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Right place, right time

Former care minister Paul Burstow led an NHS Providers commission to tackle delayed transfers of care. NHE’s Luana Salles reports.

Delayed transfers of care have been a particularly crippling affliction in the NHS, exacerbating the already-critical deficits situation (see page 6). The domino effect behind often-avoidable delayed transfers cannot be understated: the longer it takes to transfer patients, the heavier the pressure on A&E and the faster the cash drain in the health service. 

Unfortunately for individual trusts, fixing the problem can only be done collaboratively, since they are a symptom of mounting pressures and waits at all points in the urgent care pathway. Every piece in the health and social care jigsaw needs to act harmoniously, regardless of how integrated the two sectors are at a regional level, to tackle the issue at the root. 

Understanding delays 

To facilitate this, NHS Providers has launched its much-anticipated ‘Right Place, Right Time’ report, setting out calls to action for every single part of the health and social care sphere. The document, unveiled at NHS Providers’ annual conference, explores the reasons behind delayed transfers of care, the realms in which they occur (mental health patients experience it just as much as social care users, for example) and how to fix the growing issue. 

Paul Burstow, the former care minister who led the commission, wrote in the foreword to the report: “All NHS providers face the challenge of ensuring timely patient discharge and managing the ‘flow’ of patients through their organisations. 

“An increase in patients with high acuity and complex needs has piled on the pressure, with rising admissions, and more complex discharges. 

“Winter is coming, and a perfect storm is brewing. Hospitals are struggling financially and greatly increased capacity is often simply not an option. There are real concerns that another NHS bed crisis is just around the corner.” 

Action at every level 

While the future looks bleak, Burstow, who was already anticipating the report’s launch when NHE interviewed him for our previous edition, said there is cause for hope. Some commissioners and providers are already managing pressures well, with excellent examples of innovation peppered around the country. 

But with excellence not universal, NHS Providers has issued a to-do list for every major health organisation. At the very top was the recommendation that the Department of Health must set the framework to ensure NHS capacity meets the level of demand in future years, as well as assess the price of a sustainable social care market. 

The precise recommendations to other organisations depended on their role, but the overall message was the same – commissioners, regulators, providers and local authorities must talk and collaborate to improve services. It will not happen on its own. 

Engaging staff and building data 

Staff understanding is a vital prerequisite to change, Burstow said. “It is difficult to change practice and behaviour if staff cannot see why such change is necessary.”

Data on bed occupancy rates, A&E target times, delayed transfers of care and inpatient length of stay are helpful indicators, and should all play a part when exploring data variation in granular detail. Without the right data, NHS Providers says, it will be impossible to confront or even understand the root causes of delays. 

Whole patient journeys 

Staff should then begin to explore whole patient journeys, putting people at the centre of system diagnosis and design by mapping patient flows and thoroughly analysing how they move across the NHS. Understanding patients is the starting point to developing action plans, keeping an eye on what works best, and comparing internal behaviours with those of external organisations across boundaries – ensuring, at all times, that organisations avoid the “pitfalls of wrangling over budgets and working in silos”. 

“It is important to keep patients, service users and carers at the heart of solving the problem and to work with staff across all levels, taking everyone with you on the improvement journey,” the report said. 

“By making the process leaner, understanding it end-to-end, designing change in partnership with the front line, and making sure the patient’s perspective is held at the centre of everyone’s practice, we can reduce length of stay, speed up the process of discharge, ensure adequate ongoing support and most important, improve patient care and health outcomes.”

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