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.

Managing transfers of care: an example of how a local area is working to implement system change. In Lincolnshire, a number of delays were occurring while waiting for care homes to visit the acute hospital to carry out assessments. Lincolnshire chose to address this through the introduction of a care home trusted assessor role, which would not only enable assessments to be carried out more quickly, but would also help to develop relationships and trust across the system.

Derbyshire County Council has been working with local partners to develop and deliver a clear plan for use of the improved Better Care Fund. The approach is helping to maintain capacity across both social work and the independent sector, and supporting system flow and hospital discharges. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.

The health service and local government have worked together closely across the Bradford and Airedale region to provide telemedicine to care home residents and people in the community.

Local authorities and clinical commissioning groups (CCGs) across London have set up an online platform to provide help and support to people with mental health problems.

Four north east London boroughs - Barking and Dagenham, Havering, Redbridge and Waltham Forest - are working with the local NHS and private sector partners to trail a range of different technologies to help people with long-term conditions.