Delayed transfers of care (DTOC) from hospital
The Council works with NHS providers to meet the national policy 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 - to 2 delayed days per 100,000 population per day.
Detailed Analysis of DToCs
January 2020 performance
Home First pathways have impacted the DToC figures as all patients waiting for this pathway are now recorded as a joint delay, with NHS and Social care, rather than being individually attributed to either organisation. This is not necessarily a negative issue as it is more accurately reflecting the demands on the system and highlights the capacity issues and presures in the market.
The Home First pathway is very successful but capcity issues are proving challenging as demand is outstripping available capacity.
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 Adults Social Care.
Work is underway to address the verification processes with community NHS partners ie SCFT and SPFT, this should result in more accurate reporting in the coming months.
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.
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.
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.
Other work to resolve this includes 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.