Local Government Association

Overview

Prior to the COVID-19 pandemic, Halton’s intermediate care provision was delivered through several separate services. These included the Rapid Access Rehabilitation Service, a Capacity and Demand Team, falls prevention team, hospital discharge teams and a Frailty team. While each service provided valuable support, they operated largely independently.

Overview

Demand pressures and increasing costs were putting strain on the system, making it difficult to maintain service quality and meet the needs of service users efficiently. There was recognition that no single partner could deliver systemic improvement alone; effective collaboration across Stoke-on-Trent City Council, Staffordshire County Council and Midlands Partnership Foundation was essential for meaningful change. 

Action

Overview

The ‘Guiding You Home’ programme was established in 2025 as a collaboration between South Tyneside Council, Sunderland City Council, South Tyneside and Sunderland NHS Foundation Trust; and North East and North Cumbria ICB. 
The programme sees multi-agency teams working collaboratively with ward staff, care homes and home-based care services to find more effective ways of working – with the focus on helping patients get discharged faster, or stay out of hospital altogether, with more help provided at home.  

Action

Overview

Redcar and Cleveland were experiencing discharge delays across the local system, and intermediate care bedded provision was not leading to return home as frequently as would be expected.

Action

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Feedback report: Tuesday 26 to Thursday 28 March 2024