DTOC rates are rising again – five questions you need to start asking

Delayed Transfers of Care (DTOC) rates rose by 2.38% overall between August and September – the fourth consecutive monthly rise, according to the latest monthly figures from NHS England. Delays attributable to the NHS increased by 4.1%, while those attributable to local authority departments of social care fell marginally by 0.5%. This equates to an additional 112 beds being blocked in September.

This should not be brushed under the carpet – winter is virtually here, and local systems must ensure that they have the capacity, processes and systems in place to optimise performance.

But let’s be clear – despite the rhetoric at the national level, this isn’t as simple as beds, beds and more beds.  The debate needs to be around meeting the short term needs of patients through a suite of intermediate care services.  Whilst short term support is provided (typically for a period of six weeks) a longer-term assessment of health and care needs can be made, and focus applied to supporting people to return to live independently in their own homes, as far as possible.

This intermediate care support might be in a home (including personal care and reablement) or it might be a bed or facility that can provide a more intensive level of care.  And yes, for some people residential or nursing care might be the right solution, but let’s not commit people (and indeed, significant public or personal resources) to the path for the sake of releasing a hospital bed.

What questions should you be asking of your local system in advance of the winter, to help ensure that it meets the needs of as many patients as possible?

Five lines of enquiry for DTOC assurance

1. Is data recorded accurately? How is DTOC data recorded? Is the same data reported to all stakeholder organisations? Are clinicians and social workers involved in the coding process? How and where is the data validated?
2. Is demand actively managed? Are systems in place for patients being discharged? Are patients encouraged to return home first, prior to assessment? Does the whole system know where all discharges go? Is the flow of patients actively managed? Is the voluntary sector utilised effectively?
3. How effective is leadership, governance and operational management? Is there a joint DTOC board or overarching governance structure across the whole of the system? Are there regular quality assurance processes to check the appropriateness of discharge pathways?
4. Are processes optimised? Do both health and social care staff understand the processes in place to support discharges, and routes of escalation for funding or disputes in complex discharges?  How quickly is information shared across the teams?  Are staff clear on what is required of them?
5. Is the service offer and capacity appropriate? Does the commissioning of services across health and social care match the need of patients, and allow those responsible for the discharge to easily and quickly access the most appropriate service for each individual?

To understand more about our DTOC Assurance framework please contact John Smalley.

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.