed longer than necessary: it removes people’s dignity, reduces their quality of life; leads to poorer health and care outcomes for people; and is more expensive for the taxpayer.

In this year’s mandate to NHS England I set a clear expectation that delayed transfers of care (DToCs) should equate to no more than 3.5% of all hospital beds by September. Alongside this, the spring 2017 Budget announced an additional £2 billion to councils in England over the next three years to spend on adult social care services.

The system has worked extremely hard to agree spending plans and put in place actions to make use of the £1 billion provided in 2017-18 to meet the three purposes of the funding:

meeting adult social care needs;

reducing pressures on the NHS, including getting supporting more people to be discharged from hospital when they are ready; and,

ensuring that the local social care provider market is supported.

Since February, there have been significant improvements within the health and care system, with a record decrease in month-on month delayed discharges in April 2017. We are supportive of the best performing systems where local government and the NHS are working together to tackle the challenge of delayed transfers of care. However, we are clear that we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments.

This is why today we are setting out a further package of measures to support both the NHS and local government to reduce delays. This package supports all organisations to make improvements, and includes:

The integration and better care fund planning requirements 2017-19, clarifying how this, and other aspects of the better care fund planning process, will operate.

Joint NHS England, NHS Improvement, Local Government Association and Association of Directors of Adult Social Services guidance on implementing trusted assessors.

A performance dashboard showing how local areas in England are performing against metrics across the NHS-social care interface including delayed discharges.

Plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds, including a breakdown of delayed days per 100,000 of the population and the indicative reduction levels required by each local authority and local NHS, which can be shared out differently at local level if agreed by both organisations.

Considering a review, in November, of 2018-19 allocations of the social care funding provided at spring Budget 2017 for areas that are poorly performing. This funding will all remain with local government, to be used for adult social care.

In addition, I have asked the chief executive of the Care Quality Commission to commission 12 reviews of local areas to consider how well they are working at the health and social care boundary. A further 8 reviews will be commissioned based on the performance dashboard and informed by local authority returns due in July. These reviews will commence immediately with the majority complete by the end of November, with a view to identifying issues and driving rapid improvement.

We are also putting in place a comprehensive sector-led support offer and in early July NHS England, NHS improvement, Local Government Association, Association of Directors of Adult Social Services and the better care support team are publishing the definitive national offer to support reductions in delayed transfers of care to all areas.

The health and care system has committed health and social care staff and managers up and down the country working every single day to deliver the best outcomes for people. Today’s announcement will give our workforce and their leaders clarity on how the Government expect the NHS and local government to work together to achieve this joint ambition.