Families and Professionals
For Families
- Clear communication
- Consistent care teams
- Appropriate clinical oversight
- Focus on dignity and safety
For Commissioners & Professionals
- Discharge-to-assess pathways
- Hospital avoidance
- Long-term stable care
- Supported living provision
Discharge-to-Assess
Supporting safe discharge and reducing delayed transfers of care.
Hospital Avoidance Model
Early risk identification and proactive escalation.
Governance & Reporting
Clear documentation, outcome tracking, and CQC-aligned governance.
Referral Criteria
Adults requiring social care, rehabilitation, complex, mental health, learning disability, or supported living support.
What Happens After Referral
Initial discussion → assessment → care planning → start of support → review.
