Delayed transfer of care (DTOC) among the older population

Karen Jones Completed   2019


The National Audit Office (NAO) (2016) estimated delayed transfers of care (DTOCs) costs the NHS up to £820 million a year. At a time of financial austerity, the NAO highlighted the need for the care sectors to work together to reduce DTOCs. In addition to financial costs, previous research has found that unnecessarily long stays can lead to an increased need for social care support following discharge, such as requiring help at home. Few studies have explored the relationship between community support (e.g. care home and home care supply) and DTOCs.


This study aimed to bridge the gap in evidence by answering two questions:

  1. Why delays in discharge are (still) happening; and
  2. How they might be reduced or prevented.


The project used quantitative and case study analysis to explore why DTOCs occur and how rates could be prevented or reduced.

The quantitative data analysis used publicly available information to assess: the level of local DTOC rates that cannot be explained by local demand and supply characteristics, and the influence of social care  supply, local discharge processes and urgent and emergency care vanguard on DTOCs, respectively.

Thirty-one discharge teams completed an online questionnaire that explored their local discharge arrangements, with some supplementary information added to the dataset which was available online.

Fifty two professional stakeholders across six case study sites (including operational managers from adult social care and the NHS, members of discharge teams and other key professionals) took part in qualitative interviews in 2018. A case study was a local authority (LA) with associated NHS, voluntary and care organisations, purposively selected to reflect variation in DTOCs, geography and population.

Interviews covered details of teams and processes, strategic issues, perceived causes of delays and facilitators of smooth transfers.


  • Delayed transfers of care were identified that cannot be explained by local authority-level demographic, demand and supply factors
  • The supply of care home beds and home care can help reduce DTOCs
  • The interventions included in the Urgent and Emergency Care (UEC) vanguards have a statistically significant association with lower local DTOC rates
  • Planning for discharge gives more time to set-up care packages that may help to prevent or reduce
  • DTOCs, alongside helping to avoid unsustainable packages of care that can contribute to re-admissions
  • Physically co-locating social care and NHS discharge teams can assist with the visibility of teams as well as communication across disciplines
  • Clear discharge pathways are especially important where there is high ward staff turnover or use of agency nurses
  • Some DTOCs could be due to communication problems between organisational representatives.