While Delayed Transfers of Care (DTOCs), bed shortages, and needless hospital stays negatively affect every patient, the NHS still has a responsibility to pay special attention to the most vulnerable people in our society. But, given the nature of acute hospital beds and potential transfers to social care, the frail elderly and sick children make up a considerable part of the pressure that the NHS faces in handling its current backlog of more than 7 million people waiting for treatment.
In an effort to improve collaboration between disciplinary teams, the NHS has been taking steps to rectify the specific challenge focussed on the vulnerable and . Between 2013 and 2015, 25 integrated care pioneer sites were selected by the NHS to develop and test new ways of joining up health and social care services across England. In 2015, 50 vanguards were chosen to lead the development of new care models, becoming blueprints for the wider NHS moving forward and the inspiration to the rest of the health and care system moving forward.
Through the new care models programme, a complete redesign of whole health and care systems was being considered. That care model was to take into account improving care not simply for older people, but with a focus on frailty vs. age and the differing needs of our ageing population. An ageing population that is living longer and presenting with more complex illnesses that require complicated care. At the same time, similar complexity can be found in a vulnerable group at the other end of the patient age spectrum – the young (children). These factors compound today’s NHS bed shortages, understaffing, burdened workflows, bottlenecks and burned-out clinicians and nurses. They also add to the DTOC problem.
While DTOCs can occur for a wide variety of reasons in the patient journeys of the above two mentioned vulnerable groups, data shows significant challenges in bed capacity, particularly for children. For older patients, awaiting care packages in their own home or nursing home availability are among the most common causes. Meanwhile, Multidisciplinary Teams (MDTs) have a pivotal role to play in enabling seamless journeys, without being limited by inaccurate patient reports, loss of reports, and delays in information sharing (a topic we’ll go into more detail in our next blog post).
In this post, we focus on how DTOCs affect the vulnerable most frequently and how speech recognition technology could help improve this situation to deliver a more consistently available level of care and, ultimately, improve outcomes.
Treating severely ill children
Recent data from Nuffield Trust examined the impact of NHS pressure on children, looking specifically at intensive care beds across the challenging winter period.
According to the report, December 2021 saw just 314 beds per day across the whole of England. While this was marginally higher than availability in previous winters, occupancy was higher too. On average, 89% of these beds were occupied, leaving just 35 beds available to new admissions.
This is by no means the direct consequence of DTOCs and patients failing to be transferred or discharged appropriately. But, it is a sign of a healthcare system in crisis, dealing with peak demand and increased instances of flu, scarlet fever and Strep A with little room to manoeuvre. Bed stocks have been reduced to an extent where any unexpected demand – or delay – could have disastrous consequences.
DTOCs and older patients
For older frail patients, effective care takes a seamless approach between the NHS, community services, and social care providers. It is often these cases where the discharge and transfer process is most complex, requiring collaboration between multiple parties and effectively prioritising what are often multifaceted, intricate needs.
According to a study in Age and Ageing, Volume 50, Issue 4, the average cost to the NHS of DTOCs in older patients was £820 million each year. However, the study highlights the importance of keeping patients central, even where most data gathering is focused on wasted costs.
The reality is that DTOCs aren’t just a cost centre. They create a ripple effect across our entire healthcare system – and out into the lives of patients and our wider communities. Reducing wasted costs is simple: discharge patients faster and more effectively – that’s just one part of the story.
For older patients – and patients of any age – the discharge and transfer process is a key part of their experience. Delays create distress and negatively impact healthcare outcomes. And the knock-on implications of bed shortages, soaring occupancy, and unavailability of care, tend to lower standards across the entire system.
The human cost of DTOCs and bed shortages
At the end of 2022, Landmark Chambers reported on a specific judicial review of an individual Integrated Care Board (ICB). A patient with complex physical needs and autism was stuck on a ward for 8 months when the NHS and social care bodies failed to agree on a discharge plan.
The ICB was ordered to pay the patient’s legal fees as well as their own costs – a legal bill estimated at more than £100,000. The real cost in this, and sadly many similar DTOCs isn’t financial. The real cost is to the patient: a vulnerable individual, already in a challenging environment, needlessly kept waiting for almost a year.
Look behind the scenes, and there’s also a human cost to the overworked, under-pressure MDTs based on the disjointed transfer of care process itself, providing these teams with unwieldy, often outdated reporting platforms and slow, manual processes that make efficient discharge and transfer more difficult than they need to be.
How can technology help?
Augnito’s AI speech recognition empowers all healthcare professionals to save time, increase productivity and, ultimately, reduce costs. It was created to play a part in rethinking models and workflows in healthcare, to actively improve the patient journey by making accurate, agile technology available to entire MDTs across Trusts and across primary care. The challenges the NHS continues to face are sizable, constantly evolving, and not easily solved. We believe a way for professionals to work more flexibly, cope with considerable workloads, and focus their efforts on delivering exceptional patient care will be key steps towards a solution.
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