Delayed transfers of care

Introduction

A delayed transfer of care occurs when a patient who is ready for transfer from a hospital bed to a community setting remains in hospital due to non-clinical reasons.

People who cannot leave their hospital bed and who do not need treatment:

  • reduces the number of hospital beds available to other patients, reducing access to care and increasing waiting times
  • puts patients at increased risk of an acquired hospital infection
  • causes unnecessarily long stays in hospital for patients
  • encourages low mood and reduced motivation, which can affect a patient’s health after they’ve been discharged and increases their odds of re-admission

Minimising delayed transfers of care and enabling people to live independently at home is therefore one of the key outcomes of social care. 

Measuring delays in transfers of care helps understand how hospital services (acute, mental health and non-acute) and community-based care are working together and is an indicator of the effectiveness of the interface within the NHS, and between health and social care services.

Key inequalities and risk factors

Effects on mobility can be particularly keenly felt by older patients: A wait of more than two days negates the additional benefit of intermediate care, and seven days is associated with a 10% decline in muscle strength for people with frailty for whom muscle weakness is a defining characteristic.

Nationally, between 1987 and 2015, the average daily number of available hospital beds reduced by 54% to 136,000. Delayed transfers of care reduce the availability of specialist beds for people with learning disabilities, mental illness and for longer-term geriatric care (House of Commons Briefing Paper, 7415, December 2015).

Delayed transfers of care delay appointments for patients for planned, elective procedures prolonging care and support which would otherwise be avoidable.

Facts, figures and trends

A patient is ready for transfer when:

  • a clinical decision has been made that the patient is ready for transfer
  • a multidisciplinary team decision has been made that the patient is ready for transfer
  • the patient is safe to discharge/transfer

In 2015/16 the daily average number of delayed transfers of care nationally per 100,000 population (aged 18+) was 12.3, which compares to 11.1 in 2014/15. Since August 2010, the number of delayed days attributable to each organisation/sector has been changing gradually. In 2015/16, the number of delays attributable to NHS, Social Care and both sectors all increased.

The Kings Fund gives several reasons for delayed transfers:

  • patients can often be delayed waiting for onwards health care, for example at a community NHS facility such as a community hospital
  • they can also be delayed by waiting for social care to be arranged at a residential or nursing home or for a care package at home to be developed
  • patient assessments are not completed before they recover due to the complexity of agreement from a multidisciplinary group of acute clinicians, social workers and other care workers
  • agreeing that a patient is fit for discharge, as well as acquiring a care package and getting paperwork completed on time, can be a difficult process

Other factors can also come into play. These include disputes between families/patients and providers concerning where the patient should be transferred; waiting for equipment to be installed in the community; awaiting public funding and housing issues.  National figures can be found in NHS England Annual Statistics Reports.

The rate of total delayed transfers of care per 100,000 population in Bracknell Forest has risen slightly since 2010/11. In 2013/14 the rate was lower than, but not significantly different to, the national average. (Accessed 28 June 2016).

The rate of delayed transfers of care from hospital attributable to adult social care in Bracknell Forest increased slightly between 2010/11 and 2011/12 and have remained steady since this time. The rate in 2013/14 was 2.2 per 100,000 population. Rates each year have been similar to the national average:

Prevention and management

There are a range of services within Bracknell Forest that can deliver or support intermediate care functions.

The main service is the Community Response and Reablement Team, which delivers intermediate care in people’s homes and own communities as well as in the local bed based service in the Bridgewell Centre. Services such as community hospitals, Rapid Access Community Services, Community Health Clinics, specialist nurses, GP services, district nursing, physiotherapists and social care teams also have a role in intermediate care.

The 2012-2015 Joint Commissioning Strategy for Intermediate Care sets out the model for intermediate care in Bracknell Forest which seeks to avoid unnecessary hospital admission, reduce unnecessarily long hospital stays and help patients to improve and maintain independence and reduce readmissions to hospitals.

