The problem of DTOC has basically been addressed, but the problem of demand most certainly has not
It’s winter, the pressure on hospital beds is getting worse (emergency admissions were at their highest ever level in November), and you might reasonably expect NHS England’s delayed transfers of care (DTOC) statistics to be heading in the wrong direction. But interestingly, they are not.
In October (when emergency admissions were the second highest on record) the previously deteriorating DTOC position turned around, and a 1.5% improvement in performance was recorded. And in November there was an overall performance improvement of 3.3%, with delays attributable to social care improving by 4.2% and delays attributable to the NHS improving by 2.9%.
Overall 68 of the 150 local areas hit target in November, and a total of 116 have improved since the government set performance targets in February 2017. The social care sector has performed particularly well, with 72 hitting target.
Cynics might say that the health and care systems have finally done some proper winter planning, (and that this has required additional money). Something positive has certainly happened as the major rise in emergency admissions (which were 6.4% higher in November 2018 than 12 months before that) hasn’t resulted in a return to the level of delays we saw between June and September last year.
Whatever you think is behind this, most people would agree that health and social care services should not be managed from one crisis to another. Even if delayed transfers of care were eliminated entirely, this would not reduce demand pressure on hospital beds – it would simply free up capacity to deal with more demand. It is worth highlighted the findings from a set of hospital case reviews we conducted last year:
- 47% of people accessing discharge services could have had their admission prevented with earlier intervention
- In 95% of these cases the admission could have been avoided using services that were already in place
- For those whose admission could have been avoided, 2 out of 5 were already accessing some type of health or care service prior to admission
- 10% of people accessing discharge services had come from care homes, and over half of them were not able to return to them due to a deterioration in their condition whilst in hospital.
Ongoing work in Gloucestershire is demonstrating the impact on emergency admissions of providing complex care at home, and of using a population health system (run by Sollis) and regression analysis to predict what would have happened to a cohort of patients without intervention. The sector needs to continue to put faith – and money – into projects like this, as recognised by the new 10 year NHS plan (even if it has forgotten about the importance of social care).
The sector doesn’t need a policy change, a new plan or more national initiatives to get on with providing better outcomes for people. But it is necessary to reframe the crisis away from ‘we can’t get people out of hospital beds’ and towards ‘people are not able to live independently in their own homes and are admitted to hospital too frequently’.