Social services told to agree local targets to cut delayed discharges

Ministers are demanding health and care services agree local targets with NHS commissioners to cut delayed hospital discharges after becoming concerned the level is “unacceptably high” nationally.

The requirement, which will come into force from next April, was announced in a framework for the 2016-17 Better Care Fund (BCF) published by the Department of Health and Department for Communities and Local Government last week.

The BCF will pool £3.9bn of central health and social care funding next year, up from £3.8bn this year. Most of the fund comes from the NHS but around £400m is from a local government grant. The cash is channelled to local areas to deliver on approved plans for integrated health and social care.

Local authorities and NHS clinical commissioning groups (CCGs) can choose to top up their local BCF funding pots.

In a second change to how the BCF will work next year, the government is scrapping a ‘pay-for-performance’ element which linked £1bn of the funding to local areas’ success in cutting emergency hospital admissions.

Local areas will instead get a share of £1bn of ringfenced funding to invest in NHS-commissioned out-of-hospital services, including social care, with the option to hold back an “appropriate portion” of the cash for contingency planning.

Richard Humphries, assistant director of policy at the King’s Fund, told Community Care: “Easing up on the performance fund does make sense, but arguably the pressures on NHS budgets are now so great that clinical commissioning groups (CCGs) will not need externally imposed conditions to want to drive a hard bargain with their social care partners.

“There is now an intrinsic motivation for CCGs and local authorities to get the best outcomes possible for every pound spent. The focus on delayed transfers also make sense, but only if the underlying causes are addressed and not just the symptoms. Otherwise there’s a great risk of hitting the target but missing the point.”

The government hopes the changes will help improve the health and care system’s deteriorating performance on discharge delays.

The latest NHS figures show patients spent 160,094 extra days in hospital due to discharge delays in October 2015 – up 29% on the previous year.

Humphries felt the 2016-17 guidance was “marking time” ahead of a complete overhaul of the BCF in 2017. The government’s spending review promised to channel an extra £1.5bn a year into the fund via local authorities from 2017-18 onwards. The move is part of efforts to ensure health and social care are ‘integrated across the country’ by 2020.