High impact change model Managing transfers of care

This resource supports the High Impact Change model for managing transfers of care. It contains examples for the eight system changes where there is evidence of impact, examples of emerging practice that are starting to make a difference and includes links to guidance and further information.

NHS Performance Statistics - January 2018

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

Delayed transfers of care: a quick guide

King's Fund briefing on why delayed transfers of care occur, and their impact on the wider health system.

NHS performance statistics - December 2017

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

Combined Performance Summary - October 2017

This publication from NHS England summarises the data around NHS performance for October 2017. It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Intermediate care including reablement

This new NICE guideline covers referral and assessment for intermediate care and how to deliver the service. 

Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.

Recommendations include:
1.1 Core principles of intermediate care, including reablement
1.2 Supporting infrastructure
1.3 Assessment of need for intermediate care
1.4 Referral into intermediate care
1.5 Entering intermediate care
1.6 Delivering intermediate care
1.7 Transition from intermediate care
1.8 Training and development

Combined Performance Summary - August 2017

This publication from NHS England summarises the data around NHS performance for August 2017. It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Adult patient transfer checklist

George Eliot Hospital NHS Trust has introduced a patient checklist to maintain safety upon transfer. It has information to prepare the ward or department that is expecting the patient.
The checklist is concise and looks at three distinct phases:

• preparation for transfer (before)
• physical transport of the patient (during)
• handover of the patient to receiving staff (handover)

Read more about how to use the checklist.

Patient transfers and bullying in the NHS

DTOCs warning
Ministers are set to issue a fresh warning to councils deemed to have made insufficient progress tackling delayed transfers of care, amid a bitter row over the withholding of funding.


Bullying in the NHS – a bully’s perspective
Retired hospital chief executive Kate Grimes reflects on recognising bullying in her own behaviour, and on three aspects of bullying in the NHS

To read the full articles please copy and paste the above post into an email and send it to library@uhcw.nhs.uk with the subject line reading Please obtain this article

Simon Stevens: Cut DTOCs to prepare for possible flu outbreak

Freeing up delayed transfer of care beds will be vital to ensuring the NHS has enough capacity to manage winter pressures and a possible flu outbreak, Simon Stevens has warned.

To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.

Plans to improve NHS Continuing Healthcare assessment processes

This letter, from NHS England, outlines revised guidance in relation to NHS Continuing Healthcare assessments in order to promote a reduction in delayed transfers of care.

The reduction in Delayed Transfers of Care (DTOCs) is a key priority for the NHS, with delays needing to reduce from approximately 6,428 per day to 4,080 per day in order to release the needed bed capacity within health systems. It is estimated that resolution of the factors causing delays due to NHS CHC assessment could help free up to a quarter of the total number of beds the NHS is required to release

Combined Performance Summary - May 2017

This publication from NHS England summarises the data around NHS performance for May 2017.

It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Reducing delays for people moving from hospital to social care

In a written ministerial statement Health Secretary Jeremy Hunt announced (on 3 July 2017) measures to support the NHS and local government in reducing delays for people being discharged from hospital to local social care services.

The measures include:

• local authorities agreeing with local NHS organisations on the contribution they will make to reducing the number of delayed transfers of care in their local areas
• a performance dashboard showing how health and social care partners in every local authority area in England are performing against a number of metrics, including: delayed transfers of care, emergency admissions, length of stay in hospital, the number of people still at home 90 days after being discharged from hospital
• the Integration and Better Care Fund Planning Requirements 2017 to 2019, which set out how the Better Care Fund Planning process will operate

Report on transition of care between childhood and adulthood for people with diabetes

NHS Digital has published a new report that charts the care of young people with Type-1 diabetes as they move from paediatric to adult services.

The National Diabetes Transition Audit (NDTA) links datasets from the adult and paediatric national diabetes audits and examines whether the transition between childhood and adulthood has an effect on care.  The report includes figures on the percentage of people who are receiving the nine NICE recommended care processes, as well as the percentage of people who have met the NICE treatment targets for diabetes care.

The report also examines how young people with Type-1 diabetes are monitored against risk factors4 associated with diabetes care as well as Diabetic ketoacidosis (DKA) inpatient admissions.

Quarterly performance of the NHS provider sector: quarter 4 2016/17

The NHS provider sector's deficit has been cut by two-thirds in the financial year just ended – from £2.4 billion in 2015/16 to £791 million in 2016/17.

These figures represent an improvement of £1.7 billion, driven by savings of over £3.1 billion with over £700 million saved on locum and agency use in the year.

This is against a backdrop of rising demand and a significant increase in delayed transfers of care. Our analysis shows that providers experienced a 24.5% increase in delayed days in 2016/17 compared to 2015/16.

Combined performance summary: April 2017

This publication from NHS England summarises the data around NHS performance for April 2017. It finds that the long-term trend of increased demand on urgent and emergency care and elective activity continues and that waiting time standards for A&E waiting times, ambulance response times and cancer waiting times were not met.

BMA analysis shows that NHS patients endured one of the worst winters on record, with year-round crisis set to become the norm

The BMA is warning that the NHS in England is unlikely to recover from the pressure it faces during the winter, with trends suggesting that the health system is entering a state of year-round crisis.

The analysis of NHS performance data shows that bed occupancy, delayed transfers of care and A&E waiting times are all increasing and that key performance targets are consistently not being met across the health system.

Monthly performance statistics, March 2017

Performance statistics for March 2017 have been published by NHS England. These cover the following:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Integrating health and social care

This report from the House of Commons Committee of Public Accounts investigates the Better Care Fund and concludes that it has missed targets for reducing emergency admissions and delayed transfers of care.

Rapid improvement guide: trusted assessors

Use this guide to learn how adopting a trusted assessor model can improve the experience for the patient and reduce delayed transfers of care.