Delayed transfers of care: not to be tackled in isolation
Featured article -
04 May 2017
By Richard Humphries, Senior Fellow, Policy, the King's Fund
My first job after completing my social work training was as a hospital social worker. That nearly forty years later I find myself writing my first blog in a new role as SCIE Associate on the issue of delayed hospital discharges reflects the enduring importance of social work in hospital settings. When acute treatment is over, getting stranded in hospital imposes huge human and financial costs on people directly affected, including those waiting for admission in emergency departments and in queuing ambulances. And it isn’t getting any better, with bed days lost up 60% over the last five years.
The social care sector should be especially concerned. Delays attributed to social care have soared by 23 per cent in the last year alone. But there are a few myths that need to be punctured if we are to get to grips with the problem.
The most obvious is that it is not just about social care or variations in council performance. Most delays are still due to the NHS where variations between places are even greater than those for social care. It is about the performance of the system as a whole, not the culpability of individual organisations.
- DH / ADASS / NHS England: Quick guide. Discharge to access (pdf)
- Hospital discharges: Tackling the issue in Wigan
- SCIE resources on integrated health and social care
Delayed transfers are one particular bottleneck in the system
If tackled in isolation they will simply displace pressure to some other point in the individual’s pathway. And as geriatrician John Young once pointed out, if the hospital is full so is the community. The hospital bed is a powerful unit of currency but there is no equivalent metric for community services that are essential for people, especially older people, to stay well and keep out of hospital. Prioritising hospital discharge at the expense of investment in community services might help to hit a target but misses the point.
Finally there are usually no quick fixes – it is tempting for hospitals to short circuit delays by making their own discharge arrangements with care providers which store up bigger problems further down the line. Indiscriminate discharge of older people to permanent residential care is risky, expensive and bad for individual outcomes.
There is no shortage of good practice and proven innovations. How we embed this everywhere and all of the time remains a huge challenge. Collaboration and partnership between organisations and professions – key themes of SCIE’s work on integrated care - will drive progress.