Case studies

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.

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.

Partners in Leicester have taken a five-stage approach to improving discharge and avoiding unnecessary admissions. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.

Over the past five years, the use of the single health resilience early warning database (SHREWD) has enabled Kent County Council to supply real-time data to support internal management and also operational partners. 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. The system in North Staffordshire faced a number of issues, including risk-averse practice and fragmented services in the community. 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. 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. Care navigators use their local knowledge of community services and care options available to help individuals and their families make decisions about the best ways to stay independent and safe. This example of a local initiative forms part of our managing transfers of care resource.

This example of a local initiative forms part of our managing transfers of care resource. In 2015, a whole-system review looked at the interface between social care and health. This improved working relationships, and enabled open and honest system challenges.

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.