December 2019 performance
DTOCs have been increasing over the winter months, this is due to multiple factors, including increased demand and pressure in acute hospitals, which has resulted in an increase in referrals for hospital social work teams. Lack of capacity in the care market, creates delays and staff have also uncovered some errors with the verification processes, which has resulted in non-acute DToCs, being incorrectly attributed to ASC. Mitigating actions in place include a focus on the verification process, implementation of the joint Home First model, with health and social care and purchasing additional capacity in the market, which is covered by the Winter Plan.
November 2019 performance
Recorded and reported Delayed Transfers of Care (DTOCs) from July to September 2019 have been above target for delays attributable to both NHS and Social Care. September’s social care DTOCs reflects an increase of 2.1% from the previous month and 11.6% above target. The increase reflects the position felt in the summer months with challenges sourcing sufficient capacity to meet demand across the social care market, and whilst August was a slightly improved position for social care from the previous month this has unfortunately increased again in September. Non acute social care delays appear to be a particular challenge.
The three highest reasons for social care DTOCs have been for people waiting for residential care, nursing care and a package of care in their own home. The increase in DTOCs in recent months is a particular concern going into winter, where pressures across the system can often be intensified with increasing demand and limitations in capacity in the care market. To mitigate this, winter plans have been developed, and for social care this includes commissioning additional home care capacity and block booking beds for nursing and dementia provision. In addition, a high priority in focus and investment in time for winter is the implementation of Home First, a joint health and social care discharge to assess pathway for patients to be enabled to return home as soon as they are medically ready for discharge. This enables support in a person’s own home to consider any ongoing care and support needs and how these might be most appropriately met, which whilst improving DTOCs should also improve outcomes for customers after their discharge. The pathway has now commenced in wards in East Surrey, Worthing and Princess Royal Hospitals, with plans to commence in St. Richards after Christmas. The impact on DTOCs will be continue to be monitored as we proceed into the winter months.
October 2019 performance
New national guidance being implemented, which may have a temporary, negative impact on DToC figures, however this is being mitigated by the introduction of a Home First joint health and social are discharge pathway.
September 2019 performance
After nine months consistently below target for Delayed Transfers of Care, July 2019 unfortunately reflects the pressures across the system over the summer months with an increase in delayed days by 18.2% compared to the previous month, and delays attributable to both NHS and Social care having increased.
The highest increase in reasons for the social care delay in July was due to delays awaiting a package of care in a person’s own home. This is a reflection of the challenges in sourcing sufficient care for people to meet the levels of demand for services. This can be intensified over the summer when service providers ability to commence new packages of care can be limited due to reduction in staff availability during these times. To work to resolve this the Council has implemented an action plan focused on both short and long term interventions to work with providers to improve capacity. This includes support for providers to recruit and retain through the ‘proud to care’ workforce team, proactively contacting providers contracted with the Council and utilising capacity from providers not yet on contract following a process of due diligence. The Council is also investing into a new care service from October 2019 to support the development of the ‘Home First’ health and social care pathway. This pathway will support people in hospital to return home as soon as they are medically fit for discharge and safe to return home with health and or social care assessments then being undertaken in their own home. Whilst this doesn’t impact on the levels of DTOCs over the summer, this and other plans as we go into the autumn will hope to support the pressures across the health and social care system as we move through the year.
July 2019 performance
The total number of days recorded as Delayed Transfers of Care across West Sussex in June 2019 was below target for the 9th consecutive month at 2538 days (target 2611) reflecting a positive position for health and social care in managing continued pressures across the system. However, it also reflects the 3rd consecutive month in which delayed days have increased and an increase in 103 days compared to the previous month’s figures.
In respect of delays attributable to social care, June’s figures are also under target at 422 days compared to a target of 517. In comparison to a year earlier June 2019 figures are 87 days lower than June 2018. However, this is a slight increase from May 2019, and it is anticipated that pressure for social care will increase over the summer months figures where sourcing care provision can be challenging. The three highest social care reasons for delays in June 2019 relate to care packages in own home, residential home placements and nursing home placements. Over the summer the Council has been developing action plans to support increasing capacity and sourcing placements in order to support improvements in these areas.
