A delayed transfer of care (DTOC) (formerly known as a delayed discharge) is a patient who has been deemed clinically fit for discharge from an acute bed but whose discharge is delayed because they are waiting for some form of on-going support or care following their discharge.
Our hospitals, emergency departments in particular, are under ongoing pressures with regard to demand for services. My Department is committed to progressing measures in the short, medium and longer term to deal with this issue and its underlying factors. There has been a sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital sooner. Over the years additional funding has been provided for home supports, for transitional care, for the Nursing Homes Support Scheme, for aids and appliances and to provide increased capacity in both the acute and community settings.
This year, services are being stretched more than ever, with demand consistently outstripping supply and over the last number of weeks we have seen significant increases in delayed transfers of care. While the HSE maximises the use of resources, prioritising those requiring discharge from acute hospitals, there is a growing demand for egress support.
The Department of Health is engaging extensively with the HSE in the context of planning for winter, including the response to the current challenge. An additional €26m has been made available for the last quarter of 2019 to support the hospital and community system to improve patient egress. The investment is supporting home support and transitional care as well as keeping the waiting time for access to support under the Nursing Homes Support Scheme (NHSS) at 4 weeks to the end of the year. The HSE were authorised to take immediate action in that regard last month, and released significant support to over 700 people to take up places under the NHSS and over 300 transitional care bed approvals. My Department is continuing active engagement with the HSE with regard to planning for the winter ahead.
Under Budget 2020, the Government has made improved access to home support services a priority. We have committed to an additional investment of €52 million in Budget 2020 to bring the total funding for home supports to €487 million in 2020. In 2020 the HSE will deliver over 19.2 million hours of home support, representing a substantial increase of 1 million hours more than this year’s target.
This investment is focused on enabling older people to remain at home and, as appropriate, provision of hours will also be targeted at times of peak demand in Winter 2020, at the beginning and end of the year, to ensure more timely egress from hospital for our older citizens. Over the last two years, an additional €45million has been provided to the Nursing Homes Support Scheme budget. In 2020, the NHSS will see a further investment into its budget of €45 million, bringing its total annual budget to €1.03 billion.
While I am mindful of the present pressures and challenges, there is a need for longer term planning and action. Last year I established an expert working group to carry out an independent expert review of delayed transfers of care. The review was established in recognition of the need to identify focused actions that will ensure that older people who are fit for discharge from hospital are supported to return to their homes and communities as early as possible. The Group reported its findings in November 2018.
The review recognised that delayed transfers of care are caused by a multitude of factors and it made nine recommendations which include the development of a national policy to provide for a more consistent approach to recording delayed discharges, strengthening data collection, standardising definitions and ensuring consistent discharge guidelines. The report underlines the importance of hospitals and communities working together to improve patient flow. This is in line with the overall direction of an integrated care approach, expanding community-based care to bring care closer to home, as outlined in Sláintecare.
I subsequently requested the HSE establish an appropriate multi-disciplinary structure to progress implementation of the recommendations. Arising from this a HSE Implementation Group has been established. I have also established and chair a Cross Divisional Oversight Group within the Department of Health to oversee the HSE’s implementation of the recommendations. Work is progressing well and last month the HSE hosted a collaborative learning event amongst staff to assist with the development of medium to long-term solutions.