Information Services A Division of NHS National Services Scotland Contents Page Introduction and background.. 2 Summary of Key Points.. 4 Commentary. 6 Tables 1 Numbers, median and mean duration; by principal reason. 9 2 Numbers by NHS Board area of treatment and principal reason 10 3 Numbers by Local Authority Partner and principal reason 14 4 Numbers by NHS Board area of treatment and duration of delay 18 Charts 1 Numbers by Principal Reason and census.. 8 2 Numbers by duration (weeks) 20 3 Numbers by Specialty group.. 20 4 Numbers by Age Group and Principal Reason 21 5 Numbers by Principal Reason and duration of delay.. 21 Appendices 1 Basic Approach 22 2 Definitions & Terms. 23 3 Data Quality.. 25 4 Census Dates 26 5 Supplementary Items. 27 6 Effect of change in definition 29 Acknowledgements.. 30 Future publication and further information 30 release http://www.isdscotland.org/delayed_discharges health briefing number 06/03 issued August 2006 For further information please contact Caroll Brown 0131 275 6099
Introduction and background About this report This publication summarises the results of patients ready for discharge from a snapshot of NHS inpatients as at the July 2006 census. There have been some changes in the definition, and recording of the data, which has resulted in changes to the presentation of this report. These changes are detailed below. Note also that delayed discharges for the old Argyll and Clyde Health Board are now shown in two parts headed Argyll (NHS Highland) and Clyde (NHS Greater Glasgow). It is planned that this will continue until the April 2007 report. ISD Scotland, in conjunction with the Scottish Executive and health and local authority partners at local level, has been reviewing the definition of what constitutes a delayed discharge. We have also been assessing how best to present this census data. All of the changes outlined below have been the subject of a wideranging consultation and have been agreed by the National Advisory Group on Delayed Discharges Information. In some instances the revisions have been made to reflect the introduction of revised Scottish Executive targets. Patients delayed due to awaiting place/bed availability in a specialist residential facility where no facilities exist (codes 24DX, 24EX and 42X), or due to requirements of the Adults with Incapacity Act (code 51X) are already reported separately. These patients will continue to be reported separately; but will now be categorised under Complex Needs (code 9). These codes will now operate as secondary reason codes to Complex Needs. From July 2006, cases where partnerships are unable, for reasons beyond their control, to secure a patient s safe, timely and appropriate discharge from hospital will also be shown under the category Complex Needs but with no secondary code. These cases were previously included in the census totals but are now reported separately, at the time of the July 2006 census there were 5 in total. Directors of Social Work, NHS Board Chief Executives or their nominated representatives have reported these cases formally to ISD and the Scottish Executive. All Complex Needs cases are reported separately as a supplement to this report [see Appendix 5]. Effect of the changes From the July 2006 census patients whose clinical readiness for discharge has only been ascertained the 3 working days or less preceding the census date have been omitted from the census totals, these patients are now categorised as Zero delay cases. At the time of the July 2006 census this affects 116 cases. From the July 2006 census patients who have a planned discharge and an agreed discharge date 3 working days of the census have been omitted from the census totals. At the time of the July 2006 census this affects 51 cases of which 22 were over 6 weeks. Principal reason code 33 (change in patients health circumstances i.e. patient too ill at the time of the census to be discharged) was previously reported on separately in the report. From the July 2006 census the definition of a delayed discharge has been amended to exclude such cases and census reports are being adjusted accordingly. Based on the four quarterly Census reports for the period July 05 to April 06, the average number of patients being reported on separately due to a change in health circumstances was 20. This change has no effect on the numbers of delayed discharges reported in the main report. page 2
About patients ready for discharge For most patients, following completion of health and social care assessments, the necessary care, support and accommodation arrangements are put in place in the community without any delay in the patient s safe and appropriate discharge from hospital. A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave the hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available, to purchase a care home place, for example. Patients Ready for Discharge data has been collected nationally since September 2000 according to national standard definitions and data recording criteria laid out in Management Executive Letter (MEL)(2000)07. issued in February 2000 by the Scottish Executive Health Department (SEHD). The national definitions allow for a consistent approach to a patient being considered ready for discharge i.e. the patient is clinically ready to move on to the next stage of care. For most Local Authority Partners there is an accepted period beyond the clinically ready for discharge date during which all assessment and follow-on arrangements are put in place. The common period for local discharge planning is six weeks. From the April 2004 census the report focuses mainly on those patients who have been ready for discharge for more than six weeks at the time of the census [see Appendix 2]. A separate report has been produced showing information at Local Authority Partner level. page 3
