David Lee on delayed transfers of care

Please be assured this was nothing personal.

This is a very sensitive subject in 2008-09. People who have sweated blood to achieve foundation status and the prized green governance rating have seen the fruits of their labour put at risk by the new 7.5 per cent maximum delayed transfer target.

Some trusts cry foul - "What are we supposed to do if another part of the local system fails?". Monitor has politely indicated that it is in no mood to hear any special pleading. So, without any reimbursement regulation, trusts are engaged in hand-to-hand battle with the 7.5 per cent target.

But work to reduce delayed transfers did not begin in 2008. Some years ago there were ill-tempered discussions about reimbursement and how discriminating against mental health would create perverse disincentives. But that starts to sound like special pleading. Here is some of the work we are doing in Camden and Islington.

For over five years we have operated a robust bed-management system to review and monitor transfer of care delays with regular weekly monitoring against action plans. Delays are scrutinised against targets. Our weekly bed-management group, always personally led by the medical director, plays a pivotal role.

This year we have refocused on working practices between wards and community teams, to ensure the whole system is more efficient.

Detailed individual patient reports are reviewed weekly. The board's performance committee scrutinises the position every month and borough-based reporting to commissioners also happens monthly. The board of directors reviews the position every month for the performance report.

We keep up an intensive search for new models and efficiencies, including step-down beds, intermediate care and alternative provision, as well as addressing the critical issue of capacity in residential and nursing homes.

We are reviewing working practices in community teams in an attempt to increase capacity to support people at home.

We are also in discussions with commissioners about the use of potential spare capacity in extra-care sheltered accommodation for intermediate care, as well as investigating whether further spot purchasing can be of value.

We have brought transfer delay in our adult beds down to virtually zero, which means even with the tougher agenda in mental healthcare of older people we are within a shout of coming in under the 7.5 per cent line.

This target will be monitored on year-end performance, not quarterly, so some trusts will rely on dramatic improvements towards the end of 2008-09. It promises a tighter finish than the Formula One championship for a few - only time will tell who will play the part of Lewis Hamilton and who will be Felipe Massa.