Delayed transfers of care

For most people, NHS treatment will be successful and they will return home. However, some people will need to be transferred to other forms of care. Effective discharges require joined-up working, otherwise there can be delays in the transfer of care.

How many patients are affected by delayed transfers of care and how has this changed?

The number of patients experiencing a delayed transfer of care decreased from 4,940 in August 2010 until it reached a relatively steady state between May 2011 and November 2013. During that period, the number of patients delayed ranged between a minimum of 3,448 patients in December 2012 and maximum of 5,004 patients in September 2010.

However, since January 2014 the number of patients experiencing a delay has steadily increased, reaching a maximum of 7,106 patients in January 2017.

The absolute difference between January 2011 and January 2017 is an increase of just over 2,500 patients experiencing a delay- a 55% increase.

Updated March 2017.

How many days in total are patients delayed and how has this changed?

Despite individual monthly fluctuations, the total number of days patients are delayed per month has increased over time from 109,918 in August 2010, to 197,054 in January 2017- (a 79% increase) and it reached a maximum of 200,008 delayed days in October 2016.

There is a fairly consistent steep increase in the number of delayed days occurring as of April 2014. Some of this will be because of the increases in the number of patients delayed observed in the above chart. However, it is difficult to determine whether this is the sole contributory factor or if patients are also waiting longer than before.

Updated March 2017.

How many patients are affected by delayed transfers by the type of care they received?

The overall pattern seen in the number of patients experiencing a delayed transfer of care is not replicated across both types of care patients received. From January 2011 to January 2017, there was a 15% increase in the number of non-acute patients who experienced a delayed transfer of care (300 patients). The number of patients in acute care who experienced a delayed transfer actually increased by 86% (2,209 patients) in this time period.

Updated March 2017.

How many days in total are patients delayed by the type of care received?

There is currently large variation in the number of days a patient is likely to be delayed based on the type of care that they received. Delays in transfer from acute care and non-acute care were very similar in August 2010, but from that point onwards the total number of days delayed accrued in a month in acute and non-acute care have diverged from one another. The number of days delayed per month in acute care increased by 117% between January 2011 (60,125 days) and January 2017 (130,422 days). The number of days delayed per month in non-acute care has decreased by 23% between Janaury 2011 (54,221 days) and January 2017 (66,632 days).

Updated March 2017.

Which organisations are responsible for the number of patients delayed?

The overall pattern seen in the number of patients experiencing a delayed transfer of care is not uniformly replicated when looking at which organisations are responsible for the delay. There is a relatively flat trend in the number of patients delayed over time when the delay is due to NHS and social care organisations combined. There is, however, an upward trend in delays due to NHS or Social care organisations separately.

Between January 2011 and January 2017 there were 1193 more patients experiencing a delay where the NHS was responsible, a 42% increase. Over the same period there were 1040 more patients with a delay due to social care, representing a 71% increase.

Updated March 2017.

Which organisations are responsible for the number of delayed days?

Between January 2011 and January 2017, the total number of delayed days accrued in a month when the delay is attributable to NHS organisations has increased by approximately 63%. The increase was 95% for social care organisations and 110% when both organisations are responsible. The total number of delayed days was fairly static between August 2010 and February 2015. However, after February 2015 the number of delayed days began to increase at a far greater rate than it had done previously.

Updated March 2017.

Which organisations are responsible for patients being delayed, when they're awaiting a care package in their own home?

Despite the fact that overall most patient delays are attributable to the NHS, patient delays that are as a result of patients awaiting care packages in their own home are mainly attributable to social care. This is for both the number of patients delayed (data not shown) and the number of days patients are delayed.

For NHS, social care and both combined the number of delay days remained relatively steady until around July 2014. After this point there were steeper rises in the total number of delayed days when awaiting a care package at home. As of January 2017 there were 24,581 total delayed days due to social care, 9,554 due to the NHS and 6,094 due to delays associated with both NHS and social care combined.

This chart shows an increase in the number of delayed days from May 2014 onwards which may be due tomajor cuts to local government funding of social care for older adults in recent years.

Updated March 2017.

About this data

The Community Care Act 2003 introduced responsibilities for the NHS to notify social services of a patient’s likely need for community care services on discharge, and to give 24 hours’ notice of actual discharge. It also requires local authorities to reimburse the NHS for each day an acute patient’s discharge is delayed where social services are solely responsible for that delay.

A delayed transfer of care from acute or non-acute care occurs when a patient is ready to depart from such care and is still occupying a bed. A patient is ready for transfer when:

a. A clinical decision has been made that the patient is ready for transfer; and

b. A multi-disciplinary team decision has been made that the patient is ready for transfer; and

c. The patient is safe to discharge/transfer.

There is an expectation that delays to transfers of care will be minimised through the following steps:

• Discharge planning begins on admission to hospital or in the early stages of recovery

• There are no built-in delays in the process.

• Services will jointly review policies and protocols around discharge and have systems and processes for assessment, safe transfer and placement, as part of their capacity planning.

These steps should be guided by good professional practice and safe, person-centred transfers. 

The focus of this data set is to identify patients who are in the wrong care setting for their current level of need. The number of patients delayed is a proxy for all patients as it is a snap-shot view determined by the number of patients who had a delayed transfer of care at midnight on the last Thursday of the reporting period. These figures are being collected for all adults (over 18s) in SITREPs. 

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