Delayed transfer of care
Alternatives to ease delayed transfer of care need to be effectively recognised in order to take effect
From the desk of Peta Wilkinson CEO at Enham Trust
Peta Wilkinson, CEO at disability charity, Enham Trust highlights the low occupancy rates at alternative facilities and new solutions that could ease the NHS burden. Delayed transfers of care – or bed blocking as it is more commonly written about - is a serious problem for the NHS and has hit a new high, according to the latest figures from NHS Data, up 25% year on year.
It currently eats up some £900m a year – that’s almost 1 per cent of its entire annual budget. And it’s not forecast to get any better. According to a recent study by ResPublica, delayed transfers of care is expected to cost the NHS £3.3bn over the next five years as people continue to be stuck in hospitals rather than being discharged and cared for in the community.
This is money the NHS can ill afford. This year we have seen a catalogue of worrying announcements about the closure of hospital departments including accident and emergency services for children at County Hospital Stafford and Fairfield General in Greater Manchester due to lack of funds and budget deficits. More are expected.
At the same time, the NHS has diverted almost £1bn from investment to balance its budget (or rather to help cut the deficit from £930m to £461m from April to June year on year), which is unsustainable. But it’s not just an economic crisis. It’s a medical crisis. Delayed transfers of care – when a patient is medically fit to be discharged but care is not in place for them outside of hospital - is part of the chronic problem of high occupancy rates, which can lead to increased infection, lower recovery rates and delayed operations.
Richard Murray of the Kings Fund recently said rates were “eye wateringly high” at over 90 per cent – experts say 85 per cent is a safe limit to reduce the chance of infection and ensure slack in the system to deal with surges in demand.
It was with all this in mind that we, as the board of Hampshire’s leading disability charity Enham Trust, decided to open respite care apartments available to NHS and private patients leaving hospital with nowhere to provide the care they needed in the short term.
On July 5 we opened Cedar Park Apartments, a collection of 10 apartments that offer a high standard of accommodation where residents can benefit from tailored packages of care and support and therapy interventions for varying lengths of stay. Care provision is available 365 days a year, 24 hours a day.
The service is designed for disabled, elderly and/or vulnerable people who may be leaving hospital or just need to stay somewhere while health and social care plans are put in place, or their home is adapted for them to return to.
Those needing a short-term break, respite care, rehabilitation or therapies in one location can also access the service. People can be funded by the NHS, Local Authorities, or from private means.
Although it’s still early days, to date, we have had three residents for a total of just 6 weeks. That’s just 10% occupancy.
It’s impossible to convey the frustration we feel at Enham about this shockingly low up-take. While the NHS is expected to spend an astonishing £3.3bn caring for delayed transfers of care patients over the next five years, facilities like ours would cost just £835m over the same period to accommodate and care for those patients. But it’s not just about the money; it’s about quality care and rehabilitation, and quality of life.
People discharged from hospital to transition care are less likely to be re admitted and their rehabilitation tends to be faster. This is better for patients long-term outcomes, health and wellbeing – and the NHS.
So what’s gone wrong? Why aren’t we over subscribed?
When people visit the apartments they are genuinely impressed, yet despite our best efforts, there is still a widespread lack of knowledge about our services, a pattern repeated elsewhere. With time, we can change this but besides a lack of awareness there are significant barriers behind the lack of take-up.
We have discovered just how difficult it is to incorporate services like ours into patient care plans. Moreover, the complexity of patient care plans and their funding arrangements are also against us.
This has got to change.
Processes and mechanisms to substitute one kind of care for another need to become more flexible, the ability for people to move to more suitable services should not be blocked by gaps in commissioning or reluctance to work collaboratively on funding solutions, such as the Better Care Fund. In addition, the leeway that already exists in the system has got to be more widely used.
Feedback from the health and social care professionals we have spoken to has been immensely positive. But they do not control budgets. One senior social worker is keen to use Cedar Park Apartments, but has had their hands tied by waiting for approval from the region’s health commissioners. This could take months, leaving people in expensive hospital beds, reducing the availability for others, restricting their rightful pathway to recovery, or worse, at home with inadequate care.
These budget decisions need to be brought closer to the people at the centre of this crisis.
Whilst personal health budgets, which allow patients and their carers to choose how best to use an annual budget allocated to treat a chronic problem, go some way towards this, take-up to date in Hampshire has been very low. Doctors and community nursing teams need to look at how they might increase their use and look for appropriate cases for implementation.
This way, respite and post hospital care can become an integral part of a patient’s journey through their treatment, and could be incorporated into a personal care plan at the start. Indeed, planning is sorely lacking in many instances, adding unnecessary cost to the NHS of many patients.
All too often, solutions in the NHS are short term, – just look at the use of investment money to plug part of the deficit. We’re not proposing wholesale change, but even small adjustments would make a big difference. When a doctor books an operation or procedure, for example, the whole patient journey should be mapped out and planned, all the way through to recovery at home. Different services should be booked and all the relevant providers included in decision-making.
This would undoubtedly lead to multiple savings, across the wider health and social care economy, together with reducing the risk of delayed transfers of care, delivering faster rehabilitation and reducing the risk of a return to hospital, for many disabled, elderly or vulnerable people.
Similarly, the private health insurers can see immense benefits but their policies are currently limited to medical procedures and therapies, not care. They need to set up partnerships with organisations like us to fill this gap.
Meanwhile, private hospitals too like the idea of being able to refer recuperating patients to a care environment, freeing up beds so that they can perform more operations. They need to be better informed and support their patients to look at the alternatives.
We have worked tirelessly to get our message out there but we are only one voice and are making very slow progress. Our message would travel further and faster if we were included on the NHS Choices website. This would mean we would appear in Google searches for say ‘NHS respite care’. But despite our best efforts, we have yet to find the right contact to get us included.
Critically, this means that when a nurse is trying to arrange a patient’s discharge from hospital only to find that the family is on holiday, as does happen, Enham’s Cedar Park does not come up as an alternative.
But the need for education goes beyond professional services. Private individuals who want respite care can’t find out about us easily. Many people don’t want to involve social workers or their GPs – preferring to keep their affairs private. A listing on NHS Choices would make Cedar Park easier for them to find too. Equally, carers who need a break and who save the country £4bn a year should be able to find us easily.
It comes down to a lack of process and flexibility and the fact that social care is still seen as separate from health care. Despite recognition of the problem from Dr Sarah Wollaston MP who recently said the ResPublica research provided “compelling evidence that social care cannot be seen in isolation from the NHS” and Baroness Joan Bakewell, a champion for older people, who welcomed the research and its call for mechanisms to support care homes, the future still looks unnecessarily tough.
Our apartments have been open for nearly 12 weeks now and when we have had residents we have seen the difference our facilities can make. However, the individual health care plans, the ability of social services to make decisions, the complexity of NHS funding, and the labyrinthine path to inclusion on NHS Choices are working against us.
Delayed transfer of care is not a new phenomenon.
Solutions like Cedar Park Apartments are.
Unless we can overcome these problems our apartments will continue to be underused and patients will continue to receive sub-optimum care. It’s time everyone involved grasped the nettle. It’s time to get involved.
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