• Efforts to cut delayed transfers hampered by care package assessment problems
  • “Very ambitious” targets driving poor commissioning decisions, experts warn
  • DTOCs feud between councils and NHS intensifies

Efforts to cut delayed discharges to free up between 2,000 and 3,000 beds are being hampered by problems with the assessment process for long term care packages, a senior policy expert has warned.

NHS England ordered clinical commissioning groups to address issues with Continuing Healthcare assessments, which determine if patients are eligible for ongoing NHS care, over the summer. The number of people assessed as eligible for CHC has been growing by 6 per cent annually in recent years, and costs the NHS in excess of £3bn, according to a National Audit Office report.

The national commissioning body found 100 out of 207 clinical commissioning groups had reported that over 30 per of CHC assessments in their area took place in hospital, despite a national target to reduce this to less than 15 per cent, for the first quarter of 2017-18.

It said if CCGs met the national CHC assessment target it could help “free up to a quarter of the total number of the beds the NHS is required to release”.

However, a senior Health Foundation figure told HSJ there were no “quick wins” and “very ambitious and challenging” national targets were, in places, driving poor commissioning decisions that could detrimentally impact patients’ recovery.

Senior policy fellow Tim Gardner added: “The push… is having some unintended consequences in some parts of the country. Anecdotally we hear some NHS organisations are desperately looking for non-acute capacity to meet the target and are rushing into purchasing any type of step-down capacity, rather than the right type of capacity for the patient concerned.

“This could see the system get into a vicious cycle whereby patients don’t recover properly and need further treatment or readmittance. The priority has to be getting the right care for patients and the NHS needs to invest in rehabilitation and other forms of intermediate care.”

The warning follows ministers making a new intervention in what has become an increasingly bitter feud between the NHS and councils over how to spend £2bn of additional social care funding allocated in the spring budget.

Health secretary Jeremy Hunt and communities secretary Sajid Javid wrote to 32 councils to warn them their adult social care allocations could be cut next year if their delayed transfers of care performance does not significantly improve.

NHS England set a target for to cut DTOCs to 3.5 per cent of the NHS’s overall bed base by last month. While data has not been fully evaluated, NHS Providers and other policy experts have predicted the system will have fallen well short.

NHS England declined to comment on concerns about how ambitious the target was or the unintended consequences.

A spokesman said: “Patients who are well enough to leave hospital should be able to do so at the earliest opportunity. People waiting for CHC assessments in hospital add to the pressures. There is wide agreement that patients should, wherever possible, have their needs assessed when their long term needs are fully clear, not when they are lying in a hospital bed.”

Dozens of councils face funding cuts for poor DTOCs performance