Spring may be around the corner but our acute and community care services continue to feel the pressure. One of the privileges of visiting localities in different parts of the country is that I see first hand the resilience and dedication of all those working across the health and care system to provide front line support.
!['[Earlier this year] in some hospitals over 10 percent of bed-spaces were unavailable due to [DTOCs]. It was time to act, to get some more support into local areas and also challenge poor practice.'](https://jonrouse.blog.gov.uk/wp-content/uploads/sites/6/2015/02/bed-20clipart-boy-make-bed-clipartbed-clip-art-vector-clip-art-online-royalty-free-public-domain-mangugmm.png)
Not surprisingly, such delays have a negative impact on patient flow, can be detrimental to recovery and stretch limited resources even further.
Over quite a long period, through to last summer, we had managed to keep DTOCs broadly at a level, mainly though significant reductions in social care related delays. But through the autumn and early winter that number had risen quite sharply, until early in the New Year we went through the unwanted mark of over 4,000 delayed bed days across the system in a week. In some hospitals over 10 percent of bed-spaces were unavailable due to these delays. It was time to act, to get more support into local areas and also challenge poor practice.
A very practical demonstration of that help has been the introduction of the new Helping People Home team. Between now and the end of April, this joint NHS England, Department of Health , Department for Communities and Local Government (DCLG) and local government (ADASS/ LGA) team is helping to drive and coordinate action around out of hospital care to reduce DTOCs.
Headed by Mike Potts (ex-PCT CEO) with support from Hannah Miller (ex DASS) and Sarah Mitchell, Director of Towards Excellence in Adult Social Care, the team combines a wealth of experience from across the health and care sector. They are already working closely with national and local partners to support improvement, share best practice, broker and coordinate activity, and challenge local areas where necessary.
I also want to use this blog post to highlight some of the excellent practice identified by the team. In Cheshire, a system has been developed to manage resources for health and social care services during spikes in demand. The Snow White urgent care dashboard has been created by NHS Eastern Cheshire CCG to provide real-time views of local capacity, helping more patients receive good care when they need it. Data showing availability of GP appointments, beds in hospitals, care home vacancies, and ambulance turnaround times are fed into a bespoke spread sheet by local authorities (LAs) and health and care organisations. The collated information even includes a daily weather forecast - its totality helping health and care teams make fair, timely decisions for patients.
I’ve also learned of other areas using the £37 million of additional funding to LAs, which we recently distributed to achieve quick wins in the fight to reduce DTOCs. Some LAs have begun recruiting to very specific positions aimed at reducing unavoidable admissions. For example, we’re seeing a greater focus on mental health issues in the elderly. This has involved establishing stronger links with dementia liaison services and registered mental health nurses, encouraging both to work more closely with care homes to avoid or curtail hospital admissions.
Other areas are setting up new processes around ‘discharge to assess’ to move people out of hospital settings and back into the community whilst assessments are completed - and accelerating the move towards seven day working. Many are using the money to fund reablement packages and enhanced domiciliary care services to support more complex cases in the home.
I am also pleased that many areas are working more intensively with the voluntary and community sector – for example by working with VCS organisations to help people settle back into their own homes after discharge from hospital.
These and other initiatives are all about improving patient flows within the hospital, smoothing transitions between modes of care and speeding rehabilitation to avoid further unnecessary hospital admissions.
We are starting to make progress. DTOCs have reduced by 9 percent since the start of February, but there is absolutely no room for complacency if we are to get back down to the more sustainable levels we were experiencing last summer.
With all this in mind, I would ask anyone involved in this work to consider what else could be done. Are needs assessments being carried out quickly enough to avoid delays in discharge? Can Better Care Fund projects be fast-tracked to deliver results sooner? And is there appropriate governance in the system to make sure there is a constant and committed focus on reducing DTOCs?
And please tell us about any best practice we can publicise and disseminate. What is your organisation or partnership doing that’s innovative and working to ease the flow of patients back into the community with the right support?
Hospitals environments are where recovery begins, but it is in our communities where it should be strengthened and sustained. Transfers should not mean even the briefest pause in care - but a smooth continuation. Let’s work together to make sure more patients never see the join.
