The level of delayed transfers of care attributed to non-acute NHS services has been rising consistently over the past two years, HSJ analysis has revealed.
Overall delays have remained largely stagnant since the Department of Health began publishing data in August 2010, despite widespread local efficiency drives to cut the rate in health economies around England.
HSJ analysis of national figures shows that the rolling 12-month total has remained between 1.37 million and 1.39 million since July 2011 - the earliest point for which a full year of data is available.
However, within these figures, there has been a 9 per cent rise in the number of cases where a patient has been awaiting non-acute NHS care - from 246,032 to 267,954. This is the largest of 10 categories into which delayed transfers are recorded by the DH. The category includes community hospital services, mental health services and NHS-funded continuing healthcare in the private sector but does not include community services provided in a patient’s own home.
Jo Webber, deputy policy director at the NHS Confederation, said the category was a “rag bag” of types of care “where you would expect heat in the system to be seen”. She said tightening finances were putting the whole health system under increasing strain, but “we won’t be at crisis point overnight - crunch time happens in the winter,” she said.
Phil Da Silva, who leads the “right care” quality, innovation, productivity and prevention programme workstream, cautioned against a “blame game” between organisations, and said clinicians must now work to design better care around patients.
Stephen Richards, interim accountable officer for NHS Oxfordshire Clinical Commissioning Group, said partners in his local system had overcome a “blame culture” and accepted joint responsibility for dealing with the issue.
The county has the highest delayed transfer rate in England. Dr Richards described the local situation as a “debacle”, which was a symptom of parts of the system failing to join up. He said local QIPP plans had failed to reduce delayed transfers as they had focused on urgent care or complex care, rather than dealing with root causes of problems.
Commissioners in Oxfordshire are planning to pool health and social care budgets by the end of 2012-13 in order to remove perverse incentives and tackle the issue jointly.
Sir John Oldham, national QIPP lead for long-term conditions and urgent care, told HSJ that delayed transfers of care were likely to remain at their current level until “2013-14 or 2015”.
“I am relaxed that numbers are not changing at this point… you can’t switch these things on and off like a light,” he said.
Sir John argued that introducing local risk profiling for people with long-term conditions, setting up integrated health and social care teams and maximising the number of patients who could be supported to manage their own care, would reduce the problem.
“They take time to put in place, people are moving as fast as is feasible, and it’s only when they are in place that you see the numbers change,” he said.
HSJ analysis of DH data has shown that half of all delayed transfers occur in a quarter of local authority areas.
In the year to June, Oxfordshire had a rate of 129.4 delayed days per 1,000 population - almost five times the median rate of 26.6. There are 12 places with rates more than double the median.
Over the same period, the top quarter of 150 upper-tier council areas reported 686,139 delayed days between them, out of a total of 1,371,796 in England. If these areas cut their delayed days to the national average, 351,469 delayed days would be saved annually, saving up to £105m.