Delayed transfers of care

Featured article - 12 February 2018
By Ric Whalley, Associate Director, Newton

Head-shot of the author, Ric Whalley, Associate Director, Newton

We have all heard stories of people like Mike, an 89-year-old gentleman who after a fall at home spent ten days in hospital and then ended up in long-term residential care. Last year there were 2.3 million bed days lost because of delayed transfers of care, which is resulting in unnecessary costs to the NHS and Local Government, and poor outcomes for older people.

We have been working with three systems in the North of England to support them in achieving a sustainable, long term reduction in delays in such a way that outcomes are improved and costs reduced. We started by taking a closer look at the evidence and the root cause of delays - dealing with the realities not the myths – examining the operational processes and the cultural behaviours. We reviewed 2,800 patient records, discussed 132 cases in detail with professional staff and interviewed over 80 staff working in the systems.

Consistency of decision-making

There are some very real operational challenges which bely the simplicity of the headline figures. Systems report delayed transfers very differently - one system was reporting 23% of their medically optimised patients as delayed compared to another reporting 69%. Over a third of those patients who were defined as medically optimised were waiting for a decision to be made as to which discharge pathway was appropriate and another third of patients were on the wrong care pathway.

These are very complex issues - for example improving the consistency of decision making by frontline staff across the whole system, which can be made up of five or more different organisations is not easy. However, with the right leadership approach, coupled with process changes, patients, their carers and the organisations themselves can benefit. In another piece of work in Kent, effective discharge teams reduced the number of residential admissions by 54%.

Having high levels of delayed transfers is a symptom of a system not working to get it right for patients, people who use services and carers. No one part of the system is to blame - every bit of the system - primary care, community health, social care and acute decision making all contribute to creating delays in patient flow and all parts have to play their role in the solution. Behaviours and ownership by system leaders are key, creating a shared narrative which is patient focussed and is consistently delivered by all staff. We’ve seen this work in Sheffield, where we’ve worked together to reduce delayed transfers by 35% in just 12 weeks.

Our passion for this work is to help systems make sure patients get home as soon as possible with the right care by helping system leaders collaborate and support their staff to change the way they work and the decisions they make. We have gone into more detail on how we do this in our report "Why not home, why not today" which we hope you will find helpful.

Sustainable reduced delayed transfers of care can happen but it requires brave leadership which is determined to learn from the evidence produced. That leadership needs to be confident to trust in all staff to do the right thing for people like Mike: patients, people who use services and carers.

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