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Getting care in the right place, at the right time

Miriam Deakin, head of policy at NHS Providers, discusses the early findings of the ‘Right place, right time’ commission, which is due to publish its report in late autumn. 

We know that getting transfers of care right is critical for patients’ experience of care (and their outcomes) and that too many patients and service users still spend too long in the wrong care setting for their needs. 

But we also know that a wealth of activity is underway at local levels to target the problem and develop collaborative ways of working that put the patient first, and cross organisational boundaries. That is why we have asked Paul Burstow, the former care minister, to chair our ‘Right place, right time’ commission to capture and share good practice on what works in improving care transfers across all care settings – including the acute sector but also focusing on mental health, community, ambulance and care services. 

The impact of getting it wrong 

There is a wealth of evidence that getting transfers of care wrong leads to poorer patient experience, poorer clinical outcomes and the costly, sub-optimal use of limited public money and resource, not just across the NHS but including social care, housing and other public services. 

It has been estimated that delayed transfers of care from the acute sector to home or community provision alone cost the NHS an estimated £200m every year¹, and are among the top four issues of greatest concern for trust finance directors and clinical commissioners². At the end of May 2015, 4,970 people were delayed in hospitals in England; 10% more than at the same time last year³ – and it is likely that this number is an underestimate of the full scale of the problem. Even more troubling is the profound impact upon patients’ lives during extended hospital stays or when sufficient support is not available to enable them to return to their own home. We can and must do better to ensure patients receive the care they need and deserve. 

What works? 

The Commission will report in late autumn with a practical focus on what works from case studies across the country, but our emerging findings fall in to the following themes: 

A locally led, partnership approach: Despite the growing operational pressures, creating time for local collaboration and taking a systems-wide approach involving commissioners, providers, local government and the voluntary sector remains essential. 

Involving patients and service users: Patients, services users and carers must be at the heart of developing personalised approaches to care which work for them as individuals. Without meaningful engagement and tailored care, patients will not receive the right care in the right place. 

Sufficient support closer to home:  In a survey of nurses by the Royal Voluntary Service, almost 70% said they frequently had to delay discharging patients because no support was in place for them once they left hospital⁴. We also know from the work of the Commission that wider factors including the stability of domiciliary care services and wider social care capacity remain crucial. 

Lean processes and flow: Several organisations have reviewed their processes to improve pathways, and equipped multi-disciplinary teams to work more effectively together. Conducting fuller assessments upon admission to any service has also been a key feature of those systems demonstrating successful transfers of care⁵. 

Joined up national policy frameworks: National policymakers must also play their part in ensuring that targets, pricing and other incentives do not unintentionally create a barrier to integration. Enabling the local health and care workforce to work together remains essential. 

By identifying good practice, exploring the development of shared purpose and shared risk across a diverse health and care system, and the gritty practical details of multi-disciplinary working, we hope to make a helpful contribution to improving transfers of care for NHS providers and their partners – and most importantly, for patients and service users. 

References

1. Papering over the cracks: the impact of social care funding on the NHS, NHS Confederation, 2012

2. QMR 16, King’s Fund, July 2015 (ibid)

3. Quarterly monitoring report, QMR 16, King’s Fund, July 2015 

4. Delayed discharges show the NHS under strain, Royal Voluntary Service, February 2015 

5. Lean for the NHS, NHS Confed, 2006