Summary of Key Points Note that changes have been made to the definition of patients ready for discharge. It has not been possible to identify the effect of these definitional changes retrospectively, so the comparisons below are with figures previously published, and may therefore in some instances overstate reductions or understate increases. [For further information see the introduction to this report and Appendix 6]. The number of patients ready for discharge in Scotland who had been ready for discharge for over six weeks at the time of the July 2006 census has increased from the April 2006 census. There were 627 cases at the July 2006 census compared with 498 at the April 2006 census, and 753 at the July 2005 census. At the July 2006 census, there were a total of 1,243 patients ready for discharge in Scotland, compared with 1,046 at the April 2006 census, and 1,465 at the July 2005 census. The number of patients delayed for one year or more has decreased from the April 2006 census. There were 17 cases at the July 2006 census, compared with 19 at the April 2006 census, and 15 at the July 2005 census. The median duration to the census point for all patients ready for discharge was 43 days (39 days at the April 2006 census, and 44 days at the July 2005 census), while the mean duration was 71 days (69 days at the April 2006 census, and 70 days at the July 2005 census). Of the number of patients ready for discharge for more than six weeks 75% were 75 years of age and over. The number of patients ready for discharge at any point in time can be viewed as part of a dynamic process of discharge planning. For example, it is estimated that 64.5% of those patients who had a duration of six weeks or more (the common discharge planning period) at the April 2006 census had been discharged by the July 2006 census. The table below presents numbers of patients ready for discharge by reasons for delay*: - April 2006 census July 2006 census Reason for Delay (by group) six weeks Total six weeks Community Care Assessment reasons 70 339 71 350 Patients waiting to go home 54 111 66 135 Awaiting funding for a care home placement 69 104 62 101 Awaiting place availability in a care home/specialist 220 340 330 483 residential facility Healthcare Assessment/Arrangements 8 48 15 57 Patient exercising statutory right of choice** 46 62 38 52 Legal/Financial 15 19 22 28 Other*** 16 23 23 37 *The reason for delay is the patients reason for delay as at the census point. **Where principal reason is patient exercising statutory right of choice, a secondary reason is recorded indicating the destination over which the right of choice is being exercised (e.g. awaiting nursing home place availability). ***Other includes Disagreements; Other patient/carer/family related reasons excluding patient exercising statutory right of choice; Community Care Arrangements (no additional detail); awaiting completion of social care arrangements (no additional detail); Principal reason not agreed; and Principal reason not recorded. Total page 4
12 NHS Boards reported an increase in the number of patients ready for discharge the six week discharge planning period between April 2006 and July 2006. 2 NHS Boards reported a decrease and 1 NHS Board reported no change. [See Table 2]. Note that for the purpose of this comparison we have used the NHS board structure as reported at April 2006. 23 Local Authority Partners have shown an increase between April 2006 and July 2006 in the number of patients ready for discharge the six week discharge planning period who were considered to have social work involvement. 8 Local Authority Partners have shown a decrease and one Local Authority Partner has reported no change. The overall number of patients ready for discharge the six week discharge planning period who were considered to have social work involvement in the discharge planning process has increased (612 at the July 2006 census compared with 490 at the April 2006 census). [See Table 3]. The number of patients the six week discharge planning period in the Community Care Assessment reason category has increased slightly (71 at the July 2006 census compared with 70 at the April 2006 census). The number of patients the six week discharge planning period who were waiting to go home has increased (66 at the July 2006 census compared with 54 at the April 2006 census). The number of patients the six week discharge planning period who were awaiting funding for a care home placement has decreased slightly (62 at the July 2006 census compared with 69 at the April 2006 census). The number of patients the six week discharge planning period who were awaiting place availability for a care home/specialist residential facility placement has increased considerably (330 at the July 2006 census compared with 220 at the April 2006 census). The number of patients the six week discharge planning period who were in the Healthcare Assessment/Arrangements reason categories has increased (15 at the July 2006 census compared with 8 at the April 2006 census). The number of patients the six week discharge planning period who were exercising statutory right of choice has decreased (38 at July 2006 census compared with 46 at the April 2006 census). The number of patients the six week discharge planning period in the Legal/Financial reason categories has increased (22 at the July 2006 census compared with 15 at the April 2006 census). The number of patients the six week discharge planning period in the Disagreements reasons has increased (17 at the July 2006 census compared with 11 at the April 2006 census). page 5
Commentary General The information on patients ready for discharge contained in this report is derived from a series of quarterly censuses and should be interpreted with care. As described in the introduction all ready for discharge arrangements across Scotland reflect a variety of local factors, including local joint care agency discharge planning agreements. These factors should always be taken into account when making statistical comparisons. The State Hospital data has been excluded from all analyses, as the special circumstances attached to the patient group make the data distinct from the rest of Scotland. Note that changes have been made to the definition of patients ready for discharge. It has not been possible to identify the effect of these definitional changes retrospectively, so the comparisons below are with figures previously published, and may therefore in some instances overstate reductions or understate increases. [For further information see the introduction to this report and Appendix 6]. Table 1 Numbers, median and mean duration by principal reason The reason information shown represents the principal reason in each case on the census date. It is important to note that duration of delay is calculated from the point patients are considered clinically ready for discharge (and not, for example from day 43 i.e. after a duration of delay of more than 6 weeks). Principal reason can change over time, and as a