In the popular press they used to be called ‘bed blockers’. They were patients, often elderly, who were ready to be discharged from hospital but had nowhere suitable to go – and so became a contributory cause of the waiting list problem.
Now it is called Delayed Transfer of Care – and they’ve become DTOCs (as in ‘dee-tocks’.) In Wiltshire the problem falls between the Primary Care Trust (NHS Wiltshire) who pay for the hospital stay, and Wiltshire Council who have the responsibility to assess patients and find -and often pay for – the right place for them to go and the care to go with them.
These patients may need to go to a care home (even temporarily) or go home and have ‘help to live at home’ support through visiting carers. Sometimes the delay in transferring a patient is caused by delays in assessing a patient to see what support they will need once they leave hospital.
The NHS Wiltshire board meeting on Wednesday (July 25) was told that the figure for DTOC patients last Thursday stood at seventy. That’s seventy patients who, as Chairman Tony Barron, pointed out “were not in the correct place for their wellbeing.”
That is seventy patients whose health, especially if they are elderly, can deteriorate and their mobility be affected if they spend longer than they need in hospital. And it is seventy beds that cannot be used for new patients who must then wait for admission and treatment.
So it is not just a matter of cost being loaded onto either NHS Wiltshire or Wiltshire Council – it is about people’s health. Mr Barron said he was despondent about the problem and stressed that for five years he and the PCT had worked to ensure that ending the DTOC issue became “part of the culture of the NHS family in Wiltshire” – and by last August they had got the DTOC number down to thirteen.
Now there seemed to have been a change of policy at Wiltshire Council which had set the clock back. Mr Barron said the situation was “Unacceptable – we’ve got to stop it being a ‘let’s fix it for today’ problem.”
No one from Wiltshire Council was at the board meeting to discuss how the issue should be resolved. But John Thomson, the Council’s cabinet member for adult care, told Marlborough News Online that they disputed NHS Wiltshire’s figures.
For the week ending July 20 Wiltshire Council had recorded just sixteen DTOC cases across the three acute hospitals: RUH Bath, GWH Swindon and Salisbury Foundation Trust for which they were responsible: “We know that in recent months there has been a rise in the numbers of people being admitted into all Acute Hospitals and this of course has an impact on those awaiting discharge and the numbers of delays.”
Mr Thomson went on to say: “The Council fully participates with NHS and GP colleagues in a number of whole systems meetings/reviews to plan how we can work in a more integrated way to support customers to be discharged safely from hospitals. Plans are in place to improve joint working on a number of fronts following recent work with: GP Clinical Commissioning Groups across Wiltshire & B&NES; Bath Urgent Care Network; and Joint meetings with GWH/ Wiltshire Community health Services.”
However those figures from the Council do not include DTOCs in community hospitals and the local mental health partnership. The weekly NHS Wiltshire DTOC report, which the Council receives, shows that as at midnight on July 12 there were sixty-five Wiltshire DTOCs of which thirty-three were waiting for care home places and seven were waiting for assessment. That week there were 368 lost bed days due to DTOCs at a cost to NHS Wiltshire of £89,424.