1. Everyone counts: working together to tackle Delayed Transfers of Care
HFMA West Midlands 2017:
Competition to Collaboration
Rosanne Furniss June 2017

2. Strictly Private and Confidential
Agenda
Introduction
Working together – what does it mean?
What impact could it have?
Delayed Transfers of Care
A practical step on “How to”
Summary & Questions
15/11/2018
Strictly Private and Confidential

3. Strictly Private and Confidential
Agenda
Introduction
Working together – what does it mean?
What impact could it have?
Delayed Transfers of Care
A practical step on “How to”
Summary & Questions
15/11/2018
Strictly Private and Confidential

4. Strictly Private and Confidential
Working Together
15/11/2018
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5. Strictly Private and Confidential
Why does it matter?
Examples of failure and of success from in and outside healthcare
Bad example – the letters coming round from NHSI
Ask the audience for an example, or a show of hands
15/11/2018
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6. Strictly Private and Confidential
Agenda
Introduction
Working together – what does it mean?
What impact could it have?
Delayed Transfers of Care
A practical step on “How to”
Summary & Questions
15/11/2018
Strictly Private and Confidential

7. The equivalent of 200 people spending the entire year in Hospital.
DTOC
A CLOSER LOOK
WHY IS IT IMPORTANT
The equivalent of 200 people spending the entire year in Hospital.
People in Sheffield have spent 72,000 more days in Hospital over the last year than they needed to.
With a cost to the system of more than £20M.

8. 2 PATIENT PATHWAY WORKSHOPS WITH 50 STAFF
DTOC
A CLOSER LOOK
2 PATIENT PATHWAY WORKSHOPS WITH 50 STAFF
Performance and Biggest Opportunities
200 CASES REVIEWED
Process Analysis
500 DAYS OF PERFORMANCE AND FINANCIAL DATA
Opportunity Matrix and Delivery Plan
2 IN-DEPTH SURVEYS
40+ ONE-TO-ONES
Intensive, 2-week assessment process

9. REDUCING THE UNECESSARY DAYS PEOPLE SPEND IN SHEFFIELD HOSPITALS
DTOC
A CLOSER LOOK
REDUCING THE UNECESSARY DAYS PEOPLE SPEND IN SHEFFIELD HOSPITALS
32% of those impacted by DTOC are waiting for a pathway to be allocated to them.
30% of those impacted by DTOC are on a pathway to either intermediate, nursing and residential care.
31% of those impacted by DTOC are waiting to go home with some extra support.
Source: Weekly DTOC Snapshot Data 04/16-04/17
This is number of days not patients
Over the last 12 months

10. 20% ARE WAITING FOR A BEST INTEREST MEETING
DTOC
A CLOSER LOOK
35%
24% OTHER
OF MEDICALLY FIT PATIENTS REMAIN IN A HOSPITAL BED WAITING FOR THEIR PATHWAY OUT OF HOSPITAL TO BE ALLOCATED.
16%
25% NRP
HOME WITH SUPPORT
BREAKDOWN OF THE 35%
OTHER
60%
20% ARE WAITING FOR A BEST INTEREST MEETING
RELATE TO A THERAPY INTERVENTION
200 cases reviewed

11. 20% ARE WAITING FOR A BEST INTEREST MEETING
DTOC
A CLOSER LOOK 4
OTHER
days
60%
8.5
20% ARE WAITING FOR A BEST INTEREST MEETING
days
RELATE TO A THERAPY INTERVENTION
Days patient waiting

12. 20% ARE WAITING FOR A BEST INTEREST MEETING
DTOC
A CLOSER LOOK
9,400
OTHER
60%
3,500
days
20% ARE WAITING FOR A BEST INTEREST MEETING
days
RELATE TO A THERAPY INTERVENTION
9,400 is around 13% of the total DTOC challenge.
3,500 is another 5%.
Days lost over a year

13. 20% ARE WAITING FOR A BEST INTEREST MEETING
DTOC
A CLOSER LOOK
9,400
OTHER
60%
3,500
days
20% ARE WAITING FOR A BEST INTEREST MEETING
days
RELATE TO A THERAPY INTERVENTION
Reasons given:
Meeting not required but still going ahead either due to lack of understanding the guidelines, or as a safety net.
Lack of forward planning means the long lead-time to set-up is creating a delay.
Reasons given:
Waiting in a bed having completed therapy.
Could have received the therapy somewhere other than an acute setting.
Reasons given provided at workshops.

