The plan is a commendable step forward, but misses some of the most fundamental barriers to change
The increase in the number of Delayed Transfers of Care (DTOC) has finally come to a halt – just in time for winter. NHS England’s latest figures show a negligible but nonetheless positive improvement overall of 0.19% between September and October – which equates to 81 beds. Almost 62% of all delays in October were attributable to the NHS, 30% to Social Care, and 8% attributable to both NHS and Social Care.
Knowing that the figures are two months in arrears, the real cynics amongst us might say that not enough progress has been made to get through the winter – December’s figures will not be published until early February. But there is a positive story here. The continued rise in emergency admissions has not created the level of delays that we have seen in the last three months.
Cynical or not, eliminating delays won’t reduce the demand pressure. Pushing down the number of delays will simply free up capacity to deal with more demand. In the case reviews that iMPOWER presented some months ago, we suggested that:
- 47% of people accessing discharge services could have avoided admission in the first place with earlier intervention
- In 95% of these cases, the admission could have been avoided using services that were already in place
- For the people whose admission could have been avoided, two in five were already accessing some type of health or care service
- 10% of people accessing discharge services come from care homes, and for more than half, their condition deteriorates such that they are not able to return.
Our ongoing work in Gloucestershire is demonstrating the impact of complex care at home on emergency admissions using the Sollis system and regression analysis to predict what would have happened to a cohort of patients without intervention. Councils and the NHS should put more money into schemes like this as it provides better outcomes for the people at the heart of it.
We don’t need a new vanguard, policy change or any national initiatives to get on with this. We need a relentless focus on supporting people to live independently in their own homes, a spotlight on admission avoidance and more collaboration and joint working that we have seen work effectively in many areas to address DTOC.