ABRIDGED GUIDE TO THE CARE ACT 2014

AND DELAYED TRANSFERS OF CARE

Introduction
The Care Act 2014 stipulates that patients do not remain in hospital when they no longer require care.
The NHS must notify Local Authorities of a patient’s upcoming discharge so they can assess care
needs. An acute hospital is an appropriate place when a patient is unwell but patients should be
discharged as soon as possible once they are medically fit.

When must a local authority arrange care for an adult?

When the person has:
 ‘eligible’ needs, and
 ‘ordinary residence’ in the local area (meaning their home is there)

and when the person (any of the following):

 cannot afford to pay the full cost of their care and support, or
 asks the local authority to arrange their care, and pays for them to do so, or
 does not have mental capacity, and has no-one else to make arrangements,
 can have care that is offered for free, but has no-one to arrange it.

What is a Transfer of Care and a Notification of Discharge?

 Acute trusts are required to make two notifications to social service departments; a “Transfer
of Care” (previously a ‘Section 2’) and a “Notification of Discharge” (previously a ‘Section 5’.)
 The Transfer of Care (TOC) states the patient’s needs. There must be a minimum of three days
from the day the Transfer of Care is sent to the proposed discharge date.
 The Notification of Discharge (NOD) is sent afterwards and confirms the date the proposed
discharge date.
 If the agreed care is not ready by 11am on the day after the proposed discharge date, the
discharge is “delayed”
 A notification sent after 14:00 is counted as being on the next day

When is a patient Medically Fit for Discharge?

 ‘When the consultant (or deputy) judges that a hospital in-patient no longer requires acute
inpatient care.’
 A longer definition: The patient is ready for transfer home when:
• A clinical decision is made that they can go home
• A multidisciplinary team (MDT) decision says the patient is ready for home [NB. This is
often just noted by nurses/therapists rather than by a formal MDT meeting.]
• the patient is safe to discharge

When is a Notification of Discharge withdrawn?

 If the patient’s condition changes, e.g. they become medically unfit for discharge, a withdrawal
of the Notification of Discharge is sent, as the planned discharge date is no longer valid,
 Occasionally the patient’s condition changes radically e.g. they have a stroke or a fracture. If
this happens, the TOC is withdrawn and the entire process should start again.

Safeguarding Referrals and Discharge Planning

 Safeguarding is aimed at those with care and support needs who may be in vulnerable
circumstances and at risk of abuse or neglect. The Care Act requires local authorities to make
enquires, or ask others to make enquiries, when they think there is a risk.
 There will be a small number of cases where there are safety concerns linked to safeguarding
issues when the MDT agree that it is not safe for patients to be discharged.
Where are patients discharged to?
 The majority of patients should… go home with a short term package that supports recovery
and re-ablement.
 If not, the person should go with short term support (intermediate care/Enhanced Assessment
Bed) and have further assessment as they recover.
 Although occasionally it is unavoidable to discharge straight to long-term care, home should
always be considered as the first option.

House Cleaning / Equipment

 Occupational therapists will prescribe equipment needed for a patient to live at home.
 If a patient needs their house to be cleaned, it will only be organised by a social worker on their
behalf if the patient has care needs and a TOC has been submitted.

What are Direct Payments?

 This is when adults take full control of their own care.
 A payment is made by the local authority to the adults needing care and support, or to
someone on their behalf, to pay for arranging all or part of their own support.

Homeless Patients
 Homeless patients should be treated as all other patients. They should have a TOC referral only
if they have ongoing care needs. If they are independent and self-caring, a TOC is not required.
The individual should be directed to the Homelessness and Housing Advice Service.

Fast-track Discharges
 A fast-track discharge is for patients at the end of their life.

Counting up delays (SitRep)

 A delayed transfer of care (DTOC) from NHS-funded acute or non-acute care is when an adult
(18+ years) patient is ready to go home and is still occupying a bed, at midnight at the end of
the day. Every day of the week counts, including weekends and all Bank Holidays.
 Counting DTOCs helps understand unmet need and bottlenecks.
 Acute trusts may also charge social services for delays related to social care.
 Reports are made monthly and include all health, joint and social care delays. They are agreed
by both the acute trust and by social care.

There are three broad categories of delay, by reasons related to:

 Social care;
 Health care (non-acute);
 Delays in both.

Each day, a patient is counted in one category of delay only, which should the one most appropriate.
During a patient’s stay, the reason for the delay may change day-to-day.
This table shows the list of available reason codes and indicates which are attributable to the NHS,
Social Care or as Jointly owned. There are lots of subcategories, see the full guides below.

NHS Social Care Joint

A) Awaiting √ √ √
completion of
assessment
B) Awaiting public √ √ √
funding
C) Awaiting further √  
non-acute NHS care
Di) Awaiting √ √ 
residential home
placement or
availability
Dii) Awaiting nursing √ √ √
home placement or
availability
E) Awaiting care √ √ √
package in own
home
F) Awaiting √ √ √
community
equipment and
adaptations
G) Patient or family √ √ 
choice
H) Disputes √ √ 
I) Housing – patients √  
not covered by the
Care Act
O) Other √ √ 

Sources:
 Monthly Delayed Transfers of Care Situation Report. Principles, Definitions and Guidance. Nov ‘18
 Simple Guide to the Care Act and Delayed Transfers of Care (DToC). London ADASS
 University Hospitals Birmingham NHS Foundation Trust. Practice Development Myth Busters.
Leaflet.
 Department of Health & Social Care. Guidance. Care Act factsheets. Updated 19 April 2016.
https://www.gov.uk/government/publications/care-act-2014-part-1-factsheets/care-act