Press Releases

Action needed to sustain improvements in delayed transfers of care

13/05/2009

Partners must address long-term challenges to promote independence, says Auditor General

Fewer people in Wales are suffering delayed transfers of care because of a more co-ordinated approach from senior management to tackling the problem. To sustain such improvement local partners in health and social care, and the Assembly Government, must take a longer term approach and seize opportunities arising from the restructuring of the NHS.

This is the conclusion of a report released today by the Auditor General for Wales, which tracks progress made since his suite of reports in 2007. These found that the independence of vulnerable older people was compromised by unnecessary delays in hospital because the problem of delayed transfers of care had not been tackled in a co-ordinated way across the whole system of health and social care.

A delayed transfer of care occurs when a patient is ready to transfer out of hospital but is prevented by non-clinical reasons. Being delayed in hospital is bad for people 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 report, 'Delayed transfers of care follow-through', looks at delayed transfers of care in the Cardiff and Vale of Glamorgan and Gwent areas, and has found evidence of some improvements. Cardiff and Vale of Glamorgan reduced the number of lost bed days by 24 per cent (2006-07 to 2007-08), while the number of people who experienced a delayed transfer also decreased by 20 per cent over this period. In Gwent there had also been a considerable reduction in the number of people experiencing delays, falling from 148 in June 2008 to 56 in December 2008.

Delayed transfers of care affect the people who suffer a delay, the people who need the beds occupied by delayed patients, and cost the NHS money. The report estimates that the direct cost of these bed days across Wales due to delayed transfers of care in 2007-08 was over £66 million, an improvement on the 2006-07 figure of £69 million.

The report finds that the Assembly Government has taken positive steps to tackle delayed transfers of care but also identified the need for a clear vision of how health and social care partners should tackle the whole systems problems manifested by delayed transfers of care.

The report recognises the forthcoming reconfiguration on the NHS in Wales presents an opportunity to address these problems more robustly. It also highlights short-term risks which partners will need to manage.

The report makes a number of recommendations for further improvement, both for the partners in health and social care communities and for the Assembly Government.

Recommendations to local partners include:

• the development of  shared service visions to promote independence;
• providing joint leadership and plans to support the delivery of these visions; and
• developing shared performance indicators that focus on the results health and social care partners wish to deliver for vulnerable older people.

Recommendations to the Assembly Government include:

• exercising caution in designing new structures and associated funding mechanisms to ensure that resources can more easily be shared between health and social care;
• ensuring that local partnerships can be maintained, strengthened and developed within the new structures; and
• ensuring the Assembly Government's own internal reorganisation includes a stock take about how the internal operations of the Assembly Government might most effectively address issues at the interface between health and social care.

Auditor General for Wales, Jeremy Colman, said today:
"Hospital delays can have a very negative effect on the independence of vulnerable older patients. I am pleased to note the improvements in the impact and extent of delayed transfers of care, and the more serious approach taken by the Assembly Government and local partners since our first report.

There remains, however, a need for the Assembly Government to consider my recommendations and in particular to take advantage of the opportunities to develop a more robust holistic approach to promoting independence which the ongoing reconfiguration of the NHS in Wales may provide."

Notes to Editors:

• This 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.
• The report follows a series of reports produced by the Auditor General for Wales on tackling delayed transfers of care in November 2007, which can be found at:
  www.wao.gov.uk.
• The Wales Audit Office held a Shared Learning Seminar in November 2008 as part of this project, attended by over 70 senior public officials. 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 http://www.wao.gov.uk/whatwedo/delayedtransfersofcare.asp.
• The Wales Audit Office is independent of government and is responsible for the annual audit of some £20 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.