Building Partnerships: Facilitating collaboration with social care and community providers to address delays in support packages, a key cause of DToC.

Piloting Home-First Models: Supporting pilots that test home-based assessments, as described in NHS England’s D2A guidance, to free up hospital beds and reduce lengths of stay.

Coordinating D2A Pathways: Providing a platform to integrate hospital and community data, ensuring patients are discharged to home or community settings with appropriate support, reducing DToC.

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Multidisciplinary Expertise: Buuilding diverse teams of local experts (e.g., hospital administrators, clinicians, community pharmacists, social workers, and data analysts) to break down the DToC challenge into manageable components, such as discharge planning, post-discharge care coordination and resource allocation.

Collaborative Strategies: Creating partnerships between ICBs, hospitals, general practitioners (GPs), and community pharmacies to streamline discharge processes.

AI Driven Technology: Deployed across our collaborative framework, we reduce DToC by predicting delays, streamlining care coordination, optimising resources, and enhancing patient support.

Improving Patient Outcomes: Reducing readmission rates by clever matching and monitoring of patient's conditions.

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Collaborative Discharge Planning: Facilitate partnerships between GP surgeries, hospitals, and community pharmacists to improve post-discharge care transitions.

AI-Powered Triage: Deploy AI triage tools to prioritize urgent cases and divert non-emergency patients to community pharmacies or self-care resources, easing GP workload.

Integrated Platforms: AI-driven care coordination tools (e.g., secure, compliant digital platforms) to share real-time patient data between GPs, hospitals, and care providers, ensuring seamless follow-up care.

AI Chatbots: AI-powered virtual assistants to send appointment reminders, provide medication guidance, or answer common patient queries.

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Integrated Platforms: Deploy AI-driven, secure, compliant platforms to share real-time patient data, ensuring social care teams have up-to-date information on discharge plans or care needs.

Capacity Planning: Analyse regional data to identify gaps in social care capacity.

AI Risk Stratification: AI tools can identify high-risk patients and recommend personalised care plans, such as increased home visits or assistive technologies.

Community Partnerships: Collaborate with community providers to deliver holistic care, reducing reliance on social care teams alone.

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