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The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

Malisauskaite, Gintare, Jones, Karen, Lau, Yiu-Shing, Sutton, Matthew, Checkland, Katherine, Morciano, Marcello (2023) The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities. Health & Social Care in the Community, 2023 . Article Number 8365147. ISSN 1365-2524. (doi:10.1155/2023/8365147) (KAR id:100121)


This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC.

Item Type: Article
DOI/Identification number: 10.1155/2023/8365147
Uncontrolled keywords: Public Health, Environmental and Occupational Health, Health Policy, Sociology and Political Science, Social Sciences (miscellaneous)
Subjects: H Social Sciences
H Social Sciences > HV Social pathology. Social and public welfare
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Personal Social Services Research Unit
Funders: NIHR Academy (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 17 Feb 2023 14:27 UTC
Last Modified: 12 Dec 2023 14:09 UTC
Resource URI: (The current URI for this page, for reference purposes)

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