consequence each duration shown may not be wholly attributable to the reason against which it appears. For example, awaiting assessment may be the first identified principal reason for a patient then, subsequently, the principal reason may change to become awaiting the finalisation of the safe discharge arrangements. Noteworthy points from Table 1 are covered in the Summary of Key Points. Table 2 Numbers by NHS Board area of treatment and principal reason For those patients who have been ready for discharge the six week discharge planning period most NHS Board areas have Community Care Arrangements as the most common reason category except for NHS Highland which has Other Patient/carer/family related reasons as the most common reason category. The frequency of individual reasons the categories varies markedly between NHS Board areas. Overall the number of patients the six week discharge planning period who were exercising their statutory right of choice has shown a decrease (38 at the July 2006 census compared with 46 at the April 2006 census). The largest decrease was in NHS Borders with no cases at the July 2006 census compared with 9 at the April 2006 census. The number of patients exercising their statutory right of choice who were the six week discharge planning period in NHS Highland increased from no cases at the April 2006 census to 6 cases at the July 2006 census, and NHS Ayrshire & Arran increased from 11 cases at the April 2006 census to 15 cases at the July 2006 census. For 32 (84.2%) of those the six week discharge planning period who were exercising their statutory right of choice, the destination over which right of choice was being exercised was care home placement (41 (89.1%) at the April 2006 census and 69 (83.1%) at the July 2005 census). page 6
Table 3 Numbers by Local Authority Partner and principal reason The total number of patients ready for discharge the six week discharge planning period is based on those resident in each Local Authority Partner area. Not all of these patients will have Social Work involvement in their discharge planning, or in their post-hospital care arrangements. A patient ready for discharge is not considered to have social work involvement in their discharge planning process if the principal reason for delay is in the Healthcare groups. 612 patients who had been ready for discharge for over six weeks were considered to have Social Work involvement in their discharge planning process at the July 2006 census, compared with 490 at the April 2006 census and 728 at the July 2005 census. For those patients the six week discharge planning period Community Care Arrangements is the most common reason category in all Local Authority Partner areas except East Ayrshire and Highland which both have Other patient/carer/family related reasons as the most common reason category. West Lothian has Disagreements as the most common reason category. The number of cases the six week discharge planning period with social work involvement where the Local Authority Partner was not identified was 0 at the July 2006 and 1 at the April 2006 census (there were 2 cases at the July 2005 census). Table 4 Numbers by NHS Board area of treatment and by duration It is important to note for most patients, any delay in discharge is of a relatively short duration, such patients are therefore unlikely to appear in quarterly census figures. The varied distribution of durations may be influenced by specialty and case mix differences, differences in local discharge planning agreements and the availability of local care facilities (care home places etc). Comparisons should be made against this background. There has been a slight decrease in the number of patients who had been delayed for over a year. There were 17 cases at the July 2006 census compared with 19 at the April 2006 census (there were 15 cases at the July 2005 census). The largest proportional increase was in the number of patients with duration of delay of 3-5 months. There were 249 cases at the July 2006 census compared with 187 at the April 2006 census (there were 276 at the July 2005 census). page 7
Chart 1 who are the six week discharge planning period by principal reason for delay: Scotland; September 2000 to July 2006 There has been a considerable decrease in the number of patients waiting the six week discharge planning period over the last four years. The October 2001 census shows the point where the figures were at their highest, there were 2,162 patients delayed the six week discharge planning period. At the July 2006 census there were 627 1 patients delayed the six week discharge planning period, a reduction of 70.9% since the peak. At most censuses the most commonly reported reason for delay for those the six week discharge planning period is that the patient is awaiting place availability in a care home/specialist residential facility placement. At the July 2006 census 52.6% of all cases the six week discharge planning period were awaiting place availability for a care home/specialist residential facility placement. 11.3% were delayed due to Community Care Assessment reasons; 10.5% were waiting to go home; 9.9% were awaiting funding to purchase a care home place; 6.1% were exercising statutory right of choice; 3.7% were delayed due to other reasons, 3.5% were delayed due to Legal/Financial reason and 2.4% were delayed due to Healthcare reasons. 2500 2000 Number of patients 1500 1000 500 Other Legal/Financial Patient exercising statutory right of choice Healthcare Assessment/Arrangements Awaiting place availability in a care home 0 Sep 2000 Jan 2001 Apr 2001 July 2001 Oct 2001 Jan 2002 Apr 2002 July 2002 Oct 2002 Jan 2003 Apr 2003 July 2003 Oct 2003 Census Jan 2004 Apr 2004 July 2004 Oct 2004 Jan 2005 Apr 2005 July 2005 Oct 2005 Jan 2006 Apr 2006 July 2006 Awaiting funding for a care home placement Patients waiting to go home Community Care Assessment reasons Other includes Disagreements; Other patient/carer/family related reasons excluding patient exercising statutory right of choice; Community Care Arrangements (no additional detail); awaiting completion of social care arrangements (no additional detail); Principal reason not agreed; and Principal reason not recorded. The reason codes 24DX, 24EX and 42X (awaiting place or bed availability where no appropriate facilities exist) now act as secondary codes to Complex Needs [See introduction to this report and appendix 5]. Prior to the April 2003 census these codes were included under codes 24D, 24E and 42 (awaiting place or bed availability). Therefore cannot be taken out of the census totals prior to April 2003 census. The reason code 51X (Adults with Incapacity Act) now acts as a secondary code to Complex Needs [See introduction to the July 2006 report and appendix 5]. Prior to the July 2004 census these codes were included under code 51 (legal issues). Therefore cannot be taken out of the census totals prior to July 2004 census. 1 Prior to the revision of the definition, the total would have been 649. page 8
