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The burden of delayed transfers of care

The burden of delayed transfers of care
By Léa Legraien Reporter
9 July 2018

New figures released today by charity Age UK revealed that delayed transfers of care (DTOC) due to a lack of social care support cost the NHS £550 a minute, which represents around £289m a year.

DTOC have fallen by 30% since July 2017, according to the Local Government Association (LGA), but there are still one in seven older people living with unmet social care needs, a 19% rise compared to 2015.

How can trusts minimise DTOC to alleviate pressures on the healthcare system?

What causes DTOC?

DTOCs are when a patient is ready to leave acute or non-acute care but still occupies a bed.

One of the main causes of DTOC is the lack of social care support. If an older patient is ready to be discharged but there is no appropriate care and support in their community, it could be harmful or unethical to discharge them.

This causes patients who do not have clinical needs to remain in hospital and generates higher costs for the system than if they were receiving the care they need in their communities.

DTOC also increase waiting times for patients who are in need of a bed and can cause distress in patients who are ready to leave.

How big is the problem?

According to official figures, there were 843,971 delayed days in 2017/18 – equivalent to 2,310 years – caused by insufficient social care support. The average number of delayed days was 2,311, or four full hospitals every day.

Other than causing financial issues and increased waiting times, DTOC have a negative impact on patients.

A National Audit of Intermediate Care report, published in 2014, shows that a wait of more than two days ‘negates the additional benefit of intermediate care’, while seven days is ‘associated with a 10% decline in muscle strength’.

What about social care funding?

Local authorities have suffered an estimated £6bn worth of cuts to their adult social care budgets since 2009/10, which will lead to a funding gap of more than £2bn by 2020, according to the LGA.

The Institute for Fiscal Studies found last year that local authority spending on adult social care fell by 8% between 2009/10 and 2016/17, with the average spend per adult to decreasing from £439 to £379.

Age UK director Caroline Abrahams says: ‘[Our] older people and the NHS are both being very badly let down by the catastrophic lack of Government funding for social care.

‘Our new analysis echoes what we hear all round the country: it is getting ever harder to access care if you need it and increasing numbers of frail, ill older people are being left to manage alone.

‘This is why it is so important that the Government brings forward some bold proposals to improve social care later this year, and even sooner that it injects several more billions into care services to arrest their continued decline.’

The Government is expected to release a green paper, which will set out long-term plans on the future of adult social care, in Autumn.

How can organisations minimise DTOC?

According NHS England, commissioners and providers can improve hospital discharge into the care sector by:

  • Working in partnership with the care sector providers, such as housing associations and the voluntary sector, to put in place arrangements, with at least one meeting a year
  • Improving communication with care sector providers, such as care homes, by creating common documentation for assessment and agreeing escalation processes at times of greater pressures among others
  • Assessing patients outside a hospital setting to improve patient flow. Continuing healthcare, for example, does not need to take place in a hospital
  • Implementing actions including take-away medicines made available a day before the patient’s discharge
  • Making sure community-based services have the necessary capacities, with a system for mapping care home capacity on a daily basis, for instance
  • Involving the patients and relatives on assessment and discharge processes decisions
  • Providing care packages at home
  • Considering the implementation of a trusted assessment model. This involves a trusted assessor who carries out an assessment of the patient’s health and social care needs on behalf of and with the permission of a group of independent and voluntary sector care providers

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