1. Winter Evaluation 2015/16
Sarah Mitchell, Director Social Care Improvement, Local Government Association
June 2016

2. Winter 2015/16 9 regional DToC roadshows 3 DToC masterclasses
ECIP social care leads working with LGA
8 high impact change model

3. Change 1 : Early Discharge Planning
Change 1 : Early Discharge Planning. In elective care, planning should begin before admission. In emergency/unscheduled care, robust systems need to be in place to develop plans for management and discharge, and to allow an expected dates of discharge to be set within 48 hours.
Change 2 : Systems to Monitor Patient Flow. Robust Patient flow models for health and social care, including electronic patient flow systems, enable teams to identify and manage problems (for example, if capacity is not available to meet demand), and to plan services around the individual.
Change 3 : Multi-Disciplinary/Multi-Agency Discharge Teams, including the voluntary and community sector. Co-ordinated discharge planning based on joint assessment processes and protocols, and on shared and agreed responsibilities, promotes effective discharge and good outcomes for patients
Change 4 : Home First/Discharge to Access. Providing short-term care and reablement in people’s homes or using ‘step-down’ beds to bridge the gap between hospital and home means that people no longer need wait unnecessarily for assessments in hospital. In turn, this reduces delayed discharges and improves patient flow.
Change 5 : Seven-Day Service. Successful, joint 24/7 working improves the flow of people through the system and across the interface between health and social care, and means that services are more responsive to people’s needs.
Change 6 : Trusted Assessors. Using trusted assessors to carry out a holistic assessment of need avoids duplication and speeds up response times so that people can be discharged in a safe and timely way.
Change 7 : Focus on Choice. Early engagement with patients, families and carers is vital. A robust protocol, underpinned by a fair and transparent escalation process, is essential so that people can consider their options, the voluntary sector can be a real help to patients in considering their choices and reaching decisions about their future care.
Change 8 : Enhancing Health in Care Homes. Offering people joined-up, co-ordinated health and care services, for example by aligning community nurse teams and GP practices with care homes, can help reduce unnecessary admissions to hospital as well as improve hospital discharge.

4. What has worked this winter
Earlier central government planning starting in September with SoS roundtable
DCLG leadership and support has strengthened Local Government voice 
Learning from winter 15/16 - blame culture doesn't improve performance - changed behaviour at the centre helped change behaviour locally - different tone to follow up conversations 
Recognition that change  takes time - 18 months - starting to see places from last year turn round 
Recognition that DToCs are important SLI issue - sector reputation 
Recognition that LG doesn't benefit financially from DToCs - human and real cost   

5. What has worked this winter continued
Joined up approach - social care experts in ECIP, working with NHSI/E Discharge Programme Board 
Greater understanding of the varied reasons for delayed transfers of care, A&E performance, patient flow - more inquisitive enquiry rather than blame
Revised DToC guidance - has it impacted on this year's increase ? 
Understanding of LG financial challenge - Dom care crisis is not just about commissioning capability
8 High Impact Change Tool - LAs and joint systems have developed plans and it has structured BCF DToC plans
Safer Bundle used by ECIP - systems want more support to embed change
Care providers more engaged in system work

6. Regions
London weekly data collection and ADs group shifting performance
SE and SW investment in High Impact Tool consultants and bespoke work
WM work with NHSE to develop long term change plan
Y and H risk assessment work to identify DToC as major risk and best practice work
Eastern and East Midlands weekly data collection and investment in best practice support - the Leicester model
SW ADs group coordinating social care improvement 
NE consistently good performance

7. What has not worked so well…
SRG leadership remains variable and plans don't connect with BCF plans - need care providers and voluntary sector round the table 
Lack of understanding by people outside the system of the financial pressures on LG and CCGs and the lack of change management capacity
Concentration on short term delivery of performance counters successful change - we can do it properly or we can do it quickly - change fatigue 
Leadership turnover of DASSs - leaders do not understand DToCs and can't see solutions - need master classes using Quick Guides
CHC still being done in hospital - needs to be done at home - risk averse culture
Concentrate on simple discharges - voluntary sector 
Understanding of the Dom care market - low wage economy with high employment in retail and tourism 
Latest thinking and best practice needs spreading but don't lift and shift as it won't work! 