Table 1 NHS - - Scotland Numbers, median and mean duration by principal reason; % of total duration; % of total; as at July 2006 census Principal Reason Number the six week discharge planning period 1 Total 2 Median Duration (days) 3 Mean Duration (days) 3 % of total Duration 4 % of total number 5 All reasons 627 1243 43 71 100.0 100.0 Community Care Assessment 71 350 22 33 13.1 28.2 Community Care Assessment (no additional detail) 6 - - - - - - awaiting commencement of post-hospital social care assessment 7 6 65 15 22 1.6 5.2 awaiting completion of post-hospital social care assessment 7 57 271 23 34 10.2 21.8 post-hospital social care assessment completed: awaiting agreement of senior social work practitioner 8 14 46 79 1.2 1.1 disagreement about social care recommendations between social work and health services - - - - - - Community Care Arrangements 458 720 62 88 71.5 57.9 Community Care Arrangements (no additional detail) 6 - - - - - - awaiting re-start services to discharge home - 2 0.0 0.2 awaiting new services to discharge home 13 44 25 41 2.0 3.5 non-availability of public funding to purchase Residential/Nursing Home Place (no additional detail): - - - - - - Residential Home place 14 22 64 73 1.8 1.8 Nursing Home place 48 79 51 68 6.0 6.4 awaiting place availability (no additional detail): 2 6 0.3 0.5 in Local Authority Residential Home 36 50 76 97 5.4 4.0 in Independent Residential Home 29 49 45 79 4.3 3.9 in Nursing Home (not NHS funded) 208 318 63 92 33.0 25.6 in Specialist Residential Facility for younger age groups (<65) 24 28 148 183 5.8 2.3 in Specialist Residential Facility for older age groups (65+) 15 15 121 127 2.2 1.2 awaiting completion of social care arrangements (no additional detail): - 1 0.0 0.1 Local Authority Residential Home placement 2 2 0.4 0.2 Independent Residential Home placement 12 13 131 124 1.8 1.0 Nursing Home placement (not NHS funded) 2 2 0.5 0.2 In order to live in their own home - awaiting social support (eg carer) 16 28 45 86 2.7 2.3 In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted 8 18 33 73 1.5 1.4 Specialist Housing provision 29 43 61 77 3.7 3.5 Healthcare Assessment 2 7 15 69 0.5 0.6 Healthcare Assessment (no additional detail) 6 - - - - - - awaiting commencement/completion of post-hospital healthcare assessment 1 5 0.3 0.4 disagreement about healthcare recommendations between social work and health services 1 2 0.3 0.2 Healthcare Arrangements 13 50 32 40 2.3 4.0 Healthcare Arrangements (no additional detail) 6 - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) 1 1 0.1 0.1 awaiting bed availability in other NHS hospital/specialty/facility 12 48 32 41 2.2 3.9 awaiting bed availability in non-nhs facility (eg hospice) - - - - - - awaiting availability of transport - - - - - - awaiting routine discharge - 1 0.0 0.1 Legal/Financial 22 28 81 116 3.7 2.3 Legal Financial (no additional detail) 6 - - - - - - legal issues (including intervention by patient s lawyer) 3 6 0.4 0.5 financial and personal assets problem 19 22 91 130 3.2 1.8 Disagreements 17 25 72 89 2.5 2.0 Disagreements (no additional detail) 6-1 0.0 0.1 internal family dispute issues 2 3 0.2 0.2 disagreement between patient/carer and health services 5 6 0.9 0.5 disagreement between patient/carer and social work services 3 4 0.3 0.3 disagreement between family and health services 2 4 0.3 0.3 disagreement between family and social work services 5 7 0.8 0.6 Other patient/carer/family related reasons 44 63 62 91 6.4 5.1 Other (no additional detail) 6 1 1 0.1 0.1 patient exercising statutory right of choice 38 52 62 92 5.4 4.2 patient does not qualify for care - - - - - - family/relatives arranging care 2 3 0.5 0.2 other patient/carer/family-related reason 3 7 0.5 0.6 Principal reason not agreed - - - - - - Reason not recorded - - - - x x x. not applicable. not shown (less than 10 cases). 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. Calculated on the number of cases where a ready for discharge date was recorded. Duration calculated from Ready for Discharge Date to July 2006 census date. 4. Duration expressed as a percentage of total cumulative duration. (Excludes the number where Ready for Discharge Date was not recorded). 5. Number of patients ready for discharge expressed as a percentage of the total number. 6. On a number of occasions the reason was recorded to category level only. 7. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). page 9
Table 2 NHS - Numbers by NHS board area of treatment and principal reason; as at July 2006 census Principal Reason Number the Total 2 six week discharge planning period 1 Argyll (NHS Highland) 4 1 NHS Board area of treatment 3 Clyde (NHS Greater Ayrshire & Arran Glasgow) 4 1 [see next page for other NHS Boards] Borders Dumfries & Galloway All reasons 627 1243 17 64 46 58 53 73 12 16 5 1 Community Care Assessment 71 350 5 15 18 7 38 10 5 5 1 - Community Care Assessment (no additional detail) 5 - - - - - - - - - - - - awaiting commencement of post-hospital social care assessment 6 6 65-1 2-4 - 1 1 - - awaiting completion of post-hospital social care assessment 6 57 271 5 14 14 6 31 7 4 3 1 - post-hospital social care assessment completed: awaiting agreement of senior Social work practitioner 8 14 - - 2 1 3 3-1 - - disagreement about social care recommendations between social work and health services - - - - - - - - - - - - Community Care Arrangements 461 723 12 40 22 43 9 38 6 10 1 1 Community Care Arrangements (no additional detail) 5 - - - - - - - - - - - - awaiting re-start services to discharge home - 2 - - 1-1 - - - - - awaiting new services to discharge home 13 44 3-1 - - - 2-1 1 non-availability of public funding to purchase Resid'l/Nursing Home Place (no add'l detail): - - - - - - - - - - - - Residential Home place 14 22 2 1 1 - - 5 - - - - Nursing Home place 48 79 - - 8 12 2 11 - - - - awaiting place availability (no