PPL Perspectives

‘Come together, right now, over me’? Delayed Transfers of Care affect partners and patients across the system – but how can organisations work effectively together to tackle the issue?’

27 November 2017

David Segal, Principal Consultant

Fixing delayed transfers of care – more to it than just topping the table

The issue

Throughout 2017, tacking Delayed Transfers of Care (DTOC) has been a strong focus of the health and social care improvement agenda. Earlier in the year, HSJ provided a run-down of the best and worst performing Trusts and an ominous look at NHS England’s target of 3.5% - a target that is already being missed in many areas, and if trends continue will get worse and not better.

Top 3 - based on average DTOC Rate

DTOC   tOP 3

Bottom 3 - based on average DTOC Rate


The good, the bad, and the ugly? So is it as simple as looking at the league tables to identify the local systems that have got it right and those have got it wrong? Does DToC data have all the answers, detecting the exact problem in the system and allowing us to tailor exact solutions? The answer of course is no, and looking at the league table for January to March brings up different players in both the best and worst spots. The answer however isn’t to ignore these league tables completely. High levels of DToC might not explain the cause of a problem or the true severity, but it does have a real impact and is a symptom of something that has gone wrong. To use a crude analogy, DToC is like the bad headache of the health and care system. Even the worst headache may have a relatively harmless route cause, but if left untreated and without investigation, severe consequences could emerge.

Key Takeaways The more detailed DTOC information can guide our focus when looking for solution, however our experience has shown that building in some key lessons learnt from our ‘top performers’ will have the biggest impact on longer term reduction to delays. Here are just three lessons that should feature in the thinking for any challenge and potential solution:

  1. Change anywhere in the system can reduce DToC. High DToC in a local economy puts a magnify glass inside the hospital walls, but solving issues in the hospital often moves DTOC to the next place. Providing a comprehensive safety net in the community creates a powerful pull effect for patients ready to go home.
  2. Capitalise on talent but don’t rely on individual personalities. Success will always require the incredible efforts seen from staff across the system, but a slip down the league tables can be caused by the simple departure of a key individual. Systems must embed and systemise good practice to ensure long term success whatever the change in personnel.
  3. Make the patient the centre of everything. Of course systems will consider patient outcomes when making a change, but making the patient the centre of all considerations throughout the process will lead to much greater success than detailed analysis of DToC categories. Asking how a change will improve a patient outcome is more likely to achieve a reduction in DToC in the long run.