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 March 2011 to January 2014. During that period, the number of patients delayed ranged between a minimum of 3,857 patients in May 2012 and maximum of 4,231 patients in September 2013 - excluding the annual decreases seen in the months of December.

However, since January 2014 the number of patients experiencing a delay has steadily increased, reaching a maximum of 5,924 patients in April 2016.

The absolute difference between August 2010 and April 2016 is an increase of just under 1,000 patients experiencing a delay. Comparing data from the same time of year, the absolute difference between November 2010 and November 2015 which is an absolute difference is 1,164 patients experiencing a delay, which is a 26% increase.

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 167,677 in April 2016 (a 53% increase) and it reached a maximum of 169,928 delayed days in March 2016.

There is also a fairly consistent steep increase in the number of delayed days occurring from 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.

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 August 2010 to April 2016, there was a 20% increase in the number of patients who experienced a delayed transfer of care: an absolute increase of 984 patients. The number of patients in non-acute care who experienced a delayed transfer actually decreased by 17% (403 patients) in this time period. The overall increase was due to a 54% (1,387 patients) increase in the transfer of acute care patients.

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 have diverged between the care settings. The number of days delayed per month in acute care has increased by 104% between August 2010 (55,332 days) and April 2016 (112,720 days). The number of days delayed per month in non-acute care has decreased by 1% between August 2010 (54,586 days) and April 2016 (54,957 days).

Which organisations are responsible for the number of patients delayed?

Again 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 social care organisations or when both NHS and social care organisations are responsible. There is, however, an upward trend in delays due to NHS organisations.

The absolute difference between August 2010 and April 2016 is an increase of 622 patients experiencing a delay when the NHS is the responsible organisation. Looking at the difference between November 2010 and November 2015 this is an absolute difference of 804 patients experiencing a delay, which is a 30% increase.

Which organisations are responsible for the number of delayed days?

The total number of delayed days accrued in a month when the delay is attributable to NHS organisations has increased by approximately 57%. The increase was 44% for social care organisations and by 59% when both organisations are responsible. The total number of delayed days was fairly static between August 2010 and February 2015 and ranged between 27,654 and 40,036. However, after February 2015 the number of delayed days began to increase at a far greater rate than it had done previously. By April 2016 this was an extra 20,280 days per month (a 58% increase).

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.

When looking at the comparable month of November in 2010 and November 2015 there are 293 more patients per day delayed because of social care when waiting for a care package in their own home. The number of delayed days caused by this more than doubled between August 2010 and April 2016.

For both the number of patients delayed and the number of delayed days the increases observed occured from May 2014 onwards and may be a result of major cuts to local government funding of social care for older adults in recent years

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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