The influence of social care on delayed transfers of care (DTOC) among older people

SPRU research team

• Yvonne Birks
• Kate Gridley

External collaborators

• Karen Jones, PSSRU, University of Kent
• Stephen Allan, PSSRU, University of Kent
• Gintare Malisauskaite, PSSRU, University of Kent
• Daniel Roland, PSSRU, University of Kent

Project summary

Background

A ‘delayed transfer of care’ (DTOC) occurs when a patient has been delayed at least one day after they were medically fit to be transferred/discharged. The National Audit Office (2016) estimated that delayed transfers among older people cost the NHS up to £820 million every year, with many requiring social care support from their local authorities (LAs) following discharge. At a time of financial austerity, the health and social care sectors need to work together to reduce, or prevent, DTOC.

Aims

Is there a relationship between the discharge approach employed by a particular site and their DTOC rates? The project aims to answer two questions: 1) why delays are happening; and 2) how they might be reduced or prevented. The project aims to establish:

1) The extent of any relationship between DTOC rates, home care expenditure by local authorities, and home care and residential care supply.

2) Current discharge arrangements (across LAs and the NHS) and the relationship between specific discharge approaches and local DTOC rates among older people. Which approaches are effective in reducing or preventing DTOC?

3) The effect of local context (e.g. home care and residential care beds supply, need and demand characteristics) on the impact of different discharge arrangements for older people.

Methods

The research has three main elements.

1) A statistical analysis of the monthly LAlevel DTOC data submitted to NHS England. The data will be used to create a panel of LA-level DTOC rates from 2010-2016, with data on both total number of patients delayed and total days delayed. This data will be further refined by the organisation responsible for the delay (NHS, LA, or both), and the reason for the delay. The DTOC dataset will be populated with data on LA home care expenditure, residential care beds and home care availability.

2) Representatives from NHS Trusts, NHS Foundation Trusts, Social Enterprises and Local Authorities will be invited to complete an online survey to identify their local discharge arrangements.

3) Data from the online survey will be used to develop discharge models for the quantitative analysis. This typology will be informed, as far as possible, by the results of the case studies.

4) Six case studies detailing the local transfer arrangements will be developed. Up to eight organisational representatives within each case study will be invited to participate in a face-to-face or telephone in-depth interview. The interviews will be conducted at a time and location preferred by the participant and will last up to 60 minutes.

Outputs

We expect to report findings through journal articles, reports and at appropriate conferences. We also plan to report findings on our project website. 

Additional information