Delayed transfers of care: does geography matter?

“The difference between the worst performing council in relation to delayed discharges and the best is a 20 fold difference. That’s not about the difference of funding, it’s about the difference of delivery.”

Theresa May, 14 December 2016

It’s not immediately obvious what time period, or even how many councils are being referred to here. It’s a claim the government has made in various forms before.

We’ve done our own estimates based on figures for last year in the English NHS, and this claim seems to be in the right ballpark.

We’ve asked the Department of Health how the figure is calculated.

Best vs worst

There are two ways to measure the delays to hospitals and patients caused by discharges.

Based on everything the government has said it seems to be referring to the 10% of local authorities with the lowest number of delayed bed days attributed to social care and the 10% with the most.

Figures are available which give the average daily rate of delayed transfers of care from hospital per 100,000 people over 18 in each council area.

Using this measure the 10% of councils with the least delayed bed days had a rate of 0.5 delays per 100,000. The 10% of councils with the most delays had a rate of 11.3 delays per 100,000. That’s a difference of around 22 times.

For this year and using this measure, the government’s figure is roughly correct.

Funding vs delivery

The King’s Fund, a health think tank, has said that an increase in the number of delayed discharges from hospital since last year is “undoubtedly driven” by pressures in the NHS and social care.

The most common reason for a delayed discharge so far in 2016/17 has been that patients were waiting for a care package at home. This was closely followed by waiting for other non-acute NHS care, waiting for an assessment to be completed and waiting for a place in a nursing home.

Depending on the reason for the delay and whether the patient was receiving acute or non-acute care there is some variation in whether the NHS, social care, or both are considered responsible for the delay. Looking at all delays together, the NHS is responsible for the most.