Community Transformation Programme: building momentum across the system

We’re starting to see clear evidence that the Community Transformation Programme is making a positive difference across Derby and Derbyshire. This is a complex, system-wide effort and, while pressures remain, there are encouraging signs of progress in admission avoidance, discharge and care closer to home:

 

  • Community navigators are now supporting around 25 people each week to return home from ED rather than being admitted, with scope to increase this towards our target of 40 per week.
  • The Care Transfer Hub is improving coordination across organisations and supporting more timely discharge.
  • At Chesterfield Royal Hospital, early improvements have led to a 1.5 day reduction in discharge times, getting people with complex needs home with reablement support services.
  • In parts of the county and in Derby, home-based enablement support is now the strongest it has ever been.

 

These are meaningful improvements for patients and residents. In a complex system, benefits are often absorbed elsewhere, so they may not immediately show up as empty beds or financial savings, but they are undoubtedly improving flow and reducing avoidable delay. There is strong agreement that the core approaches the programme has introduced – including community navigators, the Care Transfer Hub, and new discharge pathways – are the right ones. What we’re seeing now is the impact when these are applied well across teams and organisations.

The opportunity ahead is to build on this progress and make these new ways of working routine across the system, so that patients benefit from them every day. These are not complex changes, but when delivered reliably and at scale, they make a significant difference. Sustaining our progress will depend on continuing to strengthen day-to-day working alongside the strong collaboration and shared ownership we’re already seeing across partners. Overall, the direction of travel is positive, with a clear opportunity to continue improving outcomes for patients and residents across Derby and Derbyshire.