Delayed transfers of care
Delayed transfers of care continue to create significant inefficiencies in the healthcare system.
In 2014/15 there were 1.6million delayed transfer days in England, an average of just under 4,500 per day. The UK had the second lowest number of available beds relative to population (with 2.8 per 100,000) compared to twenty EU countries) being a 20% percentage reduction from 2006. (King's Fund March 2015). Last year up to 30 September 2015, Monitor and the NHS Trust Development Agency estimated that, delayed transfers of care had cost hospital trusts £270m. NHS England's delayed transfers of care figures for the past year also show a marked rise in delays due to "awaiting a care package in own home", up 62% in comparison with the previous year. There were also 10% year on year rises for "awaiting completion of assessment", "awaiting nursing home placement or availability", and "awaiting residential home placement or availability". This has given weight to the argument that the social care system is responsible for the recent rise in delayed transfer of care.
The Government is tackling the delays in ways: -
- Delayed discharge payments; and
- Better Care Fund ("BCF").
- The Care Act 2014, requires the NHS to notify local authorities of a patient's likely care and support needs, where the patient is unlikely to be safely discharged from hospital without arrangements for support being in place (an "assessment notice"). The NHS must also give local authorities 24 hours' notice of its intention to discharge a patient (a "discharge notice"). Once an assessment and/or discharge notice have been received, should the local authority not comply with the requirements under the respective notice the NHS body can claim reimbursement for each day a patient's discharge is delayed (currently £155 per day in London and £130 outside London)
- The BCF is a pooled budget which is intended to shift resources into social care and community services for the benefit of NHS and local government. The BCF is designed to support transformation and integration of health and social care services, and was introduced in 2015/2016 with a minimum intended pooling of £3.8bn. In July 2015, Jeremy Hunt said one of the BCF aims was to reduce hospital bed days by 84,000. As a result of additional pooling, the BCF currently stands at £5.3bn.
Blake Morgan LLP have expertise in delayed transfers of care and discharge issues, from advising on individual complex care cases involving disputes with patients and families relating to assessment of capacity, best interest issues, safeguarding issues and funding disputes to review of organisational policies and procedures. Our experience is that, in individual cases, many of the issues that arise can be headed off by early intervention, detailed assessment and consideration of best interests flowing from a deeper understanding of legal requirements , such as the Mental Capacity Act 2005. An improvement in communication and dialogue between health professionals, MDTs, patients and their families is crucial.