Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of ‘provider capacity’ and ‘patient choice’

Abstract

Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.

Hospital congestion: a market solution to address delayed transfers of care from hospital beds

“…15 These changes took time to have an impact, but between 2017 and 2020 the number of delayed beddays from DTOCs decreased by 22%. Coinciding with a national policy drive that required local authorities to agree to DTOC reduction targets, 16 the number of occupied bed-days related to DTOC reduced from over 200 000 lost bed-days in a single month to a record low of under 130 000. 14 The UK experience highlights what Australia could learn analysing its own health care data.…”

Drivers of Home Care Agency Closure: Evidence from England

“…Poorer quality services have cost implications, leading to greater utilisation of health care or other forms of long-term care (e.g. Cabin et al, 2014;Chen et al, 2020;Basu et al, 2021), and hospital stays can be extended from limited long-term care supply (Fernandez & Forder, 2008;Allan, Roland et al, 2021;Gridley et al, 2022).…”

Routine data collection in home care: A national survey of home care providers in England

“…Home or domiciliary care supports almost one million people with long-term care needs in the UK, approximately twice the number of people living in care homes. It has a critical impact on the individuals and families who receive support (Boyle, Seddon, & Toms, 2023; Rand, Forder, & Malley, 2017; Rand et al, 2022) but also accounts for a significant component of public sector spending (Allan et al, 2021; Gridley et al, 2022). Data availability has been a major barrier to increasing our understanding of this important area of care.…”