Gloucestershire: care navigators

Care navigators use their local knowledge of community services and care options available to help individuals and their families make decisions about the best ways to stay independent and safe. This example of a local initiative forms part of our managing transfers of care resource.


They help people by simplifying the process of finding affordable services to meet their needs at a time of crisis, taking a broad approach, which includes housing options, signposting for financial advice and maximising income or benefit entitlement.

They are able to make appropriate links and referrals with direct access into adult social care brokerage, locality teams and voluntary and community sector services such as Age UK and a British Red Cross resettlement service.

As a result, care navigators are helping to reduce unnecessary referrals into adult social care teams from acute hospitals – a mapping exercise identified that nearly 70 per cent of referrals did not require social worker input, or result in ongoing adult care-funded services.

The team includes two navigators redeployed from reablement services, which has helped to increase the numbers of people going straight home. Other navigators have been recruited from voluntary and community sector organisations and there is also a joint post with Gloucestershire Fire and Rescue Service which has been set up as a pilot to support ‘safe and well’ visits, an existing responder service and proactive discharge follow-up.

The model includes capacity for evening and weekend visiting times.

Contact

Mary Morgan
Joint Commissioner for Older People
NHS Gloucestershire CCG
mary.morgan2@nhs.net  

This case study is an example of the High Impact Change Model (Change 7): Engagement and choice.