1. Rachel Dewar Head of community health services

3. What brought about the re-design?
2016: Better Care Together and the draft STP had high levels aims for health and care services in Leicester, Leicestershire and Rutland.
Out of the STP, two key workstreams emerged: Integrated Locality Teams (ILTs), and the Home First agenda.

4. Integrated Locality Teams (ILTs)
Developed across LLR
MDT cross system leadership teams
Testing new ways of working

5. Home First.
Integrated Discharge Team
Closer working between Social Care Crisis Services, reablement services and ICS.
Discharge Pathways
Admission avoidance

6. What is it that the System wants to achieve?
Increase integration with social care crisis response/re-ablement services
Increase number of people cared for at home and in re-ablement beds
Community nursing and therapy working in integrated teams with GP practices and social care, providing more joined-up care, with better continuity.

8. What is happening across Primary Care?
PCN development
What is happening across Local Authorities?
ICRS/HART/REACH

9. So – What are LPT being asked to do?
Reorganise current nursing and therapy teams
Move some of the capacity in the Intensive Community Support service into larger community nursing teams working at neighbourhood level. This will improve continuity of care and create better team working with GP practices
Align the rest of the Intensive Community Support service capacity into integrated ‘Home First’ services to work alongside social care crisis response and reablement
Create local decision units in each social care area, as single points of access for discharge decision making and crisis response

10. So – How will we do This?
When will the changes start?
Some already have………
Leadership review and changes to current roles and responsibilities.

12. So – How will we do This?
Identify new roles, and work with staff impacted by changes earlier than implementation date – PCCs

13. What is next?
Work up Clinical and Operational models, with staff from across the services.
Align our own transformation work, so that as we develop new service models we implement the learning and work in a consistent, efficient and measurable way across the nursing and therapy pathways
Implement new models and ways of working by Sept/Oct

14. How can you be involved?
Workshops and Engagement events.
Discussion in local team and hub areas escalated via leadership teams.
Be curious!
Have a voice!

15. Learn more Regular briefings
Regular s eSource page:

16. Any questions?