DToC

Most readers of my blog will not have heard of this term. I suspect most of those working inside the NHS don’t know of its existence either… DToC – Delayed Transfer of Care.

This is how groups of mostly older people are categorised once they are deemed medically fit – (another NHS neologism which too readily induces objectification), before they go home.

I know the people who invented (discovered/created?) this term probably didn’t intend for it to be used in a negative way – a little like Alfred Nobel and TNT; you think-up something novel, a new way to consider the workings of a system – even a person-centred interpretation of what it is to be prevented from getting home from hospital and suddenly it becomes a weapon, where the person is forgotten and the process (usually called pathway) takes-over.

Delayed Transfers of Care (I really can’t cope with saying ‘DToCs’) happen, in hospital, when a doctor deems a person fit for discharge. That is, in the eyes of the hospital, or the clinical team, there is nothing more that can be done to improve an individual’s health or wellbeing – indeed, the longer they remain in hospital the greater the likelihood of harm from all the risks of being somewhere you shouldn’t – medicalization, over-diagnosis, over-investigation, falls, hospital acquired infection and so on.

From the point the doctor says ‘MFFD’ (Medically Fit for Discharge – another term I don’t really like), the clock starts, with discharge teams, collaborations of health and social care, management and pathway staff rushing around in flurries of waiting times, lists and numbers to ensure that the usually older person is moved out of their hospital bed as quickly as possible.

Sometimes the next step is a discharge lounge – a sort of transient Neverland between hospital and home, or rehabilitation, intermediate care or step-down bed – alternatives which are a little longer lasting but just as discombobulating to older people, particularly those who have delirium, dementia or cognitive impairment:

‘Can you tell me where you are?’

‘Hospital’

‘No, actually we are in an off-site Discharge to Assess (D2A!) care facility somewhere in the North of England.’

‘Oh’

The reason some people have begun discussing Delayed Transfers of Care (which on reflection is a bit of a mouthful), is because of the Tory government’s crippling squeeze on social care – councils across the country having millions of pounds taken from their budgets which is an indirect cutback on healthcare; I know this sounds cynical – it is hard not to be a cynic when people are dying in hospital instead of living at home.

Because of this financial emasculation (too extreme a word?) of health and social care, older people are stuck in a limbo between hospital and home, with the delays becoming DToCs.

‘You are experiencing a DToC because there is no room in the intermediate/ rehab/ interim care/ step-down facility.’

You see the problem?

The person slips from experiencing a DToC to being a DToC.

You can spend lots of time and effort re-educating staff on the meaning of a word – for example, DNACPR – Do Not Attempt Cardio-Pulmonary Resuscitation, which does not mean ‘don’t treat/care’ – just don’t defibrillate or chest compress, or you can change the word and then work on the grammar, terminology and meaning later.

‘I’ve come to visit my dad, you know – bed six’

‘When is the next appendix?’

‘How many DToCs today?’

I don’t really have an answer to this, beyond a new government who doesn’t interpret balancing the books as screwing the sick, old and disadvantaged; in the meantime, perhaps, we can collaborate on finding a workaround to DToCs and a better way to keep the patients and staff people.