Shropshire again exceeds target for getting people out of hospital quicker
Health and social care organisations in Shropshire have again exceeded their Delayed Transfer of Care (DTOC) target in ensuring that residents don’t stay in hospital longer than they need to.
Current figures for 2018/19 show the number of delayed discharges of care (DTOC) across Shropshire Council adult social care services and Shrewsbury and Telford Hospital NHS Trust (SaTH) have reduced from 21.2 per day to 10.4 per day, a 60% drop since 2017/18.
The Delayed Transfer of Care figures, produced by NHS England, show that during the current year the monthly number of delayed bed days has reduced. Both the council’s adult social care services and NHS partners in Shropshire have seen a sustained long-term improvement in the reduction of delays.
Adult social care (ASC) services, as well as acute settings such as hospitals, across England, are expected to maintain or reduce the number of patients who are delayed in such circumstances. The Government has set each organisation a target to reduce the delays of transfers of care. A Delayed Transfer of Care from acute or non-acute care occurs when a patient is ready to depart and is still occupying a hospital bed.
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Dean Carroll, Shropshire Council’s Cabinet member for adult social care and climate change, said:
“I am absolutely delighted we have again exceeded the Government’s target.
“We know that no one wishes to be in hospital longer than is necessary. Over the past year our adult social care teams have worked extremely hard with our health colleagues to ensure people are discharged as soon as they are well.
“I am very proud that their work has been nationally recognised, having been awarded Social Work Team of the Year, as well as being Highly Commended at the LGC (Local Government Chronicle) Awards and recognised.”
Nigel Lee, Chief Operating Officer at SaTH, said:
“Together with the community teams, CCGs and local authorities, the Trust has halved the numbers of patients that are medically fit and awaiting transfer compared to last year. We now routinely transfer most patients within 48 hours of being fit, which is the national standard.
“We are very pleased to see yet another improvement this year which is testament to the hard work of staff across SaTH and the local system, and good news for our patients. No one wants to be in hospital longer than they need to be and we will continue to work together with our partners to look at ways of improving further.”
Shropshire’s Integrated Community Services (ICS) team, jointly run by Shropshire Council adult social care services and Shropshire Community Health NHS Trust, provide short-term support for patients who are ready to leave hospital. The team also work closely with partner organisations to identify people who need support to avoid an admission to hospital in the first place.
Steve Gregory, Director of Nursing at Shropshire Community Health NHS Trust, added:
“It is important that patients are cared for in the most appropriate setting for their needs. We work with others within the Shropshire care system to make sure any delay is kept to a minimum.”
Tanya Miles, Shropshire Council’s assistant director – adult social care, added:
“Our integrated teams work extremely hard to support people to be discharged from hospital as soon as they are well, and help people avoid hospital admissions. This year their efforts have paid off in that we exceeded the targets that had been set nationally in reducing delayed transfers of care.
“We continue work with our health and social care partners to further explore possible solutions to help reduce the number of patients remaining in hospital and returning home, which we know they prefer to be.
“I would like to offer my congratulations to all those involved who I know have worked extremely hard to ensure that people return home from hospital as soon as possible. This is a great result from the team.”
Shropshire Council and SaTH have introduced a number of initiatives which have contributed to the reduction in DTOC figures. New programmes and initiatives to help patients return home sooner, or support those to avoid hospital admission, include:
Bespoke night time support (Two carers in a car) – This pilot scheme involves two carers who can travel to any household within the Shrewsbury area to provide support between 10pm and 7am. This support may be assistance for toilet care, to getting into bed at a later time than when regular carers are available, reassurance if just home from hospital, or as an alternative to a hospital admission where night support is required. Request for placements are often due to night support being required, but many people do not need this throughout the whole night. This scheme enables care support to be provided to a number of people throughout the night.
Carer support post-hospital discharge – Carers Trust 4all are offering support for carers discharged from hospital. Carers may feel anxious following a discharge that they have lost their routine, or the person they support on discharge may require more support. This service is now available throughout Shropshire, and is provided directly for the benefit of the carer at a time of increased challenges for the carer.
Extra care units – Where additional support is needed but can’t be provided within the person’s home, the council has commissioned four new ‘independence’ units located within a local housing development. These units are individually self-contained, where couples or single people can live, and where they can continue to receive therapeutic and care support prior to, and during, their transition when moving back to their own home. These units will be particularly beneficial for those discharged patients not able to return home from hospital. They will provide people with the environment where they can continue to regain and improve their ability to live in their own home, which for many people is what they wish to achieve, and evidence demonstrates is difficult to achieve if admitted to residential placements. This will allow people who require a period of enablement in an environment where they can be accompanied by their partner and receive further support to develop their independence skills.
Let’s Talk Local hub – There is also the hospital-based ‘Let’s Talk Local’ hub, which will offer information and advice around visiting times for people who are supporting friends, neighbours, and family members who are in hospital.
SaTH Frailty Intervention Team
A frailty service at the front door of Royal Shrewsbury Hospital was launched to reduce admission and reduce lengths of stay for patients aged 75+. Working together with Shropshire CCG, Shropshire Community Health NHS Trust and Shropshire Council, the new team combines health and social care professionals. It is a fast track service to get frailer patients over 75 quickly assessed, treated and discharged safely back to their own homes.
SaTH2Home was launched to provide rapid, same-day domiciliary care for patients awaiting care packages to start or who require support to settle back to their home. This enables discharge to be facilitated on the day a decision is reached that an individual no longer requires acute care.
Adult social care DTOC figures
Current figures for 2018/19 show that adult social care services have exceeded their overall target by over 60%. For 2018/19 the target was to further reduce delays to an average of 17 per day, services have exceeded this target to now just 10.4 per day.
Adult social care services in Shropshire have worked closely with NHS trusts within Shropshire and also with out of county trusts where residents may be receiving care. This has resulted in significant improvement in the council’s results. In comparison to the year 2016/17 the results for 2018/19 show delays attributed to adult social care have reduced from 5,333 days to 118 days, a 98% improvement.
During 2016/17, on average, there were 39.7 delays per day. For the 2017/18 the target was to reduce this to 22.5 per day, which was achieved with 21.3. For 2018/19 the target was to further reduce delays to 17 per day. The services have exceeded this target, achieving 10.4.
Representatives from 10 different organisations – including Shropshire Clinical Commissioning Group (CCG), Telford & Wrekin CCG, Shropshire Council, Telford & Wrekin Council, SaTH, and representatives from Shropshire partners in care (SPIC) – spent a week together in November 2018 to explore new ways of getting patients to leave hospital sooner so they can recover in the best possible place.
What is a delayed transfer of care?
A delayed transfer of care from acute or non-acute care occurs when a patient is ready to depart from such care and is still occupying a bed. A patient is ready for transfer when:
- A clinical decision has been made that patient is ready for transfer and
- A multi-disciplinary team decision has been made that patient is ready for transfer and
- The patient is safe to discharge or transfer.