September 2018 performance
Following the 2 very good months of July and August, we have seen a fairly large rise in September. Our overall DToC delays increased in September by 181 days to 647 days in total (August 466 days) against a target of 517 days. In context, though, this is still considerably lower than at this time last year when there were a total of 852 delayed days.
- We are now at 3.16 ddp100k (August 2.20) against a target 2.47 ddp100k (September 2017 4.19 ddp100k).
- Delays in acutes rose 84 days to 222 days in September (August 138 days) against a target of 136 days.
- For the first time for a long while Western had double digit delays at 22 days (August 7 days).
Non-acute delays have increased by 100 days to 419 days (August 310 days) which meant that after 3 months of being below target in September we were over our target of 349 days.
- SCFT delays have stayed fairly level over the last 3 months and now stand at 177 days, a reduction on August of 192 days, and remain below target of 201 days.
- After 4 months of sustained reductions, SPFT delays increased to 242 days in September from 118 days in August. Work is on-going at an STP level to try to find resolution to SPFT delays and the correct and accurate recording of delays.
Our ‘Other’ delays – these reduced substantially from 60 days (pretty much average for last 6 months) to just 7 days (all at Royal Surrey County Hospital).
The Council is working closely with health partners to support improved system resilience over winter. As part of the joint health and social care winter plan the Council has just awarded contracts for 10 new domiciliary care rounds in areas where it can be difficult to source domiciliary care and a new hospital discharge domiciliary care service in the Coastal area. In addition the Council has commissioned greater bed capacity across the County. It is anticipated that this additional care capacity will help further manage short term winter pressures on transfers of care. The Council is also leading a joint social care, health and 3rd sector Step Up Step Down Programme to improve customer journeys around acute hospitals, the first phase of which is to continue to improve discharges from hospital and developing a Discharge to Assess (D2A) model (where patients who are medically fit for discharge are enabled to go home or to a D2A bed in the community to be assessed there prior to considering their longer term requirements).
July & August 2018 performance
In both July and August WSCC DTOCs were below the target of 2.47 delayed days per 100,000 population per day (ddp100k) or a total of 517 days, at 2.01 (425 days in total) (July) and 2.20 (466 days in total) (August) which is a really good effort considering the usual summer holiday workforce issues.
Both July and August were substantially below performance in 2017 in absolute terms and in terms of per 100k population with July 2017 at 831 total days v 517 total days (4.09 v 2.01 ddp100k) and August 2017 at 1121 total days v 466 total days (5.52 v 2.47 ddp100k).
The excellent performance during July and August was largely down to maintaining non-acute (SCFT and SPFT) delays steady below target, in particular with good management of SPFT delays, however across the acutes the number of delayed days rose through July and August although remained below target.
Jun 2018 performance
Our overall DToC delays decreased in June by 76 days to 509 days in total against a target of 562 days (May was 585 days). This month we have around a 1/3rd lower DToCs than we did at this time last year (June 2017 - 770 delayed days).
In June NHS DToC figures increased from 1,746 days in May to 2,016 days in June. Health 2018/19 target from September 2018 is 7.42 delayed days per 100,000 population (51 delayed days per day), down from their 2017/18 target of 9.18 delayed days per 100,000 population (63 delayed days per day). In June 2018 they were at 9.84 delayed days per 100,000 population (around 67 delayed days per day)
We are now at 2.48 delayed days per 100,000 population per day (May 2.76) against a target 2.60 delayed days per 100,000 population and baseline (February 2017) of 4.28 delayed days per 100,000 population.
Delays in acutes more than doubled from 79 days in May to 190 days in June due to a substantial rise in SASH reported DToCs (from 4 days in May to 103 days in June) which is much higher than our anticipated figure of less than 10 days. Delays at BSUH and Western remained pretty much the same. This has taken us over our Acute DToC target for the first time since December 2017.
- Non-acute delays have reduced substantially from 456 days in May to 314 days in June, below our non-acute target of 332 days for only the 2nd time in the last 12 months. After the blip in April (263 days), SCFT delays reduced in June to 106 days (down from 211 days in May).
- SPFT delays dropped slightly again in June to 208 days from 245 days in May and 287 days in April. Work is on-going at an STP level to try to find resolution to SPFT delays and the correct and accurate recording of delays.
Our ‘Other’ delays – these are out of County providers with West Sussex residents – reduced substantially to just 5 days in June (50 days in May), with the only ‘Other’ delays being at the Royal Surrey County Hospital Trust (5 days).
May 2018 performance
After 2 months of consecutive rises we have had a really good May and are now just slightly above our target of 2.6 delayed days per day per 100, 000 population at 2.76 delayed days per day per 100, 000 population. This is the 2nd lowest since April 2016.
Social care delays decreased in May by 154 days to 585 days in total against a target of 562 days (April was 739 days). This time last year we had 666 delayed days and we are therefore about 20% lower than May 2017.
NHS figures reduced from 1,872 days in April to 1,746 days in May.
April 2018 Performance
We are now at 3.61 delayed days per 100,000 population per day (March 2.85) against a target of 2.60 delayed days per 100,000 population and a baseline (February 2017) of 4.28 delayed days per 100,000 population.
