The Community Health & Social Care (CHASC) service is an integrated service with specialist community teams supporting our local population in Oldham. These teams work together for the best outcomes to support discharges, with the four key aims to;
- Support people to remain at home
- Help people to avoid going into hospital unnecessarily
- Help people return home from hospital as soon as they are medically safe to do so
- Prevent people from having to move into a residential home until they really need to.
The service provides assessment and short-term interventions including crisis intervention, facilitated hospital discharge, intermediate care and enablement services to patients.
The service consists of;
- Integrated Discharge Team
- Community Discharge Hub : should it have discharge in the title as its for step up not step down
- Crisis Enablement Team
- Intermediate Care
- Community Therapy Hub :
- Community IV Team
- District Nurse Liaison
- Palliative Care Coordination Centre
Integrated Discharge Team
The Integrated Discharge Team are based at the Royal Oldham Hospital providing support and assessment 7 days a week. The team consists of Transfer of Care Nurses, Elderly Person Mental Health Nurse and social workers who are ward based focused to support the most complex patient to be discharged to the appropriate place at the earliest opportunity.
Community Discharge Hub
The Community Discharge hub supports a person from an acute setting to the correct place to meet their needs. A Home First (pathway 1) approach is always adopted, and only where a person is unable to return home are pathways 2 (Intermediate care) and 3 (short term placement) utilised. Community support for patients in their own home or care home setting can also be requested. A Discharge to Access (D2A) referral form is completed by the most appropriate person that know the patients needs for all pathways and its then traged by the Integrated discharge hub clinician.
Crisis Enablement Team (ICET)
The ICET team helps people get home from hospital quickly and safely and provide a admission avoidance rapid community response service. They provide a rapid response service to people in urgent need of health and social care interventions at home within 4 hours of referral. They also provides short-term interventions for up to 5 days before either withdrawing or making an agreed onward referral to other community services.
These are community, short term rehabilitation beds which support the person to work with a multi-disciplinary team to gain as much independence as possible and help them return home.
Community Therapy Hub
The Community Therapists provide support and rehabilitation and support for people in their own homes following on from ICET or bed based Intermediate care. The team also support people at home to avoid an admission to hospital. The team also take referrals from the community and will support people at home to avoid an admission to hospital
Community IV Team
The delivery of IV therapy in the community setting can reduce the requirements for hospitalisation and improve quality of life.
You can be referred to our service by health and social care professionals.