additional detail): 2 6 - - - - - - 4 1 - - in Local Authority Residential Home 36 50-4 - 2 - - - 1 - - in Independent Residential Home 29 49 3 6-2 1 4 - - - - in Nursing Home (not NHS funded) 208 318 1 8 9 21 5 16-4 - - in Specialist Residential Facility for younger age groups (<65) 24 28 - - - - - - - - - - in Specialist Residential Facility for older age groups (65+) 15 15 - - - 1 - - - 3 - - awaiting completion of social care arrangements (no additional detail): - 1 - - - - - - - - - - Local Authority Residential Home placement 2 2-2 - - - - - - - - Independent Residential Home placement 12 13-11 - - - - - - - - Nursing Home placement (not NHS funded) 2 2-2 - - - - - - - - In order to live in their own home - awaiting social support (eg carer) 16 28 3 5-2 - - - - - - In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted 8 18-1 1 1 - - - - - - Specialist Housing provision 29 43 - - 1 2-2 - 1 - - Healthcare Assessment 2 7 - - - 1 1 - - - - - Healthcare Assessment (no additional detail) 5 - - - - - - - - - - - - awaiting commencement/completion of post-hospital healthcare assessment 1 5 - - - - - - - - - - disagreement about healthcare recommendations between social work and health services 1 2 - - - 1 1 - - - - - Healthcare Arrangements 13 50-1 1 - - - - - 2 - Healthcare Arrangements (no additional detail) 5 - - - - - - - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) 1 1-1 - - - - - - - - awaiting bed availability in other NHS hospital/specialty/facility 12 48 - - - - - - - - 2 - awaiting bed availability in non-nhs facility (eg hospice) - - - - - - - - - - - - awaiting availability of transport - - - - - - - - - - - - awaiting routine discharge - 1 - - 1 - - - - - - - Legal/Financial 22 28-3 3 6 1 8 - - - - Legal Financial (no additional detail) 5 - - - - - - - - - - - - legal issues (including intervention by patient s lawyer) 3 6-2 - - 1 - - - - - financial and personal assets problem 19 22-1 3 6-8 - - - - Disagreements 14 25-4 - - 1 2 1 - - - Disagreements (no additional detail) 5-1 - - - - - - 1 - - - internal family dispute issues 2 3 - - - - - - - - - - disagreement between patient/carer and health services 5 6-1 - - - - - - - - disagreement between patient/carer and social work services 3 4 - - - - - 1 - - - - disagreement between family and health services 2 4-1 - - 1 1 - - - - disagreement between family and social work services 5 7-2 - - - - - - - - Other patient/carer/family related reasons 44 63-1 2 1 3 15-1 1 - Other (no additional detail) 5 1 1 - - - - - - - 1 - - patient exercising statutory right of choice 38 52 - - - 1 3 15 - - - - patient does not qualify for care - - - - - - - - - - - - family/relatives arranging care 2 3 - - 1 - - - - - - - other patient/carer/family-related reason 3 7-1 1 - - - - - 1 - Principal reason not agreed - - - - - - - - - - - - Reason for delay not recorded - - - - - - - - - - - - 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. /continued 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. All figures are based on NHS board area of treatment. There are however, a small number of patients experiencing a delay in discharge who are residents of other NHS Board areas. This may mean that the NHS board area of treatment is not responsible for the patient's post hospital discharge planning. As at the July 2006 census NHS Clyde (NHS Greater Glasgow) had 4 residents from NHS Ayrshire & Arran and 1 resident from NHS Greater Glasgow; NHS Fife had 1 resident from NHS Tayside; NHS Greater Glasgow had 2 residents from NHS Fife and 3 residents from NHS Lanarkshire; NHS Lanarkshire had 2 residents from NHS Greater Glasgow; NHS Grampian had 1 resident from NHS Orkney; NHS Tayside had 3 residents from NHS Fife; NHS Forth Valley had 1 resident from NHS Fife. 4. The number of patients ready for discharge who are the six week discharge planning period (42 days or less). 5. On a number of occasions the reason was recorded to category level only. 6. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). 7.The principal reason will not be shown for areas with a small population where the total number of patients delayed for the area is 3 or less as at the census date. This is to avoid small numbers being identified. page 10
/ continued Table 2 NHS - Numbers by NHS board area of treatment and principal reason; as at July 2006 census Principal Reason NHS Board area of treatment 3 Fife Forth Valley Grampian Greater Glasgow Highland 5 1 [see previous and next page for total and other NHS Boards] All reasons 56 38 31 47 45 84 101 91 9 6 Community Care Assessment 26-17 9 10 5 66 11 - - Community Care Assessment (no additional detail) 5 - - - - - - - - - - awaiting commencement of post-hospital social care assessment 6 16-3 2 4-13 1 - - awaiting completion of post-hospital social care assessment 6 10-14 7 6 3 52 9 - - post-hospital social care assessment completed: awaiting agreement of senior Social work practitioner - - - - - 2 1 1 - - disagreement about social care recommendations between social work and health services - - - - - - - - - - Community Care Arrangements 27 29 12 36 23 66 32 65 - - Community Care Arrangements (no additional detail) 5 - - - - - - - - - - awaiting re-start services to discharge home - - - - - - - - - - awaiting new services to discharge home - - 1-2 - - 1 - - non-availability of public funding to purchase Resid'l/Nursing Home Place (no add'l detail): - - - - - - - - - - Residential Home place - - - - - 2-4 - - Nursing Home place - - - - 4 2 1 7 - - awaiting place availability (no additional detail): - - - - - 1 - - - - in Local Authority Residential Home - - 2 6 1 2 2 2 - - in Independent Residential Home 6 8-1 - - 1 2 - - in Nursing Home (not NHS funded) 8 11 8 21 13 47 23 22 - - in Specialist Residential Facility for younger age groups (<65) - - - 1-6 3 16 - - in Specialist Residential Facility for older age groups (65+) - - - 6-1 - 3 - - awaiting completion of social care arrangements (no additional detail): - - - - - - - - - - Local Authority Residential Home placement - - - - - - - - - - Independent Residential Home placement - - 1 - - - - 1 - - Nursing Home placement (not NHS funded) - - - - - - - - - - In order to live in their own home - awaiting social support (eg carer) 8 4 - - - 1-4 - - In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted 3 2 - - 3 2 1 1 - - Specialist Housing provision 2 4-1 - 2 1 2 - - Healthcare Assessment - - 1 1 - - 1 - - - Healthcare Assessment (no