For times when demand on hospital beds is particularly acute, Bracknell and Ascot Clinical Commissioning Group working with the council has developed an Operational Capacity and Resilience Plan to ensure the flow of patients in peak winter periods.

The 2016 Local Government Information Unit report into hospital discharge of older people concluded that local system capacity in terms of bed availability, recruitment and retention of the workforce and intermediate care placements were major problems in many areas. The council has also responded to the Care Act 2014 to put in place provisions for protecting against provider failure, thereby ensuring there is sufficient community provision for onward care and work force development is a priority of the Joint Health and Wellbeing Strategy 2015-2020.

As part of individual assessments, health and social care professionals also consider the use of assistive technology solutions to ensure that people have personalised support for independent living.

Costs

The House of Commons Briefing Paper (7415, December 2015) states that delayed transfers of care are costly for hospital trusts because they:

  • have to pay to provide places for patients who are ready to leave
  • have insufficient beds to carry out scheduled, elective procedures
  • lose income when elective procedures need to be cancelled

Monitor and the Trust Development Authority (TDA) estimated that in the year to 30 September 2015, delayed transfers of care cost hospital trusts £270m across the UK.

A report published by the National Audit Office (NAO) (May, 2016) estimates that 2.7 million bed days are lost due to the delayed transfer of older patients no longer needing hospital care. The NAO estimates that increasing social care services for older patients after hospital discharge could cost around £180 million a year but would increase the potential savings of £820 million that would arise from discharging patients earlier.

Want to know more?

A report of investigations into unsafe discharge from hospital (Parliamentary Health Service Ombudsman, 2016) – highlights three issues for particular attention for succssful discharge, namely: checks of mental capacity and offer legal protections for those who lack capacity, increased involvement of carers and relatives in discharge planning, better co-ordination within and between services

As part of individual assessments, health and social care professionals also consider the use of assistive technology solutions to ensure that people have personalised support for independent living.

Discharging older patients from hospital (National Audit Office, 2016) – an exploration of the underlying issues affecting the timely discharge of patients deemed ‘medically fit for discharge’ but who remain in hospital, exploring issues in health and social care, capacity in the system, an argument of costs of impact and value of investment and a range of recommendations for system leaders and services commissioners.

Joint Commissioning Strategy for Intermediate Care 2012-2015 (Bracknell Forest Council and Bracknell and Ascot Clinical Commissioning Group, 2012) - sets out the model for intermediate care in Bracknell Forest which seeks to avoid unnecessary hospital admission, reduce unnecessarily long hospital stays, help patients to improve and maintain independence and reduce readmissions to hospital following discharge.

National framework for NHS continuing healthcare and NHS funded nursing care (Department o Health, 2012 updated 2016) - sets out the principles and processes of the National Framework for NHS continuing healthcare and NHS-funded nursing care (the National Framework) incorporating responsibilities for transfers of care.

Transition between inpatient hospital settings and community or care home settings for adults with social care needs (NICE, 2015) -  guideline which includes recommendations on person-centred care and communication and information sharing, care planning, establishment of a hospital-based multi-disciplinary team, recording medicines and assessments and regularly reviewing and updating the person’s progress towards discharge, the role of the discharge coordinator and training and development for people involved in the hospital discharge process.

Preventing excess winter deaths and illness associated with cold homes (NICE, 2016) – sets out arrangements for people who are vulnerable to the health problems associated with a cold home who will be discharged to their own home from a care setting to have a discharge plan that includes actions to ensure their home is warm enough.

Transforming urgent and emergency care services in England (NHS England, 2015) - good practice for commissioners and providers of community health services to work together to convert urgent care into planned care by developing community nursing, rapid response and provisions for early supported discharge.

 

 

This page was created on 27 February 2014 and updated on 22 June 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Delayed Transfers of Care. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/delayed-transfers-care (Accessed: dd Mmmm yyyy)

 

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