Sarah Atkinson

If we narrow-frame DTOC as the only problem, there will be no winners in the long term

March 12, 2018

The latest NHS statistics on Delayed Transfer of Care show a dip in national performance by 1.4% between December 2017 and January 2018. Overall, delays have fallen by more than 26% since last February. Next month’s data release will therefore be an important test of whether this was just a blip or whether the gains of the past months have not been sustained.

On the one hand, the intense pressure from central government on the NHS and on local authorities, and the additional money through the Improved Better Care Fund (iBCF) to improve DTOC rates, has supported this change. There continue to be unexplained and indefensible variations across local areas, but overall, congratulations are in order.

It has been a rocky ride, but the one really important thing we should hold onto as we move forwards is that one part of the system (social care) can have a significant impact on another (health), and that both sides have worked together to solve a problem.

So what’s next? My view is that we must now must turn our attention to the framing of the problem itself.

The focus on one performance indicator within a complex system has arguably made it difficult to see the wood for the trees. Framing the problem simply as ‘DTOC’ has meant that we have lost sight of the patient as an individual, and of our desire to keep people independent, well and supported in their own homes for as long as possible.

A good illustration of the bigger picture is emergency admissions, where there were some 5,731 more cases in January than in December. And to take a longer view, there were 33,624 or 6.8% more emergency admissions than in January 2017.

When you consider the pressure that these extra admissions place on an already stretched system, the slight increase in DTOC delays were not a surprise – and in fact could have been a lot worse. If we imagine a scenario where emergency admissions had risen to current levels, but where there had not been an improvement in DTOC days over the last year, then we would have needed another 2000 hospital beds.

In other words, the number of people admitted to hospital is actually a bigger issue. How many of these admissions could either have been avoided in the first place, or addressed in a different way and therefore resulted in better outcomes?   A recent report from the National Audit Office suggested that the answer is one in four. This is where we should be focusing our attention.

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 file below.

Download the iMPOWER iNDEX

...then select your local authority area or health Trust from the list

Download

Sign up for our iMPOWER iNSIGHTS newsletter

No spam; unsubscribe easily at any time

iMPOWER is a values led consultancy dedicated to the reform of the public sector. See what we've helped to achieve.

See Our Work

Sign up for our iMPOWER iNSIGHTS newsletter

Contributors
  • Jeremy Cooper
  • James Edmondson
  • Martin Cresswell
  • Sarah Atkinson
  • Olly Swann
  • Ebony Hughes
  • Amanda Kelly
  • Alastair Thompson
  • Amy Crowson
  • Ben Evans
  • Branwen Harris
  • Campbell Walker
  • Caroline Lloyd
  • Clare Askew
  • Clare Harding
  • David Colbear
  • Debbie Owen
  • Deborah Crossan
  • Dominic Luscombe
  • Dr Ed Fitzgerald
  • Edward Wallace
  • Emma Ockelford
  • Grace Warman
  • Harrie Palmer
  • Helen Bailey
  • Helena Ball
  • Henrietta Curzon
  • Jason Walton
  • Jenna Collins
  • Jenny McArdle
  • iMPOWER
  • Jon Ainger
  • Kieran Brett
  • Laura Bushell
  • Leo Jones
  • Lia Chelminiak
  • Liam Booth-Smith
  • Maggie Atkinson
  • Mark Methven
  • Matan Czaczkes
  • Michael Whitmore
  • Nigel Guest
  • Olivia Page
  • Ralph Cook
  • Richard Hills
  • Samantha Griffin
  • Stuart Lindsay
  • Thomas Spencer
  • Vanessa Reeve
Latest Tweets
  • iMPOWER ConsultingDelayed transfers from hospitals in England fell 7.5% between April and May: did your local authority / health Trus… ,
  • iMPOWER ConsultingWise words from Hull DASS Alison Barker on independence in adult , the obstacles to achieving it, and pr… ,