Another sticking plaster for DTOC?

According to the latest monthly figures from NHS England, Delayed Transfers of Care (DTOC) rates in August rose by 4.5% overall, representing the largest monthly increase in delays since February 2017.  Delays attributable to the NHS increased by 4%, while delays attributable to local authority departments of social care rate increased by 7.7%. Overall, this resulted in an additional 200 beds blocked compared to July.

What has happened?

Quite often we can correlate poor performance on DTOC to an increase in demand caused by rises in emergency admissions.  However, there were 20,000 fewer emergency admissions in August than in July – which means that there has been a significant issue in managing the transfers of care out of hospital.

Some might argue that we should just brush the August DTOC figures under the carpet. After all:

• DTOC is still 19% lower than it was in August 2017 – the good work of the last 12 months has not all been undone
• Staff summer holidays could have impacted on the ability to run effective discharge services or provide maximum discharge capacity
• There is some more money in the system – the £240 million that has just been made available to local authorities to help cope with ‘winter pressures’.

However, this would disregard two critical, systemic issues that are not being acknowledged:

1. There hasn’t been a sustained period of reductions in delays since December 2017. In fact, DTOC has only fallen by 3% since December (equating to just 147 beds unblocked).  Yet a huge amount of money – and associated time and energy – continues to be thrown at the problem. The national view might be that the iBCF money is being used to sustain existing performance, and therefore that more money (the recently announced additional £240 million for local authorities) will surely improve performance further.   That might be true if the money was going to be used differently, but the suggestion that it should be used to provide additional beds is an indicator that this cash is simply a sticking plaster to sustain hospital performance through winter 2018/19.
2. The Government seems to be rewarding short-term thinking, instead of ensuring that systems as a whole are more innovative and prepared to invest in services that stop people going into hospital in the first place.  Every day in England, hospital admissions include 900 people who have fallen, 500 who have a urinary tract infection and 400 who have chronic obstructive pulmonary disease.  The National Audit office has long stated that 20% of hospital admissions could be avoided, and IMPOWER’s own case reviews indicate that 40% would be more accurate.  Fewer admissions would mean fewer people in beds, and by extension fewer DTOC days, but most importantly it would mean better outcomes – more people living independently in their own homes for longer.

Don’t get me wrong – the overall improvement in DTOC performance over the last 18 months should be rewarded. But it is time to move on from simply looking at the point of transfer out of hospital.  Investing energy, time and money in the communities and places where people live, and taking a person-centred approach across health and care in response to their needs, might just be the thing which sees the next step change in DTOC performance.

To see how your local authority is performing on DTOC, or to look at DTOC days and emergency admissions in your local health Trust, download the IMPOWER INDEX.