1. Supported Care Service
Update from:
Anne Borrows, Acting Assistant Director – Clinical Transformation

2. Aims
To develop and implement local integrated multidisciplinary community services closer to people’s home
To reduce emergency admissions and the need for as many intermediate care beds for post-acute rehabilitation.

3. Aims Further Project Group meetings continue to take place
The Project Group have been integral in developing a model for new services
The model will be based upon the current Integrated Care Teams, linked to GP practices and will enhance existing relationships with our primary care providers, hospital discharge teams, in-patient units and the ambulance service.
The model is being submitted to SNCCG’s Governing Body in February to agree the financial investment

4. Community Engagement and Development
Connecting health, social care and
patients with the voluntary sector and
wider community, to ensure that any
additional support needs that have
been identified are met.
Developing and maintaining community assets as strong community capacity will facilitate those in need accessing the new service in a timely way to reduce admissions.

5. Reablement Care
Increased capacity within the Norfolk First support (NFS) service through both day and night.
Overnight support will include unplanned visits and night sits to assess overnight support.
Assistive technology will allow patients to be monitored between visits.

6. Rapid Response Clinical Assessment and Review
Clinical oversight from the integrated team including rapid response medical and social assessment of needs and review.
The team will include:
Service Lead
Occupational Therapists
Physiotherapists
Registered Nurses