Delayed transfers of care peer challenges

The LGA has been asked to deliver a programme of peer challenges focusing on Delayed Transfers of Care (DToC) and Long Length of Stay by the National Better Care Fund (BCF) partners, (Department of Health and Social Care, Ministry of Housing, Communities and Local Government, Local Government Association and NHS England).


The aim is to consider what a health and care system does well and where it can improve its DToC work through a programme of peer challenges that are supportive and based on the Sector Led Improvement approach tried and tested in local government.

A peer challenge is designed to help a system of partners assess current achievements, areas for development and capacity to change. The peer challenge is not an inspection. Instead it offers a supportive approach, undertaken by friends – albeit ‘critical friends’ with no surprises. All information is collected on a non-attributable basis by a team of peers from across health and social care, in order to promote an open and honest dialogue and all advice and guidance is given by the peer team in good faith to help a system improve itself.

As part of the process each system defines a scope that speaks to the issues that all partners face in their area and creates a self-assessment prior to the peer challenge exercise. This gives the peer challenge team a view with which to compare with what they read, hear and see whilst onsite. There was also the completion of a case file audit of those who had experienced the discharge pathways from hospital.

In conjunction with this systems are invited to complete a relational audit questionnaire prior to the onsite phase, to elicit the views of those across the system at all levels as to the major issues, successes and areas that concern them. The feedback from individuals who complete the questionnaire is anonymous and only seen by the Whole Systems Partnership who are the third party organisation who write a short report covering the themes and issues raised. This report helps the peer team to understand the different perspectives in the system and guides their thinking and initial questions in interviews and focus groups.

The programme for the on-site phase includes activities designed to enable the peer team to meet and talk to a range of stakeholders across the system. These activities include:

  • meetings with managers, practitioners, frontline staff and people using services
  • interviews and discussions with organisational staff, councillors and partners
  • reading documents provided by the system including a self-assessment of areas of strength and the challenges they face
  • a case file audit of discharge cases completed independently prior to the onsite work as well as a relational audit

All feedback to the system is done through daily ‘no surprises meetings with the client and a key feature of this work is for the peer challenge team to be heard by the different partners at different levels in the health and care system. It is an assumption of peer challenge that everyone in the system working on DToC should be involved in the scoping, self-assessment, interviews and feedback for the peer challenge.  In this way issues can be aired and solutions suggested that can be heard across the system.

Whilst it is a privilege to be invited in to look at the complex and demanding work of others, it is also a responsibility for the peer challenge team to give honest and helpful feedback based on their own skills and experience that enables the system to continue to help itself to improve.

For further information on this programme of Delayed Transfers of Care peer challenges please contact:

Marcus Coulson
Programme Manager, Local Government Association
Tel: 07766 252 853
Email: marcus.coulson@local.gov.uk