The current situation

A delayed transfer of care occurs when a patient is ready for transfer from a general and acute hospital bed but is still occupying that bed. Delayed discharges can have a direct and negative impact on the quality of care of individuals. For example, older people may lose their independence, mobility, and social networks, and are at risk of falls and infection. (NHS National Library for Health)

What are we doing?

The Wales Audit Office is conducting a cross-cutting review of delayed transfers of care in the Gwent and Cardiff/Vale of Glamorgan health and social care communities.

The principal objectives of the review are to identify the key constraints in relation to delayed transfers of care in each health and social care community and to facilitate the development of sustainable long-term solutions across health and social care. We will assess the likelihood of current plans being successful, the financial position and the effectiveness of whole systems working.

Our work, which will take place in the summer and autumn of 2007, has arisen from the local risk assessment process as part of our audit of individual NHS trusts, local health boards and unitary authorities in these areas.

Our Approach

The project will address, in each health and social care community, the following questions:

Are the trust, local health boards and unitary authorities taking effective action to tackle the extent and causes of delayed transfers of care in a sustainable way in the health and social care communities?

• Across the health and social care community, is there a clear and shared understanding of the causes and impact of delayed transfer of care?
• Is there effective partnership working to tackle the causes of delayed transfer of care to deliver reductions in their extent?
• Is there an effective management framework in place to deliver sustainable improvements in delayed transfer of care performance within the health and social care community?

Our fieldwork will include:

• A set up meeting involving the Chief Executives of relevant organisations.
• An initial one-day workshop involving one key individual, ideally at executive level, from each organisation. This will include innovative focus group technology to identify the major barriers to tackling delayed transfers of care in each community. Where relevant, it will also highlight potential solutions and good practice which has led to sustainable improvements in some parts of the health and social care community. The workshop would focus particularly on the effectiveness of partnership working in the community and will shape the remainder of our work.
• A patient pathway survey in the relevant Trusts to identify the causes, impact and scale of delayed transfers of care.
• Semi-structured interviews in relevant organisations and among key stakeholders.
• Tracking implementation of work undertaken in each health community by the NLIAH Change Agent Team.
• Document review and data analysis.
• A whole system financial analysis of the delayed transfers of care in the health and social care community.
• Analysis of investment in and impact of services developed with a view to improving the delayed transfers of care position.
• A good practice module to identify good practice within the community, or outside the community but applicable to it, and the effectiveness with which good practice is disseminated.

What happens next?

The outputs of the review will be:

• a workshop presenting the findings to each community;
• an overview report for each of the communities;
• action planning workshops involving relevant local authorities, the Trust and relevant LHBs to be determined; and
• an overview report on delayed transfer of care in the communities laid before the National Assembly.

The ultimate impacts of the review should be to identify solutions at both local (local authority) and health community level that deliver sustainable reductions in delayed transfers of care. Our work will also seek to support improved partnership working in each community and better use of resources, both recurrent and those provided specifically to tackle delayed transfers of care.

Our project is likely to lead to the production of overview reports for each of Cardiff and Vale and Gwent health and social care communities.
It may also lead to a national overview report to be laid before the National Assembly, setting out the main themes to emerge from the work in the local areas.

Contributing to the review

If you have any views about delayed transfers of care in the Cardiff/Vale of Glamorgan and Gwent health and social care communities, please contact the project team using the feedback form here.