A delayed transfer of care occurs when a patient is ready for discharge from acute or non-acute care and is still occupying a bed. Delayed transfers of care 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 It has been replaced by a similar measure called delayed transfer of care beds, which is calculated by dividing the total number of delayed days in the month by the number of calendar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.
NHS England and NHS Improvement stated in their Winter 2018-19 Planning Update that they expect to see important progress delivered in several key areas. This includes increasing available hospital capacity by reducing delayed discharges and long stays in hospital. They reported that between February 2017 and July 2018, around 2,200 beds were freed up by reducing delayed discharges - equivalent to opening four new hospitals. We will be tracking this progress throughout winter both here and in our monthly Combined Performance Summary.
The average number of patients delayed per day fluctuated at around 3,800 between August 2010 and August 2013. After this, the number increased rapidly to reach a peak of 6,660 patients delayed per day in February 2017. By June 2018, the number had decreased by one third to 4,491 patients delayed on average per day. But since then the number has increased again by 5%, to an average of 4,737 patients delayed per day in October 2018.
In August 2010, the numbers of patients delayed that were receiving acute or non-acute care were almost identical. Over time, delayed transfers of care for patients receiving acute care have increased at a faster rate than those receiving non-acute care. In October 2018, around two-thirds of delayed transfer of care patients were receiving acute care and one-third were receiving non-acute care.
Since August 2010, the NHS has been responsible for the majority of delayed transfers of care. In October 2018, the NHS was responsible for 62% of patients delayed, social care was responsible for 30% of patients delayed, and both the NHS and social care were responsible for 8% of patients delayed.
The overall pattern of delayed transfers of care is not uniform between the organisations that are responsible for the delay. Between August 2010 and February 2017, 1,631 more patients were delayed per day where the NHS was responsible, respresenting an increase of 79%. Over the same time period, 1,185 more patients were delayed per day due to social care, representing a 96% increase. Since then, delayed transfers of care where the NHS was responsible have decreased by 21%, and delayed transfers of care due to social care have decreased by 41%.
In October 2018, the most common reason for delayed transfers of care was people awaiting a care package in their own home. The second most common reason was people awaiting further non-acute NHS care, and the third most common reason was people awaiting a nursing home placement. The rolling average of the number of patients delayed per day due to awaiting a care package in their own home has increased dramatically over time, from 408 patients delayed per day in October 2011 to 1,009 patients delayed per day in October 2018.
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.