8. 30 LAs with highest delayed days attributable to social care, per 100,000 aged 18+
Region LA
Winter rate
Winter rank NW
Cumbria
1727.1
151
Trafford
1624.5
150
Tameside
1587.7
149 SW
Cornwall
1544.1
148
North Somerset
1361.1
147 WM
Wolverhampton
1290.1
146
Dorset
1072.5
145
Somerset
1058.5
144
Birmingham
1045.6
143 SE
Hampshire
1037.4
142
Solihull
1033.2
141 GL
Hackney
972.1
140
Plymouth
956.4
139 YH
York
948
138
Staffordshire
875.3
137
Warwickshire
867.7
136
East Sussex
864.6
135
Swindon
854.7
134
Oxfordshire
849.7
133
West Berkshire
810.2
132
Walsall
789.2
131 E
Suffolk
779.7
130
Manchester
770.7
129
Bristol
763.6
128
Cheshire East
750.5
127
Dudley
730.5
126
Southampton
721.4
125
Liverpool
699
124
Bury
666.6
123
Brent
661
122

9. 30 LAs with lowest delayed days attributable to social care, per 100,000 aged 18+
Region LA
Winter rate
Winter rank YH
Kirklees
112.8 30 GL
Southwark
112.6 29 NE
Durham
111.6 28 NW
Salford
109 27 E
Thurrock
107.1 26 EM
Leicestershire
106.3 25
Rotherham
105.5 24 SW
Gloucestershire
102.9 23
Bedford
102 22
Nottinghamshire
99.1 21
Newcastle upon Tyne
97.6 20
Central Bedfordshire
89.8 19
Redbridge
89.2 18
Wirral
88.4 17
Havering
88.2 16
Newham
81.5 15 SE
Windsor and Maidenhead
78.1 14
Wakefield
75.9 13
Northumberland
73.4 12
Barnsley
47.3 11
North Tyneside
43.7 10
Leicester
39.7 9
Rutland 33 8
Darlington
31.4 7
Slough
8.6 6
Redcar and Cleveland
7.4 5
Bradford
6.1 4
Hartlepool 1
Middlesbrough
Stockton-On-Tees

10. 30 worst performing Trusts
BARTS HEALTH NHS TRUST
NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST
LEWISHAM AND GREENWICH NHS TRUST
UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST
UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST
NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
EAST AND NORTH HERTFORDSHIRE NHS TRUST
HEART OF ENGLAND NHS FOUNDATION TRUST
WEST HERTFORDSHIRE HOSPITALS NHS TRUST
WALSALL HEALTHCARE NHS TRUST
THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
WYE VALLEY NHS TRUST
COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST
PENNINE ACUTE HOSPITALS NHS TRUST
MID YORKSHIRE HOSPITALS NHS TRUST
HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST
YORK TEACHING HOSPITAL NHS FOUNDATION TRUST
BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST
AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
STOCKPORT NHS FOUNDATION TRUST
WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST
ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST
SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST
ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST
WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST

11. 30 best performing Trusts
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST
FRIMLEY HEALTH NHS FOUNDATION TRUST
ROYAL DEVON AND EXETER NHS FOUNDATION TRUST
SURREY AND SUSSEX HEALTHCARE NHS TRUST
ROYAL BERKSHIRE NHS FOUNDATION TRUST
SHEFFIELD CHILDREN'S NHS FOUNDATION TRUST
AIREDALE NHS FOUNDATION TRUST
LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION
THE DUDLEY GROUP NHS FOUNDATION TRUST
IPSWICH HOSPITAL NHS TRUST
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
BEDFORD HOSPITAL NHS TRUST
MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST
SALISBURY NHS FOUNDATION TRUST
DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST
TAUNTON AND SOMERSET NHS FOUNDATION TRUST
YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST
BUCKINGHAMSHIRE HEALTHCARE NHS TRUST
OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
HARROGATE AND DISTRICT NHS FOUNDATION TRUST
WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST
DONCASTER AND BASSETLAW HOSPITALS NHS FOUNDATION TRUST
CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST
BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST
NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST
SOUTH TYNESIDE NHS FOUNDATION TRUST
NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST

12. National and regional trends
Delayed transfers of care – winter
Data up to March 2016

13. Delayed days over time, by organisation, England

14. Delayed days over time by care, and organisation England

15. Delayed days over time, by reason for delay, England

16. Delayed days over time, by reason for delay, NHS

17. Delayed days over time, by reason for delay, social care

18. Delayed days over time, by reason for delay, both NHS and social care

19. Delayed days over time, by reason for delay, due to both NHS and social care, plus social care alone

20. Regional comparisons

21. Regional picture

24. Social care delays by reason

25. Social care delays by reason

26. Social care delays by reason

27. Social care delays by reason

28. Social care delays by reason

29. Social care delays by reason

30. Social care delays by reason

31. Social care delays by reason

32. Social care delays by reason

33. Contact details
Sarah Mitchell: Director of Social Care Improvement, Local Government Association
Website: