NHS trusts have issues fines of up to £280,000 to councils for delayed hospital discharges since 2016, a survey of directors has revealed.
Fines of £2,280 to £280,540 were levied on 16 councils in 2016-17, with 10 paying up; in 2017-18, eight councils have faced fines, of between £3,000 and £99,970, and six have paid them.
The figures come from an Association of Directors of Adult Social Services (ADASS) survey carried out last month, answered by 105 directors, 69% of the total.
In response to the results, ADASS president Margaret Wilcox said: “The idea of imposing further sanctions on already cash-strapped councils seems frankly bizarre.”
Under schedule 3 of the Care Act 2014, an NHS trust may require a local authority to pay a specified sum for every day for which a person’s discharge from hospital is delayed because of the council’s failure to carry out an assessment or arrange services to meet eligible needs.
Since the fines system came into force in January 2004, they have often not been enforced by trusts. But in May this year, the Local Government Association warned that trusts were starting to impose fines, a move it described as “completely counterproductive”.
The ADASS survey has now quantified the scale of the problem reported by the LGA, though figures were not available for the total cost of the fines levied in 2016-17 and 2017-18.
The news comes with the government having placed the NHS and local authorities under controversial targets to reduce delayed transfers of care. These require councils nationally to reduce the rate of delayed discharges attributable to social services by 53% from February 2017 levels in 2017-18, with councils deemed to be lower performing having to achieve a two-thirds reduction.
While the government has allocated councils £2bn to tackle adult social care pressures from 2017-20, health secretary Jeremy Hunt has threatened to review allocations for 2018-19 for those councils that fail to hit their delayed discharges targets, a move heavily criticised by ADASS and the LGA.
At the time of the latest ADASS survey, 62 of 101 directors who responded to the question had set delayed discharge reduction targets in line with national expectations for social care and health. However, only 32 considered these ambitions to be realistic for both services.
Addressing this week’s National Children and Adult Services Conference, Wilcox said: “That’s concerning. And as long as the threat of sanctions for supposed under-performance on DTOCs [delayed transfers of care] continues to hang over councils, tensions [between health and social care] are unlikely to lift entirely.”
The government’s targets were designed to combat a rise in delayed discharge rates and in the proportion of delays attributable to social care. From March 2016 to March 2017, the number of monthly delayed days rose from 169,900 to 199,300 and the proportion of delays attributable to social care rose from 32.2% to 36.8%.
The latest figures, for August 2017, show a year on year decrease in the number of delayed days but the proportion attributable to social care stood at 37.3%.
Saffron Cordery, director of policy and strategy at NHS Providers, which represents NHS trusts and foundation trusts, said the situation reflected the “extreme and shared challenges” faced by health providers and local government, namely “growing demand, rising costs, and tightening budgets and workforce challenges”.
She said that trusts had reported that additional government funding for councils “has not been consistently getting through with little or no impact on helping vulnerable patients out of hospital and into more appropriate care packages, either in the community or at home”.
She added: “In these areas where funding is not being spent on reducing delayed transfers of care, this will have a knock on effect for patients, across both the NHS and local authorities, this winter. Fines should be a last resort. In reality, the government sought a double benefit from this funding which hasn’t delivered effectively.
“In such challenging times we must remember that there is much more that unites than divides health and social care providers – that is what we have to build on. A long term strategy for social care provision is critical and must include the scope to allow the health and social care services to work in a more integrated way.”