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Hospital discharge delays drop across Lancashire - and hit "impossible" target

There was scepticism that targets to reduce discharge delays in Lancashire could be met.
There was scepticism that targets to reduce discharge delays in Lancashire could be met.
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Delays in hospital discharges across Lancashire fell rapidly during the early part of the summer, raising hopes that the county’s health and social care services will be on a stronger footing going into this winter than last.

So-called delayed transfers of care (DTOCs) dropped by more than 40 percent in the twelve months to June 2018 - and Lancashire is now meeting government targets to reduce the length of time patients spend in hospital unnecessarily. That month, a total of just over 2,700 unnecessary days were spent in hospital by people who were medically fit to leave.

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But the Lancashire County Council area - which excludes Blackpool and Blackburn - is still in a far healthier position than this time last year, when its poor performance put the authority’s share of extra government investment in social care under threat.

The county ultimately kept all of its £25m grant from the the Improved Better Care Fund (IBCF) - and a recent meeting of the Lancashire Health and Wellbeing Board heard that the additional cash was crucial to keeping patients flowing through the system.

“The last year has seen a great improvement in the level of co-operation between health and social care - the IBCF money has provided some impetus for that,” Paul Robinson, Better Care Fund Manager, told board members.

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The board’s chair, County Cllr Shaun Turner, added that NHS and social care organisations should be “buoyed” by their success in meeting targets which many thought were “impossible” when they were published last year.

But there was a warning that the system could not become reliant on the boost to funding, which is due to taper off by 2020. Less than half the amount received in 2017/18 alone is due to be paid out in total over the next two years.

“The extra money which made the difference is non-recurrent money,” Mark Youlton, Accountable Officer for East Lancashire CCG, told the meeting. “We have shown when we knuckle down to deliver things, we can do - but not if the money isn’t sustainable.”

Individual DTOCs are recorded as being the responsibility of either local authority-run social care services or the the NHS - depending on which part of the system has caused the delay.

Figures presented to the board revealed that social care made the greatest contribution to the reduction - cutting hold-ups in arranging things like care packages by 55 percent. The NHS reduced its portion of the delay, including waits for discharge assessments, by 23 percent.

That means the NHS is now responsible for the majority of delays, reversing the position from this time last year.

Mark Youlton said the recent improvements were the result of organisations daring to do something different.

“Because we felt we were all in it together, we didn’t bother so much about bureaucracy - we thought, ‘sod it - let’s have a go and see if it works’,” Mr. Youlton said. “Some of the things we did, like discharge [and then] assess, we had talked about for years - and we just did it. That generated a momentum.”

The board heard that government expectations for DTOC performance in Lancashire were now less challenging. However, there will be a new focus on reducing each patient's overall length of stay in hospital.

Lancashire is now close to the top half a of a league table which ranks local authority areas based on DTOC rates. Last year, it was in the bottom quarter.