additional detail) 5 - - - - - - - - - - awaiting commencement/completion of post-hospital healthcare assessment - - 1 1 - - 1 - - - disagreement about healthcare recommendations between social work and health services - - - - - - - - - - Healthcare Arrangements 2 2 1-10 8-1 - - Healthcare Arrangements (no additional detail) 5 - - - - - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) - - - - - - - - - - awaiting bed availability in other NHS hospital/specialty/facility 2 2 1-10 8-1 - - awaiting bed availability in non-nhs facility (eg hospice) - - - - - - - - - - awaiting availability of transport - - - - - - - - - - awaiting routine discharge - - - - - - - - - - Legal/Financial - - - 1 1 4 - - - - Legal Financial (no additional detail) 5 - - - - - - - - - - legal issues (including intervention by patient s lawyer) - - - - 1 1 - - - - financial and personal assets problem - - - 1-3 - - - - Disagreements - 2 - - 1 1 2 2 1 - Disagreements (no additional detail) 5 - - - - - - - - - - internal family dispute issues - 1 - - - - 1 1 - - disagreement between patient/carer and health services - 1 - - 1 1-1 - - disagreement between patient/carer and social work services - - - - - - - - - - disagreement between family and health services - - - - - - - - - - disagreement between family and social work services - - - - - - 1-1 - Other patient/carer/family related reasons 1 5 - - - - - 12 8 6 Other (no additional detail) 5 - - - - - - - - - - patient exercising statutory right of choice 1 5 - - - - - 9 8 6 patient does not qualify for care - - - - - - - - - - family/relatives arranging care - - - - - - - 1 - - other patient/carer/family-related reason - - - - - - - 2 - - Principal reason not agreed - - - - - - - - - - Reason for delay not recorded - - - - - - - - - - 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. /continued 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. All figures are based on NHS board area of treatment. There are however, a small number of patients experiencing a delay in discharge who are residents of other NHS Board areas. This may mean that the NHS board area of treatment is not responsible for the patient's post hospital discharge planning. As at the July 2006 census NHS Clyde (NHS Greater Glasgow) had 4 residents from NHS Ayrshire & Arran and 1 resident from NHS Greater Glasgow; NHS Fife had 1 resident from NHS Tayside; NHS Greater Glasgow had 2 residents from NHS Fife and 3 residents from NHS Lanarkshire; NHS Lanarkshire had 2 residents from NHS Greater Glasgow; NHS Grampian had 1 resident from NHS Orkney; NHS Tayside had 3 residents from NHS Fife; NHS Forth Valley had 1 resident from NHS Fife. 4. The number of patients ready for discharge who are the six week discharge planning period (42 days or less). 5. On a number of occasions the reason was recorded to category level only. 6. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). 7.The principal reason will not be shown for areas with a small population where the total number of patients delayed for the area is 3 or less as at the census date. This is to avoid small numbers being identified. page 11
/ continued Table 2 NHS - Numbers by NHS board area of treatment and principal reason; as at July 2006 census Principal Reason Lanarkshire NHS Board area of treatment 3 Lothian Orkney Shetland 7 5 1 [see previous and next page for other NHS Boards] All reasons 50 17 126 70-6 1 1 Community Care Assessment 41 2 30 4 - - - - Community Care Assessment (no additional detail) 5 - - - - - - - - awaiting commencement of post-hospital social care assessment 6 3-7 - - - - - awaiting completion of post-hospital social care assessment 6 38 2 23 4 - - - - post-hospital social care assessment completed: awaiting agreement of senior Social work practitioner - - - - - - - - disagreement about social care recommendations between social work and health services - - - - - - - - Community Care Arrangements 7 14 72 64-3 1 1 Community Care Arrangements (no additional detail) 5 - - - - - - - - awaiting re-start services to discharge home - - - - - - - - awaiting new services to discharge home - - 14 4 - - - - non-availability of public funding to purchase Resid'l/Nursing Home Place (no add'l detail): - - - - - - - - Residential Home place - 2 - - - - - - Nursing Home place 5 8 - - - - - - awaiting place availability (no additional detail): - - - - - - - - in Local Authority Residential Home - - 7 7-2 - - in Independent Residential Home - - 6 3 - - - - in Nursing Home (not NHS funded) - 2 38 45 - - - - in Specialist Residential Facility for younger age groups (<65) - - 1 1 - - - - in Specialist Residential Facility for older age groups (65+) - - - - - - - - awaiting completion of social care arrangements (no additional detail): - - - - - - - - Local Authority Residential Home placement - - - - - - - - Independent Residential Home placement - - - - - - - - Nursing Home placement (not NHS funded) - - - - - - - - In order to live in their own home - awaiting social support (eg carer) 1 - - - - - - - In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted - - 1 - - 1 - - Specialist Housing provision 1 2 5 4 - - - - Healthcare Assessment - - 1 - - - - - Healthcare Assessment (no additional detail) 5 - - - - - - - - awaiting commencement/completion of post-hospital healthcare assessment - - 1 - - - - - disagreement about healthcare recommendations between social work and health services - - - - - - - - Healthcare Arrangements 1-20 1 - - - - Healthcare Arrangements (no additional detail) 5 - - - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) - - - - - - - - awaiting bed availability in other NHS hospital/specialty/facility 1-20 1 - - - - awaiting bed availability in non-nhs facility (eg hospice) - - - - - - - - awaiting availability of transport - - - - - - - - awaiting routine discharge - - - - - - - - Legal/Financial - - - - - - - - Legal Financial (no additional detail) 5 - - - - - - - - legal issues (including intervention by patient s lawyer) - - - - - - - - financial and personal assets problem - - - - - - - - Disagreements 1-1 - - 3 - - Disagreements (no additional detail) 5 - - - - - - - - internal family dispute issues - - - - - - - - disagreement between patient/carer and health services - - - - - - - - disagreement between patient/carer and social work services 1 - - - - - - - disagreement between family and health services - - 1 - - - - - disagreement between family and social work