14. DTOC
A CLOSER LOOK
35% of those impacted by DTOC are on a pathway to either intermediate, nursing or residential care.
54%
45%
of the time, this was due to a reluctance by the decision maker to take a calculated risk with a more ‘independent’ solution.
of these people could have benefited from a different setting of care.
90%
550
The number of extra people that could have gone home with support.
of the time, the best place
for these people was home with some extra support.
3,500
The number of bed days these 550 people would release back to us.
50+ patient cases

15. DTOC
A CLOSER LOOK
ROOT CAUSES
Lack of trust and feeling of fear, both internally and externally
Process centric, rather than a patient centric mindset and system
Complexity –in the array of pathways and change initiatives
History and ‘status quo’

16. DTOC SUMMARY OF SHEFFIELD £ GETTING READY FOR WINTER
A CLOSER LOOK
SUMMARY OF SHEFFIELD
GETTING READY FOR WINTER
4,000+ people impacted each year
14, ,600 bed days could be avoided
£3million+ annualised system wide savings
PEOPLE
OPERATIONS
FINANCIALS
5,000+ people impacted each year
70,000 bed days could be avoided
£22million+ annualised system wide savings
BECOME THE SYSTEM LEADER

17. Strictly Private and Confidential
Agenda
Introduction
Working together – what does it mean?
What impact could it have?
Delayed Transfers of Care
A practical step on “How to”
Summary & Questions
15/11/2018
Strictly Private and Confidential

18. What does it really mean day to day?
Getting it right means that every person or organisation having their own interpretation, not just applying generic findings
Doing this is hard…
Talking in the language of clinicians. How many clinicians understand your job?
15/11/2018
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19. Strictly Private and Confidential
15/11/2018
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20. The Excellence Together programme will ensure that we…
Make consistent decisions about the way we work
Plan to have the right staff in the right place at the right time
Support how we remove unnecessary processes and complications in our day-to-day work
Are consistent in making sure we pay the right amount for what we use, and get paid correctly for the work we do
As one team, we will create the right environment for change

21. The Clinically Led Approach
Today
6 weeks time
Opportunity
Prioritise
Plan
Introduction 1 2 3 4
Blockers and solutions
Data analysis
Identify opportunities
Form teams
Implement improvement cycle
Preparation
Meetings
Clinically-led project streams
Consultant-led project streams
Run meetings
Own metrics
Reporting and governance

22. Strictly Private and Confidential
Model for Change
Source: Efficiency opportunities through health and social care integration
15/11/2018
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23. Strictly Private and Confidential
Agenda
Introduction
Working together – what does it mean?
What impact could it have?
Delayed Transfers of Care
A practical step on “How to”
Summary & Questions
15/11/2018
Strictly Private and Confidential

24. Strictly Private and Confidential
Summary
There are plenty of examples of both success and failure when it comes to working together
In the Healthcare context, working together has huge potential
Looking at DTOCs for example, where busting the myth that all of the issues are caused by social care can open up the potential solutions to have a significant impact on reducing DTOCs
Each area must have it’s own specific and relevant solutions
Working together doesn’t happen overnight, building personal relationships and understanding each other’s roles is a key step
15/11/2018
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25. Demand Better: How will working together change your patients’ experience in future?
Questions?
Rosanne Furniss
Business Manager, Newton Europe