Sheffield, like other areas across the country, has found itself under a lot of scrutiny both regionally and nationally because of its delayed transfers of care (DTOC) performance. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.
In the winter of 2016/17 this reached a point where challenging performance in accident and emergency, and very little flexibility or capacity in the system, meant working relationships were becoming strained and responsibilities unclear.
Support from consultancy Newton Europe, as part of a regional Better Care Support Team approach to improving delayed transfers, helped the area to diagnose system issues and identify changes that could be embedded and sustained, as well as generic lessons that could be shared more widely.
At the outset, the system recognised the importance of celebrating what was already in place, including a single shared vision; a common purpose to always put the patient first; some really strong practice and a shared high desire to improve. System leaders also understood the importance of effective relationships across health and social care, seeing this as the essential foundation for improvement.
The findings of the diagnostic work fed into a system-wide summit, led by the chief executive officers from the council, Sheffield teaching hospitals and the clinical commissioning group (CCG), and from this a clear set of outcomes were agreed, with 10 areas of focus and a clear process for overseeing progress:
Get people home
- celebrate success on every ward
- establish three routes for hospital discharge
- understand perceived barriers to discharge
- increase support to therapists.
Rapid community care
- integrated activity recovery service
- provide a seamless service to patients to improve outcomes and increase productivity
- increase resilience of homecare
- intermediate care beds: improve outcomes and productivity.
Assessment at home
- increase complex discharges via discharge to assess
- restructure assessment capacity to deliver more home-based assessments.
Partners now recognise that they have the resources locally to enable them to deliver the changes, but they also know that it takes a real ongoing commitment to make it happen – with twice weekly face to face meetings now established.
Director of Adult Services
Sheffield City Council