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Acting without delay: How the independent sector is helping the NHS reduce delayed discharges | David Hare

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David Hare

Innovative partnerships across the country are helping to tackle the complex issue of delayed transfers of care. Here, the NHS Partners Network's chief executive shines a light on two such initiatives and explains why partnerships like this have never been more vital.

Reducing delayed discharges is arguably one of the biggest priorities for the NHS. In the past year alone there has been an increase of over 28 per cent in the number of delayed transfers of care (DToCs), leading to almost 400,000 bed days lost in the third quarter of 2016/17. The National Audit Office (NAO) estimates that the annual figure may actually be as high as 2.7 million lost bed days. 

These delays have a significant impact both patients awaiting transfer – who are effectively trapped in hospitals and vulnerable to a number of adverse conditions, including a loss of muscle tone – as well as incoming patients in A&E. They are forced to wait significantly longer than the four-hour waiting target for a bed – the number of which rose by 66 per cent in the last 12 months.

Equally, there is a severe financial impact associated with the inability to free up much needed NHS beds. The annual direct cost of DTOCs is estimated to reach £169 million for 2016/17, £24 million more than 2015/16. However, full costs associated with DTOCs are likely to be much higher, with the NAO assessing the cost to the NHS of upwards of £820m every year. 

Clearly the scale of the problem is significant, but the causes are complex. While much of the focus has been on the continued cuts to local social care provision, analysis by auditors at the Oak Group found that over half of all delays are related to issues with hospitals’ own processes and almost 20 per cent around shared issues of planning, documentation and transport. 

The complexity of this issue means there is no one-size-fits-all model to tackling the rise in delayed transfers of care. But much can be learned from a number of innovative partnerships between the independent sector and the NHS. In the first of a series of reports on Helping the NHS with… (to be launched at the NHS Confederation’s annual conference in June), the NHS Partners Network (NHSPN) has identified a number of partnerships which are helping to get patients the right care in the right place.

One of these partnerships is Healthcare at Home’s (HaH) Recovery at Home and Admission Avoidance service, which allows patients to receive complex clinical care in their home via ‘virtual wards’, rather than as inpatients in a hospital. Patients are supported 24/7 by a dedicated telephone-based Care Bureau, staffed by qualified nurses and with round the clock telephone support for patients, families and health professionals. 

In 2016 alone HAH treated 11,900 patients across 19 NHS trusts, amounting to a saving of over 120,000 inpatient bed nights and creating 350 virtual beds, the equivalent of a small community hospital. And the scope for spreading these benefits is significant – an independent report last year found that the NHS in England could save half a million overnight inpatient stays per year if every acute trust in England introduced a virtual ward scheme, with NHS providers potentially saving at least £120 million – equivalent to 20 per cent of NHS providers’ predicted 2016/2017 deficit.

Similarly, Four Seasons Health Care works with 100 local authorities and 120 clinical commissioning groups, operating a discharge-to-assess service as well as rehabilitation and intermediate care. In providing high-quality step-down care between hospital and home, acute trusts are therefore better able to help discharge older patients who still need extra care but not necessarily in an acute setting. 

A key part of Four Seasons’ work is around building up the confidence of patients – providing extra care and support in an intermediary setting for people for whom going home alone can be a huge ordeal. 

These examples, among many others in NHSPN’s forthcoming report, highlight what can be done when the expertise and innovation of both the NHS and independent sector is combined. And with continuing pressures on the NHS, these partnerships have never been more vital – something the NHS Partners Network will continue to make the case for.  

David Hare is chief executive of the NHS Partners Network, part of the NHS Confederation. Follow him and the organisation on Twitter @dhareuk @nhspartners

Discover more

Have questions for David? Want to learn about other innovative partnerships helping frail and elderly patients across the country?

Head to Acting without delay – How to help the NHS reduce delayed discharges? on 14 June, a breakout session at Confed17.

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