June 2019 performance
There were 422 DToC days attributable to Social Care in June, or 2.06 per 100k population per day.
May 2019 performance
There were 395 DToC days attributable to Social Care in May, or 1.87 per 100k population per day.
February 2019 performance
Largely due to a doubling of DToCs at SCFT, we have moved to being just below our target for delayed days in February at 509 days (target 517) however, due to there being just 28 days in February, we are above our target per 100,000 population per day (p100kppd) at 2.64 p100kppd against target 2.47 p100kppd. Although around our target, and we have now had 3 successive months of increases in DToCs which reflects the pressures in the acute system during December, January and February. Over the last 9 months we have been under target 7 times.
- Our overall DToC delayed days increased in February by 91 days to 509 days (418 days in January) against a target of 517 days. In February 2018 there were just 377 delayed days.
- We are now at 2.64 ddp100k against a target 2.47 ddp100k (January 2019 1.96 ddp100k).
- Delays in acutes reduced slightly in February to 68 days (83 days in in January) against a target of 136 days.
- SASH rose slightly to 25 days (January 15 days).
- BSUH stayed similar at 30 days (January 33 days).
- Western was 11 days (January 6 days).
- Non-acute delays increased to 441 days (January 335 days) and now above target of 349 days – this is the highest non-acute delay since June 2018.
- SCFT delays doubled to 263 days (January 127 days) and now above target of 201 days – the highest for 8 months.
- After a higher level SPFT delays reduced to 149 days, a reduction of 59 days from 208 days in January.
- Our ‘Other’ delays were at 26 days against target of 32 days (January 29 days).
January 2019 performance
We continue our excellent performance, remaining significantly under target, although we have seen a slight rising trend over the last 3 months from 336 delayed days in December, to 353 delayed days in December to January, where we have 418 delayed days against target 517 (November 1.64 per 100k per day (ddp100k), December 1.67 ddp100k and January 1.96 ddp100k against target 2.47 ddp100k).
Over the last 8 months we have been level / under target 7 times.
- Our overall DToC delay increased slightly in January by 65 days to 418 days (353 days in December) against a target of 517 days. This is still lower than at this time last year (January 2018) when there were a total of 672 delayed days.
- We are now at 1.96 ddp100k against a target 2.47 ddp100k (December 2018 1.67 ddp100k).
- Delays in acutes stayed steady from 56 days in December to 54 days in January against a target of 136 days.
- SASH stayed similar at 15 days (December 16 days).
- BSUH stayed similar at 33 days (December 35 days).
- Western was 6 days (December 5 days).
- January 2018 total acute delays were at 136 days.
- Non-acute delays increased to 335 days (December 279 days) although still below target of 349 days.
- SCFT delays increased slightly to 127 days (December 119 days), still below target of 201 days (now 8 months below target).
- SPFT delays increased relatively markedly to 208 days, a rise of 48 days from 160 days in December.
- Our ‘Other’ delays were at 29 days against target of 32 days (December 18 days).
December 2018 performance
Following the excellent performance in November (336 delayed days (against target 517 delayed days) or 1.64 per 100k per day (ddp100k) against target 2.47 ddp100k), the lowest level of DToCs recorded since April 2015, in December we maintained that low level with 353 delayed days (1.67 ddp100k). This is our 2nd lowest performance and now means over the last 7 months we have been level / under target 6 times. At a time of real acute hospital pressures this is a really excellent performance.
Social Care December performance (see Tableau for details):
- Our overall DToC delay increased slightly in December by 17 days to 353 days (336 days in November) against a target of 517 days. This is considerably lower than at this time last year (December 2017) when there were a total of 628 delayed days and is the 2nd lowest level of DToCs since April 2015.
