Case studies

Bradford is a partner in West Yorkshire and Harrogate Health and Care Partnership – a first-wave integrated care system (ICS). This case study forms part of our integrated care system (ICS) resource.

In late 2017 the Technology Enabled Care (TEC) team began working on a project to improve pathways and access to TEC for those who were being discharged from hospital. The aim was to significantly increase the take-up of lifelines and telecare within a vulnerable cohort that would most benefit from them and ensure that people had access to the councils in house Reablement Enhanced Response Service (ERS). This example of a local initiative forms part of our managing transfers of care resource.

To provide an equitable hospital discharge experience for residents whilst improving performance associated to delayed transfers, a bespoke Hospital Discharge Service was established in October 2017, with the use of iBCF monies to expand the council’s ‘discharge team’ located at the hospital where the greater number of admissions historically occurred. This example of a local initiative forms part of our managing transfers of care resource.

Cheshire West and Chester Health and Wellbeing Board (HWB) is a system-leadership board which meets monthly to monitor progress on integrated health and care developments and to ensure that delayed transfers of care meet national targets. This case study forms part of our integrated care system (ICS) resource.

A key priority of the Isle of Wight’s ‘Care Close to Home’ Strategy is to deliver significant improvements to the quality of adult social care registered services. This forms part of our adult social care markets and commissioning resource.

The health and care system in Warwickshire has maintained, and strengthened, its ‘discharge to assess’ model through the COVID-19 period by remaining aligned to its core principle of maintaining a person centred Home First approach.

Following a review by the Emergency Care Improvement Programme (ECIP) in October 2016, County Durham and Darlington Local Area Delivery Board has implemented a system-wide set of changes to improve performance. This example of a local initiative forms part of our managing transfers of care resource.

Homerton University Hospital’s movement towards seven-day working to improve patient flow has been a long journey that has taken a few of years and gone through a number of iterations in terms of changes to systems and processes. This example of a local initiative forms part of our managing transfers of care resource.

With the seven-day working strategy, Hertfordshire aimed to improve the flow from the acute into the community, ensuring discharges are not delayed over the weekend while service users wait for a package of care due to processes outside of the Monday to Friday norm. This example of a local initiative 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. The model in Hull, which forms part of a system- wide approach to reducing delayed transfers of care, is based on the principle of ‘active recovery’.