1. Care in Crisis - the challenge Carol Herity – Head of Partnerships

2. Our challenge: “To identify what further support the Third and Not for Profit sector can offer to reduce delayed discharges.”

3. Scope: Delayed transfers of care Multi-disciplinary Team decision that the patient is ready for discharge/transfer

4. Whole system support is needed… Acute & Community hospitals Intermediate Care Beds Clinical Commissioning Groups Enhanced Assessment Beds Local Authority residential placements

5. Underlying principles: Coordinated inter-organisational approach In-reach model Early identification of patient needs Continuity of responsibility for delivery Daily review of progress and discharge plan update Discharges up to 8.00pm x 7 days per week Value for money Agreed evaluation criteria Sustainability

6. Benefits Increase in the number of patients referred to Third and Not for Profit Sector support each day Increase in the number of patients discharged each day with this support Daily update of the number of patients MDT fit for discharge flagged as needing the sectors support (waiting list) Daily update of the total number of occupied bed days since the patient was flagged as MDT fit for discharge awaiting this support

7. Outcomes A reduction in: Numbers of Medically Fit For Discharge in any setting Patients length of stay Readmissions

8. How will we know it is working Review of any patients readmitted as an emergency / attending ED following discharge with Third Sector support v readmissions / ED attendances of patients not receiving Third Sector support –Within 48 hours –Within 7 days –Within 30 days Review of any patients readmitted as an emergency / attending ED following cessation of this timed support

9. Thank you Questions?