Delayed transfers ‘significantly greater’ than NHS figures suggest

The number of patients stuck in hospital beds despite being well enough to leave is far higher than suggested by official data, according to research undertaken by the Nuffield Trust.

In a blog, the health think tank said that far more hospital beds are being taken up by patients due to delayed transfers of care (DToCs) than are being detected by NHS England’s counting system.

NHS leaders have agreed with the Nuffield Trust’s findings, admitting that the official figures do not accurately estimate how many people are stuck in hospital due to problems such as poor processes within the NHS – the main reason for DToCs – or a lack of social care provision, which has become responsible for 84% more DToCs since 2010.

Nigel Edwards, the chief executive of the Nuffield Trust, highlighted one example, saying: “Once maternity, paediatrics, cancer and other beds that cannot be used for emergencies are taken into account and the impact of patients waiting for discharge is allowed for, … a 650-bed hospital actually only had fewer than 250 beds available to accommodate all its emergency patients.

“This makes the system extremely fragile. What looks like efficiency is actually the opposite.”

DToCs are strictly defined by NHS England, which defines patients as ‘ready for transfer’ once both a clinician and multidisciplinary team decide that a patient is ready for transfer and the patient is “safe to discharge/transfer”.

DToCs are currently reaching record levels as NHS figures noted that patients spent a total of 200,008 days waiting to return from hospital to the community last October, a 25% rise on the previous year, with strong correlation between DTOCs and long periods spent waiting in A&E.

The news comes as the National Audit Office criticised the government’s plan to integrate health and social care services across England by 2020, which it claims is at “significant risk” due to progress being slower and less successful than had been hoped.

The Nuffield Trust’s research, which examined data from a group of three small-and-medium sized NHS hospitals, found that only 14% of 277 patients in one small rural hospital were counted as DToCs, despite twice as many (29%) being medically fit for discharge and another 13% unfit but able to be safely looked after in a nursing home.

Chris Hopson, the chief executive of NHS Providers, accepted the findings, saying: “Our hospital members tell us that because the official definition of delayed transfers is so specific, the actual number of patients medically fit to discharge, or who could be cared for in other settings, is much greater than the definition implies.

“In that sense the problem of blocked hospital capacity is significantly greater than the DToC figures by themselves suggest.”

Separate audits by specialist company the Oak Group, quoted by the Nuffield Trust, found a similar pattern across a larger number of hospitals, confirming that “significant numbers” of patients could be cared for elsewhere: “typically 50%-60% of the acute bed days examined”, according to Edwards.

“We need to beware a narrative that fixing social care will fix the problems of the NHS,” Edwards concluded. “It won’t, but it would help. Secondly, it cannot be assumed that alternatives to hospital will save large amounts of money unless far more radical changes to the system are made.”

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