services - - - - - 3 - - Other patient/carer/family related reasons - 1 2 1 - - - - Other (no additional detail) 5 - - - - - - - - patient exercising statutory right of choice - - - 1 - - - - patient does not qualify for care - - - - - - - - family/relatives arranging care - 1 - - - - - - other patient/carer/family-related reason - - 2 - - - - - Principal reason not agreed - - - - - - - - Reason for delay not recorded - - - - - - - - 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. All figures are based on NHS board area of treatment. There are however, a small number of patients experiencing a delay in discharge who are residents of other NHS Board areas. This may mean that the NHS board area of treatment is not responsible for the patient's post hospital discharge planning. As at the July 2006 census NHS Clyde (NHS Greater Glasgow) had 4 residents from NHS Ayrshire & Arran and 1 resident from NHS Greater Glasgow; NHS Fife had 1 resident from NHS Tayside; NHS Greater Glasgow had 2 residents from NHS Fife and 3 residents from NHS Lanarkshire; NHS Lanarkshire had 2 residents from NHS Greater Glasgow; NHS Grampian had 1 resident from NHS Orkney; NHS Tayside had 3 residents from NHS Fife; NHS Forth Valley had 1 resident from NHS Fife. 4. The number of patients ready for discharge who are the six week discharge planning period (42 days or less). 5. On a number of occasions the reason was recorded to category level only. 6. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). 7.The principal reason will not be shown for areas with a small population where the total number of patients delayed for the area is 3 or less as at the census date. This is to avoid small numbers being identified. page 12
/ continued Table 2 NHS - Numbers by NHS board area of treatment and principal reason; as at July 2006 census Principal Reason NHS Board area of treatment 3 Tayside Western Isles National Waiting Times Centre Board 5 1 [see previous pages for other NHS Boards] All reasons 59 52 5 3 - - Community Care Assessment 22 3 - - - - Community Care Assessment (no additional detail) 5 - - - - - - awaiting commencement of post-hospital social care assessment 6 6 1 - - - - awaiting completion of post-hospital social care assessment 6 16 2 - - - - post-hospital social care assessment completed: awaiting agreement of senior Social work practitioner - - - - - - disagreement about social care recommendations between social work and health services - - - - - - Community Care Arrangements 34 45 4 3 - - Community Care Arrangements (no additional detail) 5 - - - - - - awaiting re-start services to discharge home - - - - - - awaiting new services to discharge home 7 6 - - - - non-availability of public funding to purchase Resid'l/Nursing Home Place (no add'l detail): - - - - - - Residential Home place 5 - - - - - Nursing Home place 11 8 - - - - awaiting place availability (no additional detail): - - - - - - in Local Authority Residential Home 1 8 1 2 - - in Independent Residential Home 3 3 - - - - in Nursing Home (not NHS funded) 3 10 2 1 - - in Specialist Residential Facility for younger age groups (<65) - - - - - - in Specialist Residential Facility for older age groups (65+) - 1 - - - - awaiting completion of social care arrangements (no additional detail): - - - - - - Local Authority Residential Home placement - - - - - - Independent Residential Home placement - - - - - - Nursing Home placement (not NHS funded) - - - - - - In order to live in their own home - awaiting social support (eg carer) - - - - - - In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted - - 1 - - - Specialist Housing provision 4 9 - - - - Healthcare Assessment 1 - - - - - Healthcare Assessment (no additional detail) 5 - - - - - - awaiting commencement/completion of post-hospital healthcare assessment 1 - - - - - disagreement about healthcare recommendations between social work and health services - - - - - - Healthcare Arrangements - - - - - - Healthcare Arrangements (no additional detail) 5 - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) - - - - - - awaiting bed availability in other NHS hospital/specialty/facility - - - - - - awaiting bed availability in non-nhs facility (eg hospice) - - - - - - awaiting availability of transport - - - - - - awaiting routine discharge - - - - - - Legal/Financial 1 - - - - - Legal Financial (no additional detail) 5 - - - - - - legal issues (including intervention by patient s lawyer) 1 - - - - - financial and personal assets problem - - - - - - Disagreements - 3 - - - - Disagreements (no additional detail) 5 - - - - - - internal family dispute issues - - - - - - disagreement between patient/carer and health services - 1 - - - - disagreement between patient/carer and social work services - 2 - - - - disagreement between family and health services - - - - - - disagreement between family and social work services - - - - - - Other patient/carer/family related reasons 1 1 1 - - - Other (no additional detail) 5 - - - - - - patient exercising statutory right of choice 1 1 1 - - - patient does not qualify for care - - - - - - family/relatives arranging care - - - - - - other patient/carer/family-related reason - - - - - - Principal reason not agreed - - - - - - Reason for delay not recorded - - - - - - 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. All figures are based on NHS board area of treatment. There are however, a small number of patients experiencing a delay in discharge who are residents of other NHS Board areas. This may mean that the NHS board area of treatment is not responsible for the patient's post hospital discharge planning. As at the July 2006 census NHS Clyde (NHS Greater Glasgow) had 4 residents from NHS Ayrshire & Arran and 1 resident from NHS Greater Glasgow; NHS Fife had 1 resident from NHS Tayside; NHS Greater Glasgow had 2 residents from NHS Fife and 3 residents from NHS Lanarkshire; NHS Lanarkshire had 2 residents from NHS Greater Glasgow; NHS Grampian had 1 resident from NHS Orkney; NHS Tayside had 3 residents from NHS Fife; NHS Forth Valley had 1 resident from NHS Fife. 4. The number of patients ready for discharge who are the six week discharge planning period (42 days or less). 5. On a number of occasions the reason was recorded to category level only. 6. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). 7.The principal reason will not be shown for areas with a small population where the total number of patients delayed for the area is 3 or less as at the census date. This is to avoid small numbers being identified. page 13
