As delayed transfers of care, or ‘DTOCs’, continue to receive political and media attention Rhiannon Edge, senior research analyst, looks at how we analyse the DTOC data and some of the key messages it is telling us.
- Delayed transfers of care occur when patients who are ready to go home or be transferred to another care setting are unable to do so. As we move into winter the impact of DTOCs on the system’s ability to admit, move or discharge patients is a particular concern.
- It is important to remember that DTOCs have a very strict definition and can therefore be seen as the tip of the iceberg. Trusts will have many more patients who are ‘medically optimised’ or ‘medically fit for discharge’ who don’t qualify as DTOCs but still could be better cared for in a different setting. However this data is not nationally reported.
We can measure DTOCs in several ways:
- Total delayed days: this is the total number of days a bed was occupied by a delayed patient. This information is reported each month by NHS England, but as months have different numbers of days (“30 days hath September...”) it is worth noting that monthly comparisons can be inaccurate.
- DTOC beds: this is a new measure introduced by NHS England in 2017/18 and is the total delayed days in a month divided by the number of days in that month, averaging out the issue around the number of days in each month and enabling comparisons.
- DTOC rate: this is the total number of days a bed was occupied by a delayed patient as a percentage of the total number of occupied beds. This calculation of the DTOC rate is in line with NHS England’s calculation for the national mandate to reach 3.5% by September 2017, using both their DTOC data and their quarterly bed occupancy data. However it is only takes into consideration consultant-led beds and therefore is less accurate for providers with a high proportion of nurse-led beds, e.g. community trusts.
- In Q2 2017/18 the DTOC rate was 5.2%, consistent with the rate observed in Q1. The rate has consistently been above 5% for over a year. Calculated monthly, the rate in September 2017 was 5.0%, a slight improvement from 5.2% in August and 5.3% in July. This is still well above the 3.5% mandate set by the government.
- There were over 530,000 delayed days in Q2 2017/18, down from 533,000 in Q1 (a 1% decrease). This is the lowest quarterly number of delayed days observed for over a year. But the improvement doesn’t show in the overall DTOC rate because the number of occupied beds has also gone down, meaning the percentage has remained the same.
- Over the past few years cuts to social care funding have meant social care delays have increased faster than NHS delays. However September 2017 was the first month this financial year that social care delays have decreased compared to the same month last year.
- Delays for patients ‘awaiting a care package in their own home’ accounted for over a fifth (21%) of delayed days in Q2 2017/18. The next most common reasons for delays were for patients awaiting non-acute NHS care or nursing home placements.
- Understanding the rates of DTOCs is important. As well as not being good for patients and undermining the flow of patients through the health and care system they act as a barometer of a local area's capacity to cope with the rising demand we are likely to see over the winter period in particular.