Agenda item

To brief the Health Scrutiny Committee on Delayed Transfers of Care (DToC) from Blackpool Teaching Hospitals NHS Foundation Trust.

Ms Pat Oliver, Director of Operations, Blackpool Teaching Hospitals (BTH) and Mr Ian Ellwood, Discharge Manager, BTH presented the Delayed Transfers of Care report. Transfers of care issues concerned delays affecting patients who had finished one stage of their treatment but then had to wait some time before bed facilities became available at the next stage. Transfers of care could be internal or external and could be to another health or social care provider. The next stage of care could be at a facility such as a care home or the patient’s own home.

Ms Oliver outlined the wider background context of issues and pressures that could impact on patient discharge services. She referred to the earlier agenda item on the Blackpool Clinical Commissioning Group’s performance report and issues concerning accident and emergency waiting times and ambulance response rates. She explained that ‘front door’ issues impacted upon ‘back door’ performance and vice-versa, for example a patient unable to be transferred from  a hospital bed impacted upon an accident and emergency patient. She added that there were three wards dealing with a range of patients with complex issues.

Ms Oliver explained that there many patients arrived in winter with respiratory diseases, heart attacks, infections and were generally frail and vulnerable people.  There was a lot of pressure on local ambulance services due to much higher than average demand in Blackpool compared to regional neighbours.

Members requested if figures could be provided as to inappropriate use of ambulance services. Ms Oliver agreed to obtain inappropriate use figures from the North West Ambulance Service for a future meeting.  She added that a joint piece of work was taking place with GPs concerning out-of-hours services with a view that GPs could direct appropriate cases to hospital in good time rather than people unnecessarily using emergency services.

Mr Ellwood explained that there was a national performance dataset for measuring delayed transfers of care as presented in the report and appendices. Figures were for a five week period (one month) from 13 May 2016 to 13 June 2016. The recent five week period was compared against the parallel five week period in 2015.

Mr Ellwood reported that the number of delays for the five week period in 2015 averaged around 30 per week, which had risen to around 50 for the parallel period in 2016. He explained that the number of corresponding lost bed days, which had also risen, depended on the complexity of individual patients’ needs and reasons for delays. There could also be other factors such as seasonal variation due to bank holiday pressures.

Ms Oliver added that delayed transfers of care, with patients still resident in wards unnecessarily, could potentially have an annual financial cost of up to £1million for each ward of 20 beds. There were 25 wards and the delays equated to the loss of two wards amounting to an annual cost of up to £2million. The current pressures creating delays reflected a national trend and Ms Oliver advised that it was important to work towards reducing the number of delays to closer to the previous year’s performance of 30 delays per week.

Mr Ellwood referred to whether delayed transfers were due to health or social care services. He explained that delays could be due to issues within NHS healthcare services, social care services such as care homes or both. Delays had risen in all three service groups compared to the last year reflecting the total rise in delays. He added that whilst most delays still stemmed from healthcare services proportionately this had changed. Healthcare service delays had accounted for over half in 2015 but were now less than half with social care and joint service issues rising.

Members noted the significant increase in delays in 2016 compared to 2015 and national trends and queried if the trend was to continue how increased pressures could be managed in 2017. Mr Ellwood agreed that there were lots of pressures resulting in a worsening national trend. He referred to reasons for delayed transfers of care and highlighted that nationally several categories were used for reasons for delayed transfers. These included waiting for professional health or social care assessments, further NHS treatment, funding delays, waiting for care home packages or placements and community equipment being unavailable. The different causes in delays had all risen over the last year reflecting the total rise in delays, in particular delays in professional assessments, waiting for further NHS treatment and patient choice of care home. He added that proportionately the largest increase in cause of delay had been patient choice.

Mr Ellwood added that traditionally delays had been mainly due to internal hospital reasons such as complex assessments. However, this had shifted more towards external factors across the private social care sector. The two main factors were complexity of patients’ needs such as dementia and behavioural issues and being able to find the right environment for them and also demand against limited capacity. Enabling care at people’s home was being promoted but capacity was limited locally and nationally. Capacity had increased for issues such as dementia but pressures were constantly growing.

Mr Ellwood referred to work that had taken place over the last 18 to 24 months to tackle the range of challenges. Internal processes had been improved such as identifying robust evidence for funding and reduced bureaucracy but further improvement was still needed. Ms Oliver gave an improvement example of electronic referrals and added that communication was important in order to identify omissions or agree solutions. Mr Ellwood added that more work was taking place with multi-disciplinary teams and that improvements could be made through increasing social worker presence at hospitals in view of the increasing complexity of patients’ needs.

He also added that better links had been created with social and community services as well as health and social care commissioners of services. The links had resulted in regular meetings with social care managers and commissioners with all partners collectively looking at individual bottlenecks in care transfers and agreeing appropriate actions to tackle delays. Actions included identifying potential capacity and streamlined ways of working, consideration was also given to whether a patient needed to be in hospital.

Ms Oliver highlighted concerns that wider social funding cuts had a detrimental health impact through increasing social isolation. There was a growing elderly population who were particularly affected. There had been a debate across Lancashire concerning social care needs and funding pressures, in particular the costs of residential care homes. Blackpool Teaching Hospitals Trust was promoting better use of community services through community teams. Members agreed that cuts had had an impact but were always carefully considered.  

The Committee’s comments would be considered by Ms Oliver and Mr Ellwood and they were thanked for their report.