A blog from David Maguire, LGA Senior Research and Data Analyst, on winter pressures
“Data” is a scary word to a lot of people. It can send chills down the spine faster than the cold weather this time of year.
There’s been a lot of changes to the data that’s collected and published around discharge from the hospital sector over the last four years. In March 2020, the previous Delayed Transfers of Care collection was suspended alongside a number of other datasets to reduce the administrative burden on the hospital sector at the onset of the COVID-19 pandemic. There was no nationally published data on the subject for a number of years, until the beginning of the Discharge Delays dataset from NHS England in August 2023.
That’s made it hard to keep track of how well the sector’s been discharging people from hospital settings. It’s also created a lack of transparency around decision-making when central bodies choose where to direct their efforts when managing performance in the sector.
It's this sense of confusion that leads to me making the following statement: delayed discharges aren’t as bad in winter in the NHS compared to the rest of the year.
That’s an oversimplification, but let me explain. There are some myths about what the winter period looks like in health and social care: “Things at A&E get so much busier”; “There’s so much more pressure on the system” are common things to hear this time of year.
Those are both perfectly fair things to say when you see queues of people waiting at A&E for admission or in a ward waiting for discharge, but the winter period each year actually sees fewer people attending A&E than the summer.
Why do we use words like “busy” then? Because there are more admissions via A&E in the winter than in other seasons.
In winter the number of people with a significant ambulatory condition like COPD, CVD, etc. attending A&E increase. This typically leads to a higher rate of avoidable admissions, as these conditions could be managed within the community if care is provided.
That point about beds filling with delayed discharges in winter? There were actually fewer delays in the winter of 22/23 than that summer and a slower rate of increase in winter 21/22 than summer 21/22.
That was an especially big problem because the spring and summer is usually when the sector recovers its performance before winter pressures kick in. In effect, what we’ve seen over the last couple of years through winter isn’t just the usual pressures, it’s the after-effects of a “summer wave”. The good news is that the figures for 23/24 look more like the typical seasonal trend, with delays falling in the summer (1.39m total bed days where length of stay was 14 or more days) and autumn (1.46m total bed days where length of stay was 14 or more days) of 2023 relative to the first quarter of the year (1.6m total bed days where length of stay was 14 or more days).
We know there are delays, but where are they coming from? Delays related to the longest stays in hospital are typically more likely to be associated with delays in social care throughout the year. Shorter lengths of stay with a delay are more likely to be related to hospital based, such as issues with arranging transport, awaiting medicines, etc.
In the past, these figures have been used in less than helpful ways, with debates focusing on blame rather than improvement. With the current collection, that improvement work becomes even more difficult, as it’s hard to track those delays related to short-term stays. Changes are being made to the dataset, based on the addition of the person’s discharge ready date to the data recorded as part of each admission. You can expect a blog from us about those changes soon.
What advice would we give you about using data to inform your operations in winter? You can see a more detailed breakdown of things in my full presentation from last year (if you’re a member of the Future NHS Better Care Exchange platform), here are the headlines:
- Get the data ready for you and you ready for the data: Sort through data debates and improve access and visibility- we often talk about getting a “single version of the truth”, but this can also be used as a blocker for more progressive engagement. If there isn’t agreement about transformation need, there’s no need to have difficult discussions about resource allocation.
- Look at more than just discharge: We know that there are more admissions now for fewer beds than 15 years ago. This is about flow overall and that means keeping sight of admissions as well as discharges.
- Who’s looking at the data? Who’s allowed to look at the data? Are care partners, housing providers or VCSE sector partners around the table at escalation meetings? Does everyone understand the collective position within the system?
- Respect each other and the fact you might be wrong: I’m only comfortable writing this blog and trying to give advice because I’ve made mistakes when interpreting data and by being challenged in my assumptions about operational issues. We can often make false assumptions about what data tells us because our understanding of it is wrong, or our definitions are different. Linked to this is a need to often work against organisational interest and give ground to others. That helps build trust that pays off over the rest of the year, not just in the difficulties of winter.