Transfers of care
NHS Providers launched the Right place, right time commission in 2015 to capture good practice with regard to transfers of care in all settings involving our members – across acute, community, mental health and ambulance services. The commission was chaired by Rt Hon Paul Burstow and published its final report in November 2015.
Right place, right time: better transfers of care
Led by the former care minister and current chair of the Tavistock and Portman NHS Foundation Trust, Rt Hon Paul Burstow, the commission's report offers practical approaches, drawing on good practice in health, local government, social care and housing, and supports members to tackle the causes of delayed transfers of care in all settings. The report was launched at NHS Providers' annual conference and exhibition at the ICC in Birmingham on 11 November 2015.
There is much evidence in the acute sector about the impact delayed transfers of care can have on the quality of experience and outcomes for patients, as well as the operational and financial implications this creates for providers. We were therefore keen to capture examples of how providers are working with their local health and care economy partners to tackle this issue effectively, as well as to capture examples of good practice within mental health, community and ambulance services.
The members of the commission are:
- Rt Hon Paul Burstow, chair, Tavistock and Portman NHS Foundation Trust (chair)
- Stuart Bell CBE, chief executive, Oxford Health NHS Foundation Trust
- Helen Birtwhistle, director of external affairs, NHS Confederation
- Saffron Cordery, director of policy and strategy, NHS Providers
- David McCullough, chief executive, Royal Voluntary Service
- Sarah Mitchell, director of Towards Excellence in Adult Social Care (TEASC), Local Government Association
- David Orr, chief executive, National Housing Federation
- David Pearson, president, Association of Directors of Adult Social Services (ADASS) and corporate director, adult social care, health and public protection, Nottinghamshire County Council
- Ian Philp, deputy medical director for older people's care, Heart of England NHS Foundation Trust
The commission sought to:
- Offer an analysis of the problem and bring together the evidence, including previous attempts to solve it;
- Gather case studies of good practice in the management of transfers of care and hospital discharge;
- Identify the barriers to improving transfers of care and discharges from both physical and mental health settings, and the most promising and sustainable approaches to overcoming them;
- Set out practical measures for improving transfers of care and discharges from both physical and mental health settings that providers can adopt with partners in the local health economy.
- Provide messages and recommendations for providers of health and care services and national bodies to improve transfers of care for patients and service users.
- There is no single, simple solution to reducing delayed transfers of care;
- The key to success lies in focusing on what can be done in the hospital or inpatient setting and in partnership with other providers;
- Often it is the national frameworks, systems and processes that can unintentionally undermine local progress;
- It is important to keep patients, service users and carers at the heart of solving the problem;
- It is essential to work with staff at all levels, taking everyone with you on the improvement journey;
- Trusts should consider adopting process engineering and data analytics as valuable tools to help surface the root causes of problems;
- There needs to be a shared understanding across institutional boundaries about what the data is showing;
- Simply adding initiatives to already complex pathways is likely to exacerbate problems of flow;
- By making the process leaner, understanding it end to end, designing change in partnership with the frontline, and keeping the patient’s perspective at the centre we can reduce length of stay, speed up discharge, ensure adequate ongoing support and most importantly, improve patient care and health outcomes.