While Delayed Transfers of Care (DTOCs), bed shortages, and needless hospital stays negatively affect every patient, the NHS still has a responsibility to pay special attention to the most vulnerable people in our society. But, given the nature of acute hospital beds and potential transfers to social care, the frail elderly and sick children make up a considerable part of the pressure that the NHS faces in handling its current backlog of more than 7 million people waiting for treatment.
In an effort to improve collaboration between disciplinary teams, the NHS has been taking steps to rectify the specific challenge focussed on the vulnerable and . Between 2013 and 2015, 25 integrated care pioneer sites were selected by the NHS to develop and test new ways of joining up health and social care services across England. In 2015, 50 vanguards were chosen to lead the development of new care models, becoming blueprints for the wider NHS moving forward and the inspiration to the rest of the health and care system moving forward.
Through the new care models programme, a complete redesign of whole health and care systems was being considered. That care model was to take into account improving care not simply for older people, but with a focus on frailty vs. age and the differing needs of our ageing population. An ageing population that is living longer and presenting with more complex illnesses that require complicated care. At the same time, similar complexity can be found in a vulnerable group at the other end of the patient age spectrum – the young (children). These factors compound today’s NHS bed shortages, understaffing, burdened workflows, bottlenecks and burned-out clinicians and nurses. They also add to the DTOC problem.
While DTOCs can occur for a wide variety of reasons in the patient journeys of the above two mentioned vulnerable groups, data shows significant challenges in bed capacity, particularly for children. For older patients, awaiting care packages in their own home or nursing home availability are among the most common causes. Meanwhile, Multidisciplinary Teams (MDTs) have a pivotal role to play in enabling seamless journeys, without being limited by inaccurate patient reports, loss of reports, and delays in information sharing (a topic we’ll go into more detail in our next blog post).
In this post, we focus on how DTOCs affect the vulnerable most frequently and how speech recognition technology could help improve this situation to deliver a more consistently available level of care and, ultimately, improve outcomes.
Treating severely ill children
Recent data from Nuffield Trust examined the impact of NHS pressure on children, looking specifically at intensive care beds across the challenging winter period.
According to the report, December 2021 saw just 314 beds per day across the whole of England. While this was marginally higher than availability in previous winters, occupancy was higher too. On average, 89% of these beds were occupied, leaving just 35 beds available to new admissions.
This is by no means the direct consequence of DTOCs and patients failing to be transferred or discharged appropriately. But, it is a sign of a healthcare system in crisis, dealing with peak demand and increased instances of flu, scarlet fever and Strep A with little room to manoeuvre. Bed stocks have been reduced to an extent where any unexpected demand – or delay – could have disastrous consequences.
DTOCs and older patients
For older frail patients, effective care takes a seamless approach between the NHS, community services, and social care providers. It is often these cases where the discharge and transfer process is most complex, requiring collaboration between multiple parties and effectively prioritising what are often multifaceted, intricate needs.
According to a study in Age and Ageing, Volume 50, Issue 4, the average cost to the NHS of DTOCs in older patients was £820 million each year. However, the study highlights the importance of keeping patients central, even where most data gathering is focused on wasted costs.
The reality is that DTOCs aren’t just a cost centre. They create a ripple effect across our entire healthcare system – and out into the lives of patients and our wider communities. Reducing wasted costs is simple: discharge patients faster and more effectively – that’s just one part of the story.
For older patients – and patients of any age – the discharge and transfer process is a key part of their experience. Delays create distress and negatively impact healthcare outcomes. And the knock-on implications of bed shortages, soaring occupancy, and unavailability of care, tend to lower standards across the entire system.
The human cost of DTOCs and bed shortages
At the end of 2022, Landmark Chambers reported on a specific judicial review of an individual Integrated Care Board (ICB). A patient with complex physical needs and autism was stuck on a ward for 8 months when the NHS and social care bodies failed to agree on a discharge plan.
The ICB was ordered to pay the patient’s legal fees as well as their own costs – a legal bill estimated at more than £100,000. The real cost in this, and sadly many similar DTOCs isn’t financial. The real cost is to the patient: a vulnerable individual, already in a challenging environment, needlessly kept waiting for almost a year.
Look behind the scenes, and there’s also a human cost to the overworked, under-pressure MDTs based on the disjointed transfer of care process itself, providing these teams with unwieldy, often outdated reporting platforms and slow, manual processes that make efficient discharge and transfer more difficult than they need to be.
How can technology help?
Augnito’s AI speech recognition empowers all healthcare professionals to save time, increase productivity and, ultimately, reduce costs. It was created to play a part in rethinking models and workflows in healthcare, to actively improve the patient journey by making accurate, agile technology available to entire MDTs across Trusts and across primary care. The challenges the NHS continues to face are sizable, constantly evolving, and not easily solved. We believe a way for professionals to work more flexibly, cope with considerable workloads, and focus their efforts on delivering exceptional patient care will be key steps towards a solution.
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With the NHS under immense pressure, bed stocks are infamously limited. However, this pressure shows no signs of slowing – and the number of beds across the NHS shows no sign of growing in a way that’s substantially impactful. What other approaches can we take to address this major challenge and, crucially, how can technology help?
