Case studies

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’.

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.

For Newcastle Gateshead CCG, one of the very best things occurring as a result of being part of the NHS England New Care Models programme has been the opportunity to test and evaluate new models. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.

The hospital avoidance response team – HART – service is delivered by members of the Lincolnshire Independent Living Partnership and takes referrals from secondary care discharge hubs, A&E in-reach teams, the ambulance service, primary care and community health providers. This example of a local initiative forms part of our managing transfers of care resource.

Home First is an initiative developed through the partnership of Medway Foundation Trust Hospital, Medway CCG, Medway Council and Medway Community Healthcare. It provides support for patients medically fit to be discharged, but who still require additional home support. 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. Between January and October 2012, Surrey County Council worked closely with health partners to introduce reliable seven days per week social care services, including earlier weekday mornings and later evenings. This example of a local initiative forms part of our managing transfers of care resource.

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.

Hull and Wakefield have used PHE’s online SHAPE tool to work out how best to invest money in dental services. SHAPE has allowed officials to map where practices are against areas of high deprivation as a proxy for poor oral health.

Leicestershire’s school nursing service has set up a text messaging service for secondary school pupils. It has helped the service engage hard-to-reach groups with pupils reporting it makes them feel more comfortable discussing sensitive issues.

Staff running chair-based exercise classeshave started to use sensors and tablets to assess the falls risk of clients and helpingthem tailor exercise programmes. Theprogramme has been used in care homes andis now being tested in community settings.