Local Care Transformation Programme (LCTP)
Through our Local Care Transformation Programme, we are striving to deliver expanded community-based services so patients can more easily access a broader range of good quality services in their local communities and at home, or the place they call home, wherever possible.
The programme will look at how existing services can be provided differently and in a more joined-up way with health and care professionals working together in a joined-up way across different settings. Providing care closer to home will help to prevent unnecessary hospital admissions; however, if a hospital visit is required, community support will be provided to help people return home sooner,
The programme will focus on more proactive and joined-up care, aiming to keep people healthy and independent in their community, accessing community-based services, and ensuring that acute hospital services can provide quality services when needed. In doing so, we will provide care at the right place at the right time, avoiding unnecessary admissions to acute hospital settings and achieving improved outcomes by supporting people in the community. We want to empower people to take control of their health by providing the necessary tools, information and support to make informed decisions about their health and wellbeing.
What will the Local Care Transformation Programme provide?
- An expansion of community-based services, providing suitable alternatives to hospital-based care
- Support for people with long-term conditions, empowering people to better look after their health and wellbeing needs
- A swift response to those in crisis to prevent avoidable hospital admissions
- A focus on proactive care and early intervention that promotes good health and wellbeing
- Expanded rehabilitation services to help people maximise their functional outcomes and independence, focusing on the personal goals that matter to the individual
- Enable our staff to work flexibly across organisational boundaries in more integrated and joined-up ways that enable staff to deliver better care for their patients, reducing duplication, thereby improving staff wellbeing and job satisfaction
Patient-centred care
The patient is the most important partner in The Local Care Transformation Programme. Their involvement is crucial to the success of the programme. Evidence shows that people benefit physically and mentally if they can be cared for at or close to home by health and care staff based in the community.
Older people can lose their independence when admitted to hospital and find it harder to return home. They may also develop further health issues because of changing their routine. The Local Care Transformation Programme aims to limit this and provide health and care solutions that enable patients to be cared for in the place they call home or their local community.
The Local Care Transformation Programme means that patients will receive more responsive care suitable for them and their situation, they will also be empowered to make informed decisions and to help design their care.
How does it work?
The programme consists of five critical initiatives that will deliver more care in the community, achieving improved patient outcomes and experiences while also helping to relieve pressure on our acute hospital services so that those services can provide high-quality services when people need them.
Avoiding hospital admissions through the provision of more comprehensive services, including Rapid Response Teams, a team of experts that will be on hand within two hours to help support older people to remain well at home during a crisis, helping to avoid unnecessary hospital admissions.
Implementing an Integrated Discharge Team (IDT) to proactively manage discharge from the point of admission to safely discharge from hospital to a range of sub-acute care, reablement and rehabilitative services.
The IDT team is a multidisciplinary staff mix with a range of professional experience across acute, community, mental health and social care, supported by an administrative team, who are co-located and empowered to make autonomous and accountable decisions that are respected across all partner organisations.
The team also work closely with Pharmacy, Mental Health Liaison Services and Hospital Clinical and Management Leadership teams.
Opening 250 ‘Virtual Ward’ beds, a safe and efficient digital healthcare initiative providing remote monitoring and care to patients in their homes. It utilises technology and telemedicine to keep track of patients' vital signs, symptoms, and health progress, allowing healthcare professionals to intervene promptly when necessary.
Virtual wards will enable the appropriate patients to return to the place they call home to receive medical care that would otherwise be delivered in an acute hospital. Virtual wards help prevent avoidable admissions into hospital or support early discharge out of hospital. To find out more about virtual wards, click here.
Developing our approach to neighbourhoods to bring together multi-disciplinary teams of staff from across primary care, community care, social care and the voluntary and community sector to work together to deliver joined-up, person-centred and proactive, preventative care.
Reviewing community-based services for community sub-acute and rehabilitation, including our staff, our community buildings and facilities, to make the best use of our available resources.
After a period when patients have needed acute care, community services can provide a range of sub-acute and rehabilitative care to enable patients to regain their independence.
Involvement
The Big Health and Wellbeing Conversation has provided insight into what people would like to see in the future. This feedback will be aligned with the Joint Strategic Needs Assessments (JSNA) for Shropshire, Telford & Wrekin. The next stage of engagement with our residents, local stakeholders and neighbours within Powys will entail developing evidence-based options for care at a local level.
This page will be regularly updated as progress continues. If you would like to get involved, please contact our Engagement Team at stw.getinvolved@nhs.net to start the conversation.
Last updated on September 15th, 2023 at 12:11 pm