This article was first published at Social Care Innovation
In recent years January and February’s coverage of the peak demand on the NHS during the winter months has been accompanied by reports of stubbornly high rates of delayed transfers of care from healthcare settings.
And for good reason. A new analysis of delayed transfers data from last October by Impower shows that while there have been continual month on month improvements, 68% of councils failed to meet the targets for reducing the number of overlong hospital stays. Extended hospital stays can increase patients’ risk of likelihood, create extra stress and anxiety, and compromise their recovery.
Obstructed care
Delayed transfers are caused by patients being directed through the health care system via the wrong routes, too slowly. Too many face lengthy pauses in treatment produced by waits for the results of diagnostic tests, poorly designed internal processes, inadequate administration and a shortage of intermediate care places.
According to the Nuffield Trust, between 50% and 60% of bed days on acute care wards could be spent elsewhere. While 19% of patients on extended stays could probably return home without any form of additional support, the rest are likely to need care after their departure from hospital. For example, 28% may require nursing and social care support with input from clinical or rehabilitation specialists and a further 12% would be better served in a long-term care home. Others would require rehabilitation services, step-down care and palliative support.
Local authorities and health bodies have demonstrated that it is possible to expedite people’s progress through the system as long as the right combination of skills and resources are in place. Dudley Council has achieved a 58% reduction in delayed discharges among older people by establishing new specialist support teams to work alongside hospital accident and emergency departments and ambulances in order to prevent unnecessary admissions.
Astler Living in Somerset has been commissioned to help patients plan to return home by installing new furniture and equipment in their houses, repairing hazards and making sure people are receiving the benefits to which they are entitled.
Take a step back
Specific interventions can be effective at smoothing transitions between services, but it is also vital to look at the system-wide issues that cause unnecessary admissions. The Care Quality Commission has recently warned against focusing too much on delayed transfers at the expense of underlying problems in the local health and social care system. Primary and community care services need to work together to prevent people reaching a crisis point and make sure that there is sufficient local capacity to provide a range of care and support packages.
Making sure there is out-of-hours social work provision, that everyone is allocated a single keyworker who signposts and coordinates their health and social care, and professionals ranging from the GP to the community pharmacist are kept informed about patients’ care needs can reduce the need for intensive medical support and help people get back onto their feet after a stay in hospital. Councils and local health services need to be able to coordinate services that meet the needs of the local population, including planning for periods of elevated demand.
High delayed transfer rates are a sign that the current mix of health and social care services does not match the local demand. Health and social care commissioners have a critical role to play in designing better routes through the care system.