Table 3 NHS - Numbers by Local Authority Partner and principal reason; as at July 2006 census Local Authority Partner 4 Principal Reason Number the six week discharge planning period 1 Total 2 Argyll & Bute W Dunbartonshire 3 1 Inverclyde Renfrewshire Scottish Borders East Ayrshire North Ayrshire [ see next page for other local authority partners ] All reasons (including Health Care reasons) 4 627 1243 19 60 20 25 17 17 16 16 12 16 12 11 25 38 All reasons considered to have Social Work Involvement 612 1186 19 59 20 25 17 17 16 15 12 16 12 11 25 38 Community Care Assessment 71 350 6 15 13 2 6 1 4-5 5 10 3 21 6 Community Care Assessment (no additional detail) - - - - - - - - - - - - - - - - awaiting commencement of post-hospital social care assessment 6 65 1 1 2 - - - 1-1 1 - - 5-7 awaiting completion of post-hospital social care assessment 57 271 5 14 11 2 4-3 - 4 3 8 1 15 5 post-hosp social care assessment completed: awaiting agreement of senior social work practitioner 8 14 - - - - 2 1 - - - 1 2 2 1 1 disagreement about social care recommendations between soc work and health services - - - - - - - - - - - - - - - - Community Care Arrangements 458 720 13 37 7 22 8 12 10 12 6 10-1 2 17 Community Care Arrangements (no additional detail) - - - - - - - - - - - - - - - - awaiting re-start services to discharge home - 2 - - - - 1 - - - - - - - - - awaiting new services to discharge home 13 44 3-1 - - - - - 2 - - - - - non-availablty of public fundng to purchase Residential/Nursng Home Place: - - - - - - - - - - - - - - - - Residential Home place 14 22 3 1 - - - - - - - - - - - 5 Nursing Home place 48 79 - - - - - - 7 9 - - - - 2 10 awaiting place availability: 2 6 - - - - - - - - 4 1 - - - - in Local Authority Residential Home 36 50-4 1 2 - - - - - 1 - - - - in Independent Residential Home 29 49 3 7 1 1 - - - - - - - 1 - - in Nursing Home (not NHS funded) 208 318 1 3 3 18 6 10 2 - - 4 - - - 1 in Specialist Residential Facility for younger age groups (<65) 24 28 - - - 1 - - - - - - - - - - in Specialist Residential Facility for older age groups (65+) 15 15 - - - - - 1 - - - 3 - - - - awaiting completion of social care arrangements: 1 - - - - - - - - - - - - - - Local Authority Residential Home placement 2 2-2 - - - - - - - - - - - - Independent Residential Home placement 12 13-11 - - - - - - - - - - - - Nursing Home placement (not NHS funded) 2 2-2 - - - - - - - - - - - - In order to live in their own home - awaiting social support (eg carer) 16 28 3 6 - - - - - 1 - - - - - - In order to live in their own home - awaiting procurement/delivery of equipment/adaptations fitted 8 18-1 - - - - 1 1 - - - - - - Specialist Housing provision 29 43 - - 1-1 1-1 - 1 - - - 1 Healthcare Assessment 4 2 7 - - - - - - - 1 - - - - - - Healthcare Assessment (no additional detail) - - - - - - - - - - - - - - - - awaiting commencement/completion of post-hospital healthcare assessment 1 5 - - - - - - - - - - - - - - disagreement about healthcare recommendations between social work and health services 1 2 - - - - - - - 1 - - - - - - Healthcare Arrangements 4 13 50-1 - - - - - - - - - - - - Healthcare Arrangements (no additional detail) 6 - - - - - - - - - - - - - - - - awaiting completion of healthcare arrangements (incl. awaiting equipment supplied by health only) 1 1-1 - - - - - - - - - - - - awaiting bed availability in other NHS hospital/specialty/facility 12 48 - - - - - - - - - - - - - - awaiting bed availability in non-nhs facility (eg hospice) - - - - - - - - - - - - - - - - awaiting availability of transport - - - - - - - - - - - - - - - - awaiting routine discharge - 1 - - - - - - - - - - - - - - Legal Financial 22 28-3 - - 1 4 2 2 - - - - - 5 Legal Financial (no additional detail) 6 - - - - - - - - - - - - - - - - legal issues (including intervention by patient s lawyer) 3 6-2 - - - - - - - - - - - - financial and personal assets problem 19 22-1 - - 1 4 2 2 - - - - - 5 Disagreements 17 25-3 - - - - - - 1-1 1-1 Disagreements (no additional detail) 6-1 - - - - - - - - 1 - - - - - internal family dispute issues 2 3 - - - - - - - - - - - - - - disagreement between patient/carer and health services 5 6-1 - - - - - - - - - - - - disagreement between patient/carer and social work services 3 4 - - - - - - - - - - - - - 1 disagreement between family and health services 2 4-1 - - - - - - - - 1 1 - - disagreement between family and social work services 5 7-1 - - - - - - - - - - - - Other patient/carer/family related reasons 44 63-1 - 1 2 - - 1-1 1 6 2 9 Other (no additional detail) 6 1 1 - - - - - - - - - 1 - - - - patient exercising statutory right of choice 38 52 - - - 1 - - - 1 - - 1 6 2 9 patient does not qualify for care - - - - - - - - - - - - - - - - family/relatives arranging care 2 3 - - - - 1 - - - - - - - - - other patient/carer/family-related reason 3 7-1 - - 1 - - - - - - - - - Principal reason not agreed - - - - - - - - - - - - - - - - Reason for delay not recorded - - - - - - - - - - - - - - - - 1. Number of patients ready for discharge with a duration of over 6 weeks (43 days or more), ie the common period for discharge planning agreement timescales across Scotland. / continued 2. Total number of patients ready for discharge, in all specialties, reported as at July 2006 census. 3. The number of patients ready for discharge who are the six week discharge planning period (42 days or less). 4. A patient ready for discharge is not considered to have social work involvement in the discharge planning process if the principal reason for delay is in the Healthcare groups. 5. A patient ready for discharge is considered to have Social Work involvement if: EITHER - he/she has Principal Reason 'Community Care Assessment' or 'Community Care Arrangements'; OR - he/she has Principal Reason in the 'Patient/Carer/Family - related' categories, OR Principal Reason not agreed, OR Principal Reason not recorded AND a date of referral for Social Care Assessment has been recorded. 6. On a number of occasions the reason was recorded to category level only. 7. From the July 2006 census code 11 has been split to reflect whether the assessment was awaiting commencement (11A) or completion (11B). 8.The principal reason will not be shown for areas with a small population where the total number of patients delayed for the area is 3 or less as at the census date. This is to avoid small numbers being identified. page 14