- We are now at 1.67 ddp100k against a target 2.47 ddp100k (November 2018 1.64 ddp100k).
- Delays in acutes increased to 56 days in December (November 21 days) against a target of 136 days.
- SASH increased to 16 days (November 0 days).
- BSUH increased 35 days (November 18 days).
- Western was 5 days (November 5 days).
- December 2017 total acute delays were at 116 days.
Non-acute delays reduced slightly again to 279 days (November 301 days) below target of 349 days.
- SCFT delays reduced to 119 days (November 168 days), below target of 201 days (now 7 months below target).
- SPFT delays increased slightly to 160 days (November 133 days).
- Our ‘Other’ delays were at 18 days against target of 32 days (November 14 days).
November 2018 performance
After Octobers improvement to target (519 delayed days), in November we had 336 delayed days (against target 517) or 1.64 per 100k per day (ddp100k) against target 2.47 ddp100k. This is the lowest level of DToCs recorded since April 2015. In the last 6 months we have now been level / under target 5 times.
Social Care November performance (see attached for detail):
- Our overall DToC delay decreased in November by 183 days to 336 days in total (October 519 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 793 delayed days (around a 60% reduction).
- We are now at 1.64 ddp100k against a target 2.47 ddp100k (October 2018 2.45 ddp100k).
- Delays in acutes reduced by 81 days to 21 days in November (October 102 days) against a target of 136 days.
- SASH reduced to 0 days (October 64 days).
- BSUH reduced to 18 days (October 36 days).
- Western was 3 days (October 2 days).
- October 2017 total acute delays were at 261 days.
Non-acute delays have also reduced slightly to 301 days (October 397 days), below target of 349 days.
- SCFT delays reduced to 168 days (October 198 days), below target of 201 days (now 6 months below target).
- SPFT delays reduced to 133 days (October 199 days), below target of 149 days for the first time this year.
Our ‘Other’ delays reduced to 14 days against target of 32 days (October 20 days).
November 2018 performance
Target 2.47 delays per day per 100,000 population. October WSCC attributable DToC figure 2.45 delays per day per 100,000 population.
After September’s slight rise, we are now on target with 519 delayed days (against target 517) or 2.45 delayed days per 100k per day (ddp100k) against target 2.47 ddp100k. In the 5 months to October we have been level / under target 4 times and are considerably lower than at this time last year when there were a total of 797 delayed days (around a 35% reduction). We have a winter plan to try to mitigate against the pressures of winter and have already commissioned extra domiciliary care capacity and additional bed capacity to support the hospitals by maintaining timely discharge throughout the winter.
October 2018 performance
After September’s slight rise, we are now on target with 519 delayed days (against target 517) or 2.45 per 100k per day (ddp100k) against target 2.47 ddp100k. In the last 5 months we have been level / under target 4 times.
- Our overall DToC delay decreased in October by 128 days to 519 days in total (September 647 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 797 delayed days (around a 35% reduction.
- We are now at 2.45 ddp100k against a target 2.47 ddp100k (September 2018 3.16 ddp100k and September2017 4.19 ddp100k).
- Delays in acutes reduced by 120 days to 102 days in October (September 222 days) against a target of 136 days.
- SASH reduced to 64 days (September 110 days).
- BSUH reduced to 36 days (September 90 days).
- Western returned to usual levels at just 2 delayed days (September 22 days).
- October 2017 total acute delays were at 196 days.
- Non-acute delays have also reduced slightly to 397 days (September 419 days) although this is still slightly above target of 349 days.
- SCFT delays rose slightly to 198 days (September 177 days) but remain below target of 201 days (now 5 months below target).
- SPFT delays reduced from Septembers 4 month high and are now at 199 days (September 242 days).
- Our ‘Other’ delays – have risen and currently at 32 days against September 7 days (2 days at Royal Marsden, 1 day at Portsmouth QA, 6 days at Royal National Orthopaedic Hospital and 11 days at Royal Surrey County Hospital).
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.