A delayed transfer of care is when a patient is ready to transfer to the next stage of care, but is prevented by one or more reasons. Unnecessary delays compromise the independence of vulnerable older people who become delayed. Being unduly delayed in hospital is bad for those concerned because they can lose mobility, mental and physical function and ultimately their independence. Such delays also harm wider service delivery and performance across the whole health and social care system.

The overview report looks at delayed transfers of care in the Cardiff and Vale of Glamorgan, Gwent and Carmarthenshire areas, and is supported by three reports that cover these individual health and social care communities. The overview report identifies themes and lesson from the three communities which will be fed into the independent review of delayed transfers of care commissioned by the Assembly Government. The Auditor General’s report identifies 21 case studies of good practice from Wales and beyond which could help address delayed transfers of care and their causes.

Across Wales, there has been a downward trend in the number of people blocking beds over the last two years but the number of hospital bed-days occupied has increased by two per cent in the same time. That means fewer people are delayed but for longer. The bed days occupied by delayed transfers of care was some £69 million in 2006-2007 - £26 million of which could readily have been better spent elsewhere. The report found that the current measurement systems for delayed transfers of care understate the extent of bed blocking. For example, local agreements mean that for some types of delay there is an agreed period after a patient is declared fit for discharge before they are counted as a delayed transfer of care. This masks the extent of the problem and underestimates the impact on the independence of vulnerable people.

Once patients are admitted to hospital, the reports identify process weaknesses which compromise the efficient flow of patients throughout the system. Problems often arise, for example, when a patient transfers between health and social care services - where different systems act as a barrier to whole systems working. Yet, even within the constraints of the existing system, the report says that organisations can work more effectively and calls for a community-wide strategic focus where this is appropriate. Developing plans to reconfigure services in Gwent, Cardiff and the Vale of Glamorgan provide just such an opportunity to provide a clearer vision and approach.

As well as identifying examples of local good practice, the reports make a number of recommendations for further improvement - to the partners working together in each health and social care community and also the Assembly Government.

Recommendations to local partners include:

• further developing and delivering a shared vision for services that promote the independence of vulnerable older people;
• addressing problems at each stage of the patient pathway, including the proactive identification of those at risk of frequent admission to provide more proactive care in community settings; and
• addressing issues of capacity, especially care home capacity for the elderly mentally infirm.

Recommendations include:

• the Assembly Government and local bodies ending the practice of local authorities and Trusts using local agreements to delay the start of counting a delayed transfer of care;
• partners within health and social care communities should develop clear models of service provision and care pathways from which the configuration of future health and social care services can be developed;
• the Assembly Government should develop a clear national policy on patient choice, which includes how long it is reasonable for a vulnerable elderly person to remain in a hospital bed awaiting the placement of their choice; and
• health and social care bodies should improve performance management and the processes for managing delayed transfers of care locally.

Auditor General for Wales, Jeremy Colman, said today:
“Unnecessary delays in hospital are bad for the patients who are delayed and bad for the people who need to go into hospital but cannot. To tackle this very complex problem in Wales, the Assembly Government and health and social care bodies need to adopt more effective and mature systems thinking, more consistent adoption of good practice and to work together more effectively.”

Notes to Editors:

• The overview report examines whether NHS trusts, local health boards and councils are taking effective action across the whole system of health and social care to tackle the extent and causes of delayed transfers of care in the Cardiff and Vale of Glamorgan, Gwent and Carmarthenshire health and social care communities.
• It is published in conjunction with individual detailed reports to the Cardiff and Vale of Glamorgan, Gwent and Carmarthenshire health and communities, which will be available on our website www.wao.gov.uk
• We have worked closely with the contractor undertaking an independent review of delayed transfers of care across Wales on behalf of the Assembly Government and have shared our extensive analysis of national data. Our findings from the three localities will inform the independent review as it considers the position in other parts of Wales. The independent review will test the relevance of recommendations in this report for other health and social care communities in Wales.
• Our work identified a large number of good practice examples which are set out in case studies within the report and on The Good Practice Exchange area of our website.
• The Wales Audit Office is independent of government and is responsible for the annual audit of some £19 billion of annual public expenditure.
• Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.
• The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.