Our overall Delayed Transfers of Care (DToC) delays increased in April by 135 days to 734 days in total against a target of 562 days (March was 604 days). Whilst this is slightly better than April 2017 (797 days), this is about a 20% increase on our average performance over the last 4 months. NHS DToC figures reduced from 2,044 days in March to 1,872 days in April.
Non-acute delays have risen and are the reason for this month’s increase (April 550 days against March 406 days).
- Sussex Community Foundation Trust (SCFT) increased from 146 days in March to 264 days in April. In discussions with hospital managers this does not seem reasonable and needs to be investigated.
- Sussex Partnership Foundation Trust (SPFT) stayed roughly the same from 260 days in March to 287 days in April.
Our ‘Other’ delays – these are out of County providers with West Sussex residents - stands at 44 days in April (59 days in March). In April Croydon Health Services (2 days) and the Royal Surrey County Hospital Trust (42 days) both reported days delayed.
Quarter 4 - March 2018 performance
- The target set by NHS England is
2.6 delayed days per 100,000 population per day (from a baseline of 4.28
in February 2017). As at March 2018 2.85 delayed days per 100,000
population per day were attributable to West Sussex County Council social
- Total delayed days reduced from
628 in December 2017 to 604 in March 2018 (against a target of
526) despite West Sussex acute and community
health systems having faced what is being suggested as the worst winter
pressures seen for many years, with increases in the number of people
presenting to acute hospitals and requiring community based health care.
- Acute hospital (provided through Western Sussex Hospitals NHS
Foundation Trust, Brighton and Sussex University Hospitals NHS Trust and
Surrey and Sussex Healthcare NHS Trust) delays continue to be below target of 182 delayed
days, with there being 139 delayed days as at the end of March and each
acute hospital is below their individual target.
- Non-acute community and mental
health hospitals (provided through Sussex Community Foundation Trust and
Sussex Partnership Foundation Trust) delayed days reduced slightly from
457 delayed days as at December 2017 to 406 delayed days as at March 2018.
This will be a focus of work going forward.
Quarter 3 - December 2017 performance
- The target set by NHS England is 2.6 delayed days per 100,000 population per day (from a baseline of 4.28 in February 2017). In December we are at 2.99 delayed days per 100,000 population per day, down from 3.90 in November 2017.
- Delayed days reduced by 165 in December to 628 from 793 in November (against a target of 526) – only once in the last 3 years have we had delayed days below this level and against the pressures that acute hospitals were under in December, this is an excellent effort by the hospital teams, supported by commissioners and contract staff.
- Acute delays are now below target of 182 days at 116 in December and each acute hospital is now below their own targets. Surrey and Sussex Healthcare (SASH) and Western are inline with our own internally predicted figures and although Brighton and Sussex university (BSUH) figures are closer there is still a marked difference (91 days reported against 31 days predicted).
- Non-acute delayed days remained fairly static but had a slight reduction from 472 days to 457 days.
- Sussex Community Foundation Trust (SCFT) remained below target (actual 161 against target of 227. However despite the reduction there are still issues around monitoring and reporting and SCFT have confirmed they are unable to staff the Provider of Last Resort (POLR) service they were due to provide in the north to the expected level.
- Sussex Partnership Foundation Trust (SPFT) remains over target (296 days against a target of 104. However work has started with SPFT to clarify and agree monitoring and verification processes to ensure reported figures are accurate.
The Council works with NHS providers to meet the national policy position that no-one should stay in a hospital longer than necessary and for people to have the correct support they need on leaving hospital. However, for a range of reasons, a person may experience a delayed transfer of care from a hospital.
In March 2017 NHSE set a target as part of the Better Care Fund funding. Delays attributable to WSCC in acute hospitals have been reducing over the last two years, despite increased acute hospital attendances and increased complexity of people entering and therefore leaving acute hospitals. We are working towards the national target and have developed action plans to achieve this.
Delays attributable to WSCC in acute hospitals have been reducing over the last two years, despite increased acute hospital attendances and increased complexity of people entering and therefore leaving acute hospitals. However, The Council continues to work closely with West Sussex Clinical Commissioning Groups and acute and community health service providers across West Sussex to improve the flow of patients through hospital in a timely way.
For the Council, a key contribution to making the system flow more efficiently is to reduce delayed transfers of care (DToC) attributable to Social Care and to achieve this, the Council, during 2017-18, have:
- Assessed some 8,800 people within acute hospitals within 48 hours from referral.
- Commissioned 84 additional beds to ensure people do not have to make decisions about their future care and support in a hospital bed.
- Commissioned an estimated 5,300 extra hours of domiciliary care.
- Funded additional Occupational Therapist resource to support people to retain or regain skills when they leave hospital.
- Funded staff capacity within health services to support people to leave hospital without delay and enable them to continue to provide intermediate care services
- Over the last 2 years DToCs attributable to the Council have reduced despite increased numbers of older people, people living within increasingly complex needs and increased people going into hospital.
- Utilising over half of the Councils iBCF funding, 32 new Discharge To Assess beds and 33 winter pressure beds have been commissioned to support transfers out of hospital.
- In addition the County Council has started new domiciliary care rounds providing an additional 735 hours of care at home and is planning to start more rounds, of up to a further 500 hours of domiciliary care, in the new year.
- The County Council also continues to work with our community health provider to increase their capacity, replacing withdrawn health winter resilience funding, preventing admissions and other measures.