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Tackling delayed discharge key to NHS savings, says Carter


Hospitals must rapidly find ways to reduce delayed transfers of care by taking more responsibility for post-discharge services, according to Lord Carter of Coles.

The Labour peer was speaking ahead of publication this morning of his long-awaited review of NHS productivity, which sets out the detailed steps he argues will save £5bn across the acute sector by 2020.

“Some areas are now… sort of taking their own fate in their own hands”

Lord Carter

The wide-ranging recommendations touch on almost every aspect of the hospital sector, from clinical workforce management, to procurement, to administration and corporate costs.

But in an interview with Nursing Times’ sister title Health Service Journal, he warned that a “significant proportion” of the estimated £5bn savings in the acute sector “cannot be unlocked” unless delayed transfers are managed more effectively.

Lord Carter said his work initially focused on ways that hospitals can reduce costs, but he soon realised that delayed transfers were a crucial part of the picture. He found many cases in which trusts were losing revenue due to cancelled elective operations, and salaried clinicians were left “sitting around”.

The blocked beds also resulted in work going out to the independent sector, for which NHS provider expenditure increased by about a third last year, to £482m.

He said hospital trusts should be “taking their own fate into their own hands” by taking responsibility for, or contributing to, the post-acute phase of care. He suggested accountable care organisations, currently being tested in some areas, could ensure the financial incentives are better aligned.

Lord Carter

Lord Carter

Lord Carter

Asked whether hospitals could realistically tackle delayed discharges given the funding cuts to social care services, Lord Carter said: “A number of hospitals are saying ‘we’re going to contribute to stepdown care and we’re going to contribute to the post-acute phase so we can clear the beds, [because] it’s in our total self-interest’.

“In some areas they’re working well with local government and social services. They’re saying we’ll pay for some of this, and some areas are now moving towards building, with the independent sector, stepdown care facilities and sort of taking their own fate in their own hands,” he said.

His report cited Mid Yorkshire Hospital NHS Trust, which recently opened a 42-bed stepdown facility in Pontefract, as well as the Dudley Group NHS Foundation Trust, which has halved the days spent in hospital by fit to discharge patients by working with care broker CHS Healthcare, as examples of successful schemes.

His final report, Operational Productivity and Performance in English NHS Acute Hospitals: unwarranted variations, estimates that about 8,500 acute beds are “blocked” each day in the acute sector, costing NHS providers around £900m per year.



Readers' comments (2)

  • At last! A light bulb moment?Better late than never.
    We pioneered step down beds in a South of England Trust 15 years ago. We recognised that the wheels of an acute hospital turn much faster than the wheels of rehabilitation and recovery for frail or those less able of our communities. To ensure patient safety on discharge when setting up complex packages of care with Adult SS, patients need to be safe to transfer home. Communication channels and immediate access/ referral back through the responsible consultant was agreed with Primary care teams. Despite being positively evaluated in terms of quality and safety for patients, concurrent with a reduction in both transfer delays and costs for the acute hospital, they were closed due to withdrawal of winter pressures funding. If introduced as a multiagency initiative, sharing the cost, they foster strong partnership working which is definitely patient centric.

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  • I think you'll find many trusts had 'step down' units but they closed them all to save money!

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