Managing transfers of care – A High Impact Change Model

This model was developed in 2015 by strategic system partners, and was then refreshed in 2019 with input from a range of partners including the Local Government Association, the Association of Directors of Adult Social Services, NHS England and Improvement, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government and Think Local Act Personal Partnership. It has now been updated in July 2020 to integrate emerging learning from responding to the COVID-19 pandemic.

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It builds on lessons learnt from best practice and promotes a new approach to system resilience, moving away from a focus solely on winter pressures to a year-round approach to support timely hospital discharge resulting in quality outcomes for people. While acknowledging that there is no simple solution to creating an effective and efficient care and health system, this model signals a commitment to work together to identify what can be done to improve current ways of working. Throughout implementation of the model, achieving the right outcomes for people is key, enabling them, with the right information and advice to make the best decisions about their ongoing care. The model is endorsed by Government through its inclusion in the Integration and Better Care Fund (BCF) policy guidance.