Winter preparedness including discharge to assess implementation

Draft support offer for health and care systems from Integration and Better Care Fund, LGA and NHS


Introduction: offer of system support

The Better Care Fund Team, Local Government Association and NHS England and Improvement programmes including Emergency Care Improvement Support Team and Continuing Healthcare have developed a joint support offer

It is intended to support local health and care systems to plan and deliver their winter resilience plans including fully implementing the Hospital Discharge Service: Policy and Operating Model.

Support can be targeted on a range of issues, such as:

  • Implementing system-wide winter plans, including compliance and resilience in COVID-19 response
  • Strengthening system leadership and collaborative culture
  • Addressing inconsistent implementation of discharge operating model
  • Improving collection and quality of data, and its use to drive improvements to outcomes and services
  • Reshaping pathways and community capacity to meet the changing demand from Home First Supporting development and joint commissioning of step-up/step-down care and support to ensure safe and timely discharge
  • Developing workforce capacity, skills and multi-disciplinary culture across health and care jointly.

How is the support delivered?

  • The work is led by senior leaders with extensive experience leading and shaping health and care systems, supported by other peers in a range of disciplines depending on the needs of the local system
  • All support is co-developed with the local system, and delivered in the spirit of improvement and constructive support
  • It is designed to involve both health and care, and can be adapted from single council footprint to larger ICS or regional ones.

Available activities and support

Delivering winter plans and ongoing COVID-19 response

  • Gap analysis of winter resilience, discharge to assess or care home support planning
  • Half-day/one-day peer enquiry of readiness for winter, and plan actions to address challenges Support to implement discharge to assess and Home First policy (see next box)
  • Bespoke support to improve performance and implement plans around admissions avoidance, length of stay, discharge and COVID response
  • COVID reset and recovery workshops, including embedding positive developments established during pandemic response
  • Action to strengthen system-wide strategy, leadership, planning and joint commissioning
  • Bespoke support to embed multi-partner wraparound support to care sector

Implementing discharge to assess fully and consistently

  • Addressing unwarranted variation Improving capture, quality and analysis of discharge and community data through tools, workshops and expert peer support
  • Restarting CHC/Care Act assessment and completing deferred assessments
  • Establishing discharge hubs, streamlining model and processes, and developing workforce skills, culture and capacity
  • Half-day/one-day peer enquiry to implement D2A, and plan actions to address challenges
  • Developing joint commissioning models and understanding impact of D2A on pathways and service demand Implementing actions in High Impact Change Model for managing transfers of care

Strengthening system leadership and enablers

  • Facilitated workshops, action planning, critical friend support, mentoring and peer support around system leadership and collaborative culture, including D2A oversight and improvement of performance and outcomes
  • Developing workforce planning, capacity, skills and multi-disciplinary culture
  • Capturing and building in the voice of people using services Planning and implementing technology solutions, and homelessness support
  • Reviewing and reshaping strategy, planning and governance arrangements, including alignment across place and system
  • Evaluation of services and data analysis to drive service improvements.

As well as the bespoke support detailed below, there is a wide range of tools, case studies, guides and webinars available.

How is support accessed?

Local systems: contact your regional CHIA, BCM or ECIST lead, email chip@local.gov.uk or visit the Care and Health Improvement page.

Regional or national teams

To discuss regional needs contact fiona.russell@local.gov.uk or elizabeth.sargeant@nhs.net