Developed in partnership with Norfolk Community Health and Care NHS Trust, Norfolk County Council, Norfolk and Waveney Integrated Care Board, and private care provider Athena Care Homes, the initiative has reduced average waits for community beds from up to 20 days to just five, helping more patients safely return home sooner.
Nearly half of patients using the reablement service, which helps people relearn how to do daily activities like cooking meals and getting dressed, are now able to regain independence faster which is a significant improvement in personalisation and recovery.
Richard Parker, Interim Chief Operating Officer at The QEH, said: “This is a fantastic example of how genuine collaboration can deliver real impact for patients.
“Through digital innovation, joint working, and a shared commitment to person-centred care, we’ve created a safer, more responsive discharge process that works for everyone.”
Paula Fuller, Complex Discharge Matron, added: “Seeing the difference this has made to patients and families is incredible. We’ve gone from frustration and delays to personalised, timely discharges – and the whole system feels more connected.”
Using a cloud-based platform (OPTICA), a joint Trusted Assessment model, and newly commissioned community beds, the programme has already saved the system over £4 million by reducing the days patients are in hospital and do not need to be therefore closing 60 unfunded hospital beds.
The number of patients awaiting discharge has dropped from over, on average,140 to fewer than 50.
This project has been entered in the HSJ Partnership Awards 2025 under the category Best Partnership Supporting Personalised Care Pathways and finalists are due to be announced on 15 December.
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