Case studies

The approach to implementing trusted assessment involved identifying the best team to develop trusted assessment – using an interface team of nurse, physiotherapist, occupational therapist and social worker. The approach to implementing trusted assessment involved:

Sheffield, like other areas across the country, has found itself under a lot of scrutiny both regionally and nationally because of its delayed transfers of care (DTOC) performance. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.

Managing transfers of care: an example of how a local area is working to implement system change. Kent’s transformation journey began in 2013 with the establishment of three programmes on care pathways, optimisation, and commissioning. This example of a local initiative forms part of our managing transfers of care resource.

Since October 2013, an integrated discharge team has been up and running in North Kent. The team aims to reduce admissions, ensure patients’ needs are proactively managed to reduce their length of stay and to enable patients whose medical conditions are stable to leave hospital in a timely manner. This example of a local initiative forms part of our managing transfers of care resource.

In September 2016 these separate schemes were merged to form the admission avoidance and discharge service (AADS). This example of a local initiative forms part of our managing transfers of care resource.

Success for partners in Blackburn with Darwen has been achieved through shared recognition of a problem, and a commitment to developing a solution, and testing, revising and taking it further. This example of a local initiative forms part of our managing transfers of care resource.

In Sutton, the 'red bag' contains standardised paperwork, medication and personal belongings, and it stays with a care home resident from the time they leave the residential home to go to hospital until the time they return to their care home at the end of their stay in hospital. This example of local initiatives forms part of our managing transfers of care resource.

Managing transfers of care: an example of how a local area is working to implement system change. This initiative focuses on older people living with frailty and very complex needs in care homes. This example of a local initiative forms part of our managing transfers of care resource.

Partners in Leicester have taken a five-stage approach to improving discharge and avoiding unnecessary admissions. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.

Over the past five years, the use of the single health resilience early warning database (SHREWD) has enabled Kent County Council to supply real-time data to support internal management and also operational partners. This example of a local initiative forms part of our managing transfers of care resource.