Reducing delayed transfers of care in Haringey

Featured article - 17 May 2017
By John Everson, Assistant Director, Adult Social Services, Haringey Council

Head-shot of the author, John Everson, Assistant Director, Adult Social Services, Haringey Council

We are all aware that Delayed Transfers of Care (DTOC) have been steadily on the rise in recent years and are putting significant pressure on the NHS. In fact, one of the most common complaints of elderly patients in hospitals is not getting out of hospital when they feel well enough to go home.

This is not just distressing for the patient, but also for their carers and families.

In addressing the DTOC issues in Haringey, we recognised that a complex array of factors are at play, ranging from:

  • a bureaucratic and lengthy authorisation process from point of acute notification
  • to reablement packages
  • to Section 2 and 5 notifications being submitted with limited information – and therefore adding no real value to the referral process.

How did we respond?

In response, we set ourselves a goal to implement significant changes to the reablement and hospital social work pathway at North Middlesex University Hospital NHS Trust to improve patient flow and reduce DTOC in September 2016.

The key elements of our plan were underpinned by:

  • working together with local acute trusts to remove the section 2 and 5 notifications and devising a one page referral form for hospital staff - and then either emailed to Adult Social Services or phoned to a centralised number
  • co-locating a reablement administrator and a manager within the local discharge team to build relationships and improve communication with acute staff
  • agreeing a trusted assessment model that involves a clinical response service and backed up by practical support to manage people through a crisis in their own homes and communities and into planned integrated care
  • providing extensive training for staff and partners of the new notification process.

One recent example saw a patient assessed by North Middlesex Hospital ward staff as needing a hoist on discharge. The patient was verbally handed over to Haringey reablement by the hospital occupational therapist. The patient was promptly accepted for home –based assessment by the team for moving and handling equipment; within 24 hours of her return home. The new process is estimated to have removed five days from the length of hospital stay.

I believe we now have a more sustainable, streamlined and proactive service that supports the independence of patients and offers better care and support at home and in the community.

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