Nathan Hollow

Board Director - Head of Health and Social Care - Head of South West


As winter approaches, all eyes are focused on the need to reduce Delayed Transfers of Care (DTOC) to free up much needed acute bed capacity within the NHS.

The latest figures, released in October, showed there were a total of 180,100 DTOC days lost within the NHS in August 2017, a reduction of just 4% on August 2016.  Health Secretary Jeremy Hunt and Communities Secretary Sajid Javid subsequently wrote to councils, warning that NHS England would “take action” if they failed to deliver their reduction targets before the winter.

Yet, those targets are exceptionally onerous. Analysis by the County Councils Network (CCN) suggests rural councils need to achieve an averaging 43 per cent reduction in DTOCs before winter – double that of London.

Such pressure has led some areas to consider implementing some eyebrow-raising proposals – for example, the suggestion last week that homeowners, without medical experience, could be paid £1,000 per month to look after patients being discharged from hospital. The Southend University Hospital and CareRooms proposal was an innovative, if arguably flawed, proposal. Having been widely critiqued by politicians of all parties, the hospital has subsequently pulled out of the trial.

But what remains on the table is a proposal to pay bed and breakfast owners to take care of recuperating patients to free up hospital beds. This weekend, Health Minister Philip Dunne refused to rule out moving forward with this proposal, noting that it could be “workable” if B&B owners had “relevant experience” in healthcare.

Whilst it is absolute right to consider any innovative proposal that could help resolve the challenges facing our NHS, I’d be rather surprised if there were many B&B’s around the country that are run by former doctors and nurses.

A much better and far more workable solution would be to utilise bed capacity within care homes, community facilities that are already staffed around the clock by trained care professionals. If properly funded, such a scheme would free up much-needed capacity within hospitals, reduce NHS costs by replacing expensive acute beds with more cost-efficient care home places, and help diversify revenue streams for care providers, aiding financial stability in the sector.

Such a plan was proposed last year by the think tank Respublica, and backed by the five largest care providers, the GMB Union and the Chair of the Commons Health Select Committee.

The proposed ‘Fast Track Discharge Fund’ could save an estimated £2.4bn over five years – coincidentally, roughly equal to the anticipated shortfall in social care funding by 2021/22. The plan would provide better health outcomes for patients, strengthen the financial position of the social care system, and free up existing money that could be used to plug the wider systemic funding shortfall. In these times of winter crisis, such a scheme should be urgently reconsidered.

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