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of hospital admission amongst older people and often trigger admission into longer

term care. Falls lead to debilitating injures, loss of confidence, independence". It

also noted an "extensive evidence base for intervention to prevent falls".18 Despite

this evidence, however, a survey by the Royal College of Nursing revealed that 70

per cent of people who had been seriously injured following two or more falls in

the past year reported that their doctors or nurses had not tried to understand the

underlying causes of past falls.19

Finally the 'always open' nature of acute care has a significant contribution to

avoidable admissions. The Select Committee on Public Service and Demographic

Change notes that the health system "fails outside working hours on working days.

People go by default to a hospital because it is the only part of the system that is

open 24/7".20 The inaccessibility of primary care during evenings and weekends

is also one of the key reasons why so many calls to the 111 service are directed

towards acute care. This has been accentuated by longer waiting times to see

GPs-in 2014 the Royal College of GPs estimated that a total of 58.9 million

patients in England have waited a week or more for a consultation.21

The causes of delayed transfers of care are many and varied, with the case for

discharge not always clear-cut. Causes include:

• Awaiting completion of assessment

• Awaiting public funding

• Awaiting further non-acute NHS care

• Awaiting nursing or residential home placement

• Awaiting a care package in their home.22

Data released in 2013/14 by NHS England show that 69 per cent of delayed days

in all NHS care settings were attributable to the NHS, 25 per cent attributable to

social care organisations and 6 per cent a combination of both. Patients awaiting

further non-acute NHS care was the main reason for the highest proportion of

delays in 2013/14, accounting for 21 per cent of all delays.23 It also should be

noted that in the last four years the proportion of delayed days attributable to the

NHS has risen 9 per cent whilst for social care it has fallen 8 per cent leading the

King's Fund to comment that councils have "generally done a good job for the NHS

in supporting people to leave hospital".24

What is clear, however, is the huge financial cost of delayed transfers to the NHS.

The number of delayed patient discharge days from all NHS care settings has risen

300,000 in the last year alone from 1.38 million in 2012/13 to 1.41 million in

2013/14.25 62 per cent of these delays in 2013/14 took place in an acute care

setting. Based on an estimated bed day cost of around £30026 these delays in

2013/14 in acute care alone equate to costs of more than £250 million per year.

Age UK reported that in 2013/14 patients were remaining in hospital on average

30 days longer than necessary (and one day longer than 2010) to be transferred to

residential care although this figure is disputed by the Department of Health.27 And

with a bed in an NHS hospital estimated to cost about £1,900-a-week compared

to £530-a-week typically charged by residential homes, it is clear how greater

integration could reduce inefficient spending. So it is not surprising that a King's

Fund report found delayed transfers of care to be the second biggest concern for

NHS trust finance directors, especially given that the number of delayed patient

discharge days is expected to rise further to 1.5 million in 2014/15.28

Clearly this problem is well recognised, and successive Governments have tried

various approaches to tackle it. For example, the Care Act 2014 provides that

if a local authority, having received a discharge notice from a NHS body, has

not carried out the relevant care and support assessments or put the required

18 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

19 Royal College of Nursing, Safe

staffing for older people's wards

(2012)

20 Annex 13: Health and social

care, Select Committee on Public

Services and Demographic

Change, Ready for Ageing?

(2013)

21 Campbell, D "Patients' waiting

times on NHS 'a national

disgrace' - GP leader", The

Guardian (26 September 2014)

22 NHS England, Delayed transfers

of care statistics for England

2013/14 (May 2014)

23 NHS England, Delayed transfers

of care statistics for England

2013/14 (May 2014)

24 Humphries, R, "The NHS needs

more money - but social care

does too" (4 December 2014)

25 Williams, D "Exclusive: Delayed

transfer rate soars to highest

level" (18 November 2014)

26 Williams, D "Exclusive: Delayed

transfer rate soars to highest

level" (18 November 2014)

27 Age UK, "Nearly 2 million NHS

days lost to delayed discharge"

(11 June 2014)

28 Campbell, D "Social care

problems lead to hospital bed

blocking, says Age UK" (11 June

2014)

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