HCL Issue 10 - Page 19

INSIGHT 19 How our council reduced delayed transfers of care by 75% Northamptonshire County Council’s Anna Earnshaw explains how collaborative working helped them cut delayed transfers of care by three-quarters orthamptonshire County Council has collaborated with local health partners to reduce the number of delayed transfers of care (DTOCs). These happen when a patient who is clinically fit for discharge continues to occupy a bed because follow-up care is not available or readily accessible. By introducing a more integrated way of working, the council registered a 75% reduction in DTOCs related to adult social care: down from 108 in 2016 to 27 in January 2019. N The problem We decided to try to improve our performance because a high rate of DTOCs meant there were a lot of people stranded in hospital. We know that the longer people are delayed in their transfer, the more likely they are to end up in long-term care. A high number of DTOCs meant our care and nursing home costs were also going up. So we decided to introduce some actions to get more patients home and allow them to move across care faster. The solution In our previous system, a multidisciplinary team made decisions about a patient’s journey through care by looking at forms that gave an outline of the patient. They weren’t making the decisions in hospitals. We now have an integrated discharge team in the hospital. This means the team is able to see the patient and understand their needs before making a judgment. We also set up better processes with our health partners and have agreed with clinical colleagues which are clinical and which are social care decisions. The benefits What we were doing before was working in isolation, waiting for each organisation to make its decisions. Even if we knew that a patient might need to go into a care home, we wouldn’t start considering it as an option until our clinical colleagues said we should. Now we work in parallel and collectively make a judgment about the care a patient will need. Before, the hospital decided that exclusively, and we had overprescribing of onward care. The council spends around £198m a year on care provision. The care budget for older people is £69m annually and we are currently overspending by £10.7m a year on care and support for the over-65s. About £7m of that £10.7m comes from demand from our hospitals. In 2017/18 the care budget for older people was under great pressure as we were seeing very high demand. More people were staying in hospital for longer and ending up in expensive long- term care. The full-year cost for people placed in long- term nursing and residential care after leaving hospital was £4m. This winter we have significantly invested in our crisis support teams, who help people recover at home with short-term assistance. On average, a short-term support package for reablement costs the council £700 per patient and a complex reablement and rehabilitation plan around £2,500. This is compared with an annual cost of £34,000 for residential or nursing care. Initially, we assumed we would see a similar level of demand as last year for 2018/19. However, the actual spend has been dropping month on month compared with the original forecast to the year end – which was based on last year’s spending. This year, we have undertaken more short-term and reablement activity, which has allowed us to reduce long-term-care placements. So far, this has resulted in a £2m care cost saving compared with the last financial year. In January this year the number of DTOCs attributable to adult social care was 27, compared with 51 in 2017 and 108 in 2016. The challenges The biggest challenge is culture change. We had a lot of conversations with partners about risks. Everyone wants to make sure risk is minimised. Social care colleagues make a judgment of a patient’s needs, taking into account their wishes and whether they have the capacity to make a decision. For example, if a person says they would rather go home and get support there, we’ll aim to help them to do that. In the past, I think clinical colleagues were more concerned about letting people make that judgment, as they wanted to make sure the patient had access to the absolute right amount of care. I think we are now in a much more comfortable place culturally, which is about trusting each other. We don’t just think ‘it’s your patient’. Instead, we think ‘it’s one person we all have to work with’. We have massively improved the way we are working and finding solutions together: that’s our biggest achievement. Anna Earnshaw is director of adult social care at Northamptonshire County Council Additional reporting by Valeria Fiore More online For the latest case studies, visit healthcareleadernews.com Healthcare Leader 2019 Issue 10