Trusts told to halve the number of ‘green to go’ patients

Clinical Commissioning Groups covering areas where trusts had struggled to meet the four hour accident and emergency target and also had a high number of medically fit for discharge patients - known as “green to go” patients - were told to cut the number of these patients by half throughout February.

This comes as the latest data, for January, shows that delayed transfers of care were at their highest recorded level.

The data from NHS England shows that the number of days patients have been delayed in their discharge from hospital was at the highest it has been over a 12 month period. The number of days rose from 1.4 million between February 2013 and January 2014, to 1.6 million between February 2014 and January 2015.

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HSJ reported in January that regular Cabinet level meetings were taking place between health secretary Jeremy Hunt, minister for government policy Oliver Letwin, and communities and local government secretary Eric Pickles looking at the pressure on A&E, with a particular focus on delayed transfers of care.

Trusts have not received extra funding to cut the number of delayed “green to go” patients.

The Department of Health has given £35m to local authorities to spend on reablement or intermediate care packages, as well as home based care. A further £10m has been made available for home based care.

Royal United Hospitals Foundation Trust in Bath is one of the trusts that has been asked to reduce the number of “green to go” patients. The FT said in its February board papers that it had shared its plan to do this with community organisations and NHS England “as it is not possible for RUH to deliver the full plan without the full engagement of all providers”.

Delayed transfers of care are a subset of medically fit for discharge patients. There is no definition of a patient who is medically fit for discharge and no formal collection of these numbers. However, it is an area cited by trusts as a significant problem in terms of managing urgent care.

Examples of delays where patients are considered medically fit for discharge include patients waiting for physiotherapy assessments within the hospital; lack of availability of medication to take home; lack of availability of home equipment where required; and delayed access to care packages at evenings and weekends.

An NHS England spokesman said: “We have identified a number of trusts where the delayed discharge of those who are medically fit to go home is an issue contributing to pressure on A&E departments. They have been asked to work with their partners to focus on reducing these unnecessary delays for patients, and that work is ongoing.”