Delayed transfers of care

A delayed transfer of care (DToC) occurs when a patient is ready for discharge from acute or non-acute care and is still occupying a bed. DToCs should be minimised through effective discharge planning and joint working between services to ensure safe, person-centred transfers.

Since April 2017, data on the number of patients delayed on the last Thursday of the month has stopped being collected. It has been replaced by a similar measure called delayed transfer of care beds, which is calculated by dividing the total number of delayed days in the month by the number of calendar days. The new measure is more representative of the entire month rather than providing a patient snapshot on one particular day.

What is the overall trend in the number of delayed transfer of care beds?

The number of delayed transfer of care beds fluctuated at around 3,800 between August 2010 and April 2014. After this, the number increased rapidly to reach a peak of 6,660 delayed transfer of care beds in February 2017. Since then the number has begun to decrease, falling to 5,610 in September 2017.

Updated November 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 each month increased over time from 115,855 in September 2010 to 168,302 in September 2017, and it reached a maximum of 200,095 delayed days in October 2016.

There was an increase in the number of delayed days occurring from April 2014 onwards. This may have been due to increases in the number of patients delayed, please see NHS England, patient snapshot data August 2010 to March 2017. However, it is difficult to determine whether this is the sole contributory factor or whether patients are also waiting longer than before.

Updated November 2017.

What effect does the type of care a patient receives have on the number of delayed transfer of care beds?

The trend in the number of delayed transfer of care beds is not the same for acute and non-acute care. From September 2010 to September 2017, for acute care there was an 82% increase (2,011 to 3,669) in the number of delayed transfer of care beds. But the number of delayed transfer of care beds for non-acute care only increased by 5% (1,851 to 1,942) in the same time period.

Updated November 2017.

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

The number of delayed days to transfer from acute and non-acute care were very similar in August 2010, but from that point onwards they diverged from one another. The number of days delayed per month from acute care increased by 82% between September 2010 (60,316 days) and September 2017 (110,055 days). The number of days delayed per month from non-acute care only increased by 5% between September 2010 (55,539 days) and September 2017 (58,247 days).

Updated November 2017.

Which organisations are responsible for the number of delayed transfer of care beds?

The overall pattern in the number of delayed transfer of care beds is not uniform between the organisations which are responsible for the delay. There is a relatively flat trend over time when a delay is the responsibility of both an NHS and social care organisation. There is, however, an upward trend when a delay is the sole responsibility of an NHS or social care organisation.

Between September 2010 and September 2017 there were 855 more delayed transfer of care beds where the NHS was responsible, representing a 37% increase. Over the same period there were 769 more delayed transfer of care beds due to social care, representing a 61% increase.

Updated November 2017.

Which organisations are responsible for the number of delayed days?

Between September 2010 and September 2017, the total number of delayed days accrued in a month when the delay is attributable to NHS organisations increased by approximately 37%. The increase was 61% for social care organisations and 45% when both organisations are responsible.

When social care organisations are solely 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 November 2017.

Which organisations are responsible for the number of delayed days, when patients are awaiting a care package in their own home?

Despite the fact that overall the NHS is responsible for a larger proportion of the total number of delayed transfer of care beds, delays that are as a result of patients awaiting care packages in their own home are mainly attributable to social care.

When social care organisations were solely responsible the number of delayed days remained relatively steady until around April 2014. After this point there were steep rises in the total number of delayed days when awaiting a care package at home.

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

As of September 2017 there were 20,731 total delayed days due to social care, 8,941 due to the NHS and 4,760 due to delays associated with both NHS and social care combined.

Updated November 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 indicator is to identify patients who are in the wrong care setting for their current level of need. Data are being collected for all adults (over 18s) in SITREPs.

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