Dozens of councils face funding cuts for poor DTOCs performance

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Thirty two local authorities warned social care funding could be cut next year
Councils are in the ‘bottom quartile’ on delayed discharges performance, say ministers
Letter warns ministers were ‘determined to take action’ against poor performers

Thirty two local authorities have been warned by ministers their adult social care allocations could be cut next year if their delayed transfer of care performance does not significantly improve, HSJ has learned.

HSJ exclusively revealed plans for the letters last week about withholding funding from the improved better care fund – budgeted at £1.5bn in 2018-19.

The letter, jointly sent on 10 October by health secretary Jeremy Hunt and communities secretary Sajid Javid, and seen by HSJ, told a group of councils they were in the “bottom quartile” on the government’s key delayed transfers of care measure.

It says ministers reserved “the right to reduce the published allocation for a council’s [improved better care fund share] should performance continue to fail to improve”.

The correspondence was sent to 32 local authorities deemed the worst performers based on current DTOC rates per 100,000 of the adult population, and performance improvement since February 2017. A list of the 32 has not been made available.

The letters lay bare the lack of progress made on efforts to cut delayed discharges and the increasing frustration within Whitehall about the bitter feud between the NHS and councils over how to spend the £2bn of additional social care funding.

It adds: “We are…determined to take action to challenge entrenched poor performance by councils. Where councils, including yours, have significant performance challenges, there will be additional monitoring and escalation.”

It comes amid the announcement by NHS England today of further measures to try to improve winter performance, including a push on flu vaccines, new national coordination, and an increase in emergency medicine doctor training places.

Ministers will “closely monitor” the performance of the low performing councils between now and November. “We will be looking for evidence of significant performance improvements in the September data (published in November) before making a final decision on which local authorities will be formally reviewed,” the letter says.

It continues: “All iBCF funding will remain in local government to be used for adult social care. At this stage, we can confirm that we favour options that place conditions on how you use a proportion of the additional 2018/19 iBCF funding to support DToC performance.”

The letter explains the depth of concern about the lack of progress on delayed transfers of care. “Improvements are neither consistent nor yet significant and the overall rate of improvement remains a considerable distance from where it needs to be. Between June and July the total number of DToC (NHS and adult social care) reduced by only 93.”

The letters also said the NHS was making efforts to reduce discharge delays.

There are also ongoing disputes about the release of NHS budgets to the shared better care fund during this financial year, and NHS England has suggested that withheld funds could be spent instead by the NHS to fund care packages.