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No winners in DTOCs feud

Poor progress on delayed discharges is a source of great angst at the top levels of both government and the NHS – despite councils being allocated an extra £2bn over this year and next.

As we revealed this week, ministers have threatened to cut next year’s funding allocations for 32 councils whose DTOC performance has been deemed especially poor.

The mess the system finds itself in was entirely predictable. NHS Providers warned shortly after the funding was allocated in the March budget that councils would use the cash to fill existing holes in their services (somewhat understandably given the cuts inflicted on councils since 2010) rather than on speeding up discharges.

NHS England told acute providers to “get lippy” with their local government counterparts to influence how the money was spent. But it is worth remembering it was Simon Stevens who in June 2016 called for any money available for health to go to social care rather than the NHS, to address delayed discharges.

Having made good on the request for more money from social care, it would be understandable if ministers were frustrated about the lack of progress on DTOCs.

It is not clear what material impact the ministerial threats will have. But one thing we do know is the system has got nowhere near the forecast 2,000 to 3,000 additional acute beds – which were supposed to be created by cutting DTOCs – to help the system cope with the inevitable winter demand surge.

With the latest figures showing A&E performance on a downward trend, ministers had better hope that other warnings – like Chris Hopson’s of a “winter of discontent” – don’t come to pass.