Delayed Transfers of Care: Flexible National Frameworks Required

Delayed transfers are recognised as one of the main pressures on today’s NHS; reducing its ability to meet targets and patient expectations. Some patients are kept in hospital settings long after it is appropriate, distressing many patients and carers, and reducing capacity for new patients coming into the system. 

After a significant period of stagnation in delayed transfer days, the total number of days discharges were delayed by in 2014/15, increased by 15% on the previous year, to over 210,000.  In the first 5 months of 2015/16 this rise continued, with a further 11% increase.  In response to members concerns, NHS Providers set up a commission to look into the causes of delayed discharge and route out best practice. 

Over 4 months the commission, chaired by Paul Burstow, captured evidence from across transfer of care settings, and the final report draws on good practice in health, local government, social care and housing settings.

The report does not attribute the problem of delayed discharge to any one issue or party, or find a single ‘one size fits all’ solution.  It highlights a range of complex challenges within the patient journey that can result in delayed discharge, with issues around workforce capacity, skills mix, and the flow within and between organisations all identified. 

The report recognises that only by bringing all sectors together, from health to social care and housing, can this issue be resolved.  The report goes on to demonstrate how national frameworks, systems and processes can, unintentionally, undermine local progress, and calls for the introduction of flexible frameworks, that support both best practice and local differences.

The commission recommends that Trusts consider adopting process engineering and data analytics as valuable tools to help surface out the root causes of problems with transfers of care, and the sharing of data across sectors to support this work.

The report concluded that:

 “Simply adding initiatives to already complex pathways is likely to exacerbate problems of flow. In contrast, by making the process leaner, understanding it end to end, designing change in partnership with the frontline, and making sure the patient’s perspective is held at the centre of everyone’s practice we can reduce length of stay, speed up the process of discharge, ensure adequate ongoing support and most important, improve patient care and health outcomes.”

Commission chair and report author, Rt Hon Paul Burstow, said "Local collaboration is key to improving transfers of care. It is also vital that patients, carers and service users are at the centre of developing personalised care that works for them."