From healthcare professionals to the general public, most of us are intimately familiar with the continued lack of beds in our healthcare system. Even pre-pandemic, few health experts felt we were well equipped with beds and ample resources. Now, the BMA continue to stress the severity of this problem: data from December 2022 reports occupancy rates consistently exceeding safe levels and call capacity a ‘critical limiting factor’ for the NHS.
Beyond those early adopter areas like radiology and pathology, speech recognition technology has the potential to reduce costs across entire Trusts – potentially freeing up resources to invest in new ways to grow capacity and bring occupancy down to reasonable levels.
The impact of DTOC on bed capacity
Recently, in our previous blog post, we wrote about the significant challenge of Delayed Transfers of Care (DTOCs) – those periods when a patient is ready to be discharged from an acute care bed but remains in the bed regardless. Typical bottlenecks and obstacles to discharge/transfer include:
- Awaiting completion of assessment, including incomplete documentation
- Awaiting care packages
- Awaiting nursing home placement
- Awaiting community equipment and adaptations
- Awaiting further non-acute NHS care
- Awaiting care packages in own home
- Disputes and legal challenges
Across all these areas, faster documentation and reporting time can help keep people moving along the patient journey. If not, DTOC dramatically worsens the problem of poor bed stocks and low capacity.
Every day a patient stays in an acute care bed unnecessarily, beds remain unavailable to those who need them. While this is obviously a barrier to delivering timely, effective treatment and care, it also creates unnecessary cost.
The costs of a widespread bed shortage
Bed shortages, driven by needlessly extended hospital stays and DTOCs, lead to significant costs to the NHS. This is a wasted expense that does nothing to improve patient journeys, experiences, and outcomes.
In February 2020, DTOC metrics reported by the GSS show on average 5370 people were delayed per day. The actual cost of these delays is significant by any measure. According to Age UK, in 2019, the cost of a DTOC bed per day was £346. whereas Department of Health figures from 2017 put the cost at £400 per day. Even if we assume the NHS’ own £350/day cost was accurate in February 2020, this means that month’s cost for 155,700 days was over a staggering £54 million.
An effective, accurate speech recognition technology like Augnito can reduce this cost and deliver a considerable saving by enabling clinicians and healthcare professionals to work and report more efficiently, removing some of the above mentioned common obstacles to prompt discharge or transfer. And the cost of adopting Augnito is significantly less than the cost of adding and maintaining more beds.
Repurposing even just 5% of February 2020’s estimated DTOC cost into Augnito licences could empower tens of thousands of clinicians to work more efficiently, reduce reporting time, and focus their energy on patients. Even a seemingly small 1% efficiency gain could dramatically improve both staff workloads and, more importantly, patient journeys overall.
Addressing the consistent fall in NHS beds
Over the past three decades, the total number of NHS hospital beds in England has more than halved. In part, this reflects changes to the ways patients are treated and is a trend we can see reflected in other advanced healthcare systems. For example, an increase in day surgery and long-term policies to move patients into care in the community have partly driven this ongoing reduction in capacity.
Of course, we all know that demand hasn’t followed this proposed downward trajectory. While the number of beds may have decreased, the number of patients treated has continued to rise sharply. Today, the UK has fewer acute beds relative to its population than most other European countries.
Worse, the longer-term outlook is bleak. The Health Foundation’s REAL Centre analysed bed stocks against best-case demand and found a significant gap. According to the report, 35% more beds will be required by 2030 – even if NHS initiatives to reduce hospital stay durations succeed. Apply the estimated DTOC rates we’ve shown above and the cost skyrockets.
The impact of speech recognition on efficiency and cost
As the NHS has consistently found for more than three decades, expanding bed stocks isn’t a simple task. Capacity is a complex issue and, as demand continues to surge, occupancy rates of 99% and above aren’t likely to improve without significant change.
It’s not that technology like Augnito AI powered speech recognition can solve the DTOC challenge overnight. It’s that incremental improvements to the way healthcare professionals work, collaborate, and share information creates consistent improvements over time. Eliminating the slow reporting and typing into cumbersome, often outdated systems saves time, reduces costs, and enables budgets to be repurposed into wider, systemic changes.
Augnito is already used widely across healthcare, helping those in diagnostic and reporting roles capture clinical data quickly, securely, accurately, and more cost-effectively. Crucially, Augnito’s flexible licensing means it’s available to Trusts for a fraction of the cost of adding capacity or keeping patients in beds for longer than they need them.
For Trusts, this creates time and money savings with a compound effect. The ease of implementing Augnito across multiple individuals, departments and parts of the patient journey means even small efficiency gains for healthcare professionals create a significant, meaningful saving overall. The facts speak for themselves: the cost of a single extra bed per day is close to if not 10 times more than the cost of a single Augnito licence for a month.
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Augnito is already quietly and positively impacting the patient journey and the continuum of care in primary and secondary care. Talk to us to find out more or request an evaluation version / Augnito app to see how it could help you.