Delayed Transfers of Care – Who’s to blame?

The answer of course, is no one individually. For too long however, the management of Delayed Transfer of Care (DTOC) or bed-blocking has been an organisational blame game, stifling the system response required. The DTOC challenge has never been greater. The National Audit Office recently reported that in 2015, 1.15m acute hospital bed days were incurred for patients who had been declared medically fit for discharge.

So why is it happening?

Demand challenges, particularly with the frail elderly are well publicised, but different organisational factors are exacerbating the problem. Five years of year-on-year local government cuts are significantly impacting a discharge team’s ability to provide a patient with rapid social care support when they are ready to go home. Similarly, we frequently see in our work shortages or fragmentation in intermediate care, meaning a patient has to remain in acute care for longer than required.

So only a system solution will do then?

Well yes, and no. If you were designing the NHS anew and creating a wellness organisation rather than an illness organisation, you would not create the current system. You would not have ward-based staff, discharge teams, social workers, community teams and access to beds in different organisations, budgets and decision making processes. To this end, the current model is flawed and a system solution should be driven through a new model of care and the Sustainability and Transformation Plan (STP).

Our recent work with Wolverhampton care economy however gives us confidence that short term benefits can be achieved whilst the longer system transformation bites. The pilot implementation across a mixture of Frail Elderly, Medical and Surgical wards achieved an average reduction of 15% in overall Length of Stay in a six week period. How? Not by changing the system, but through a relentless focus on operational excellence.

Another exciting example of operational innovation is through our work with all the West Yorkshire Association of Acute Trusts, the ABHI, and the Yorkshire and Humber Academic Health Sciences Network. In a ground breaking approach, the trusts are developing a dedicated hospital discharge company which will be jointly owned by them and a number of corporate partners. The service would immediately help to discharge patients by providing them and their carers with the technologies and support (e.g. sensor, remote monitoring, home care) necessary to maintain them safely at home. In order to fund the development, the group are exploring an option of taking a social investment bond, with a return on investment to be provided as the service generates a surplus.

In summary, DTOC is a system challenge and the blame-game needs to stop. A new model of care will drive significant benefits in the long term, but rapid improvements can also be made by relentless focus on operational excellence.

If you would like to discuss anything further please contact Tim Gold ([email protected]) or Mike Farrar ([email protected]).

Tim Gold Director

Mike Farrar, Chair of PwC's Public Sector Health Board
Email Mike Farrar


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