The DTOCs dashboard dilemma


Posted on October 9th, by geoff in Caring Times, CT blog. 2 comments

By guest blogger JEF SMITH

The Department of Health refers to delayed transfers of care – the issue of people not being able to move quickly from acute hospitals to less intensively medical care in the wider community – as DTOCs. My problem is – how do you pronounce it? Is it DeeTeeOhCees or detox? Until someone puts me out of my misery, I’m having to avoid the abbreviation in conversation, instead spelling out the whole inelegant phrase. It almost makes me want to bring back ‘bed-blocking’.

There are, of course, bigger issues at stake. In the absence of a timely discharge, hospital managers are left holding the baby – or, more often of course, the older person – and a hospital system which depends on steady throughput suffers increasing pressure. Fresh patients wait on trolleys or in ambulances because there are no beds, existing genuinely sick people have to be moved around wards, staff become stressed. The organisation NHS Providers has been banging-on about this since mid-summer, but their level of anxiety understandably rises as another winter approaches.

The villain of the piece as they see it is the social care sector in general and directors of adult care services in particular. £1bn pounds of Better Care Fund money was released back in the spring, but NHS Providers say that too little of this is being allocated to DTOCs. The response from local government is that there are competing priorities in these under-funded times, some of which, like stopping vulnerable people having to go into or re-enter hospital, should also be of interest to the over-stretched NHS.

The Secretary of State weighed into the argument in June with instructions for more local level discussions and better data to be kept on DTOCs, emergency hospital admissions, readmissions, and length of stays. These numbers are to be displayed on – wait for it – a ‘performance dashboard’. I don’t of course have an issue with making more information available; policy certainly needs to be evidence-based. But why ‘dashboard’? A dashboard is what you glance at in a moving vehicle, not the source of calm consideration associated with figures on a computer screen or a printed spreadsheet.

Is the image the DoH wants to project that of a speeding car, with various would-be drivers struggling for control, considerable uncertainty about the direction of travel, and the minister occasionally offering advice from the back seat? I think not. Meanwhile, as health and social care chiefs wrangle over priorities, care home and homecare managers wait for their clients, and worst of all older vulnerable people wait for services. DTOCs matter, however you say it.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.




2 responses to “The DTOCs dashboard dilemma”

  1. John Burton says:

    Acronyms and jargon, and the specialisation that goes with them, are signs that a problem is being dealt with in isolation from the whole system. They take power from ordinary people and, after the first few months of enthusiastic PR, they make matters worse. The top-down response to their failure is not to get rid of them, but to throw more money at them, give them more power and create an even worse problem. The recent introduction of dashboards (all over the place) is apt in referring to a technocratic approach to monitoring the performance of more and more sophisticated internal combustion vehicles that, in meeting individual aspirations for getting from A to B or showing off, have created huge problems for our world. “Delayed transfers of care” should remain in full – no acronym, no dashboard, no pretence that this is not merely a symptom of a much bigger problem – but it won’t!

  2. Worth noting that the Nuffield Trust have calculated that 2/3 of DTOCs are down to issues within hospitals – nothing to do with social care. Focusing wholly on social care is the equivalent of displacement activity.


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