Community care and admission avoidance

Our High Impact Change Model on Achieving integrated care through community and neighbourhood working provides a helpful list of things to consider when working with communities and wider partners to improve health and wellbeing and can form the foundation for discussions with partners.

Our paper on Community health and care discharge and crisis care model sets out the view of the Local Government Association (LGA) and Association of Directors of Adult Social Care (ADASS) that the approach – which more appropriately should be called ‘discharge to support recovery and then assess’ – is a key component of a person-centred community health and care model.

We offer a wide range of support to assist with delivering a model of community-based provision that is preventative, person-centred and proactive including ‘right sizing’ provision. We support systems to:

• reduce preventable admissions
• deliver a Home First model, including support for vulnerable groups (e.g. those experiencing homelessness)
• manage demand and flow, and implement discharge to assess
• develop robust reablement offers and home-based, wraparound care

National resources

NHS England ICS implementation guidance on partnerships with the voluntary, community and social enterprise sector (PDF)  – Guidance for health and care leaders from all organisations in ICSs that are developing partnerships across local government, health, housing, social care and the voluntary, community and social enterprise (VCSE) sector.

Briefings and publications

Care and support and homelessness: Top tips on the role of adult social care was developed as part of the LGA and ADASS's work with the Shared Outcomes Fund, and seeks to support directors of adult social services and their teams, focusing on the role of social care in supporting people experiencing and recovering from homelessness.

Community health and care discharge and crisis care model: an investment in reablement – An LGA and ADASS publication which sets out the view that the approach – which more appropriately should be called ‘discharge to support recovery and then assess’ – is a key component of a person-centred community health and care model.

Support including High Impact Change Models and case studies

Achieving integrated care through community and neighbourhood working – A High Impact Change Model – An LGA resource which focuses on how health and care partners can work differently with communities to build individual and community resilience and improve health and wellbeing.

Emerging practice guide: implementing the single coordinator role - This emerging practice guide provides a range of practical advice, ideas and learning from those in the single coordinator role, to help systems establish and support the role to operate successfully.

Reactive Emergency Assessment Community Team - Creating a fully integrated admission avoidance hub for Ipswich and East Suffolk – A case study summarising how Ipswich and East Suffolk’s Reactive Emergency Assessment Community Team (REACT) was created to integrate existing admission avoidance services and stop crisis admissions.

Resource library

Our full resource library includes a wide range of publications, tools, case studies and webinar recordings, relating to all aspects of System Transformation and Integration.