Case studies

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.

The programme aims to tackle loneliness and fragmented care by joining up services for older people in supported living schemes and care homes, to help people live longer, healthier lives at home and within their communities. This example of a local initiative forms part of our managing transfers of care resource.

In 2014 East Surrey CCG embarked on a project to improve the medical care of residents of nursing and residential homes. This example of a local initiative forms part of our managing transfers of care resource.

The No Wrong Door model provides a consistent trusting relationship for young people that sticks with them no matter how they move through care.

Embedding meaningful and sustainable involvement of children and young people at every step of the commissioning cycle has helped transform mental health services for young people in Doncaster.

Oldham Council was the first area in the country to pilot MH:2K, a powerful new model for engaging young people in conversations about mental health in their local area.