Integrated care and support
It is important for proactive and jointly delivered care to be provided for the most vulnerable people and their carers, and this will be achieved through the establishment of integrated teams and joint processes that support admission avoidance and timely discharge from hospital. Customers will only need to tell their story once, knowing their needs will be met by staff who work together to achieve the best outcomes. This is being achieved by continuing to progress existing and new initiatives to:
- Improve Delayed Transfers of Care and flow through the system – using the tools and systems recently developed to reduce length of stay.
- Redesign health and care services using a population health management system in collaboration with the Out of Hospital programme.
- Integrated Care Partnerships – Adult Social Care will continue to explore and implement integrated and aligned strategic commissioning and operational delivery of support to those people in need of care.
- Dementia – Increase the reach of support to people newly diagnosed and those living with dementia through delivery of the dementia strategy.
- Design and implement demand management solutions, including Discharge to Assess and Moving on Beds to reduce prolonged hospital length of stay and prevent delayed transfers of care. Additional Moving on Beds capacity will also continue to be funded.
Warwickshire Community and Voluntary Action (WCAVA) and the Coventry and Rugby Clinical Commissioning Group (CRCCG) are working in partnership to deliver Social Prescribing in Rugby, known as ConnectWELL.
The ethos of the project is to improve people’s health and wellbeing. ConnectWELL signposts and supports individuals to access services and activities delivered by the voluntary and community sector and statutory partners to address underlying and causal factors.
Warwickshire County Council’s online resource of services available to help people to remain in their own home.
Warwickshire County Council ‘s online resource to support good mental well being.
Coventry and Warwickshire’s online resource of dementia support services.
NHS guide to long-term conditions and self care
Support for people over the age of 65 to return home following a visit to Accident and Emergency (A&E) in the South Warwickshire Foundation Trust Hospital and the George Eliot Hospital
Mental health charity that provides advice and support to empower anyone experiencing a mental health problem. And which campaigns to improve services, raise awareness and promote understanding.