Community Transition Services

Supporting People’s Move from
Hospital to Home

About Us

Every week, our teams support people with multiple needs in complex situations who are ready to return home. People should feel supported to choose their own pathways back into the community after months or years spent in hospitals or assessment and treatment units.

Our focus of support:

Learning Disabilities Support   

Mental Health Support

Autism Support

Buccal Midazolam

Complex Care

Epilepsy Support

Makaton

Eating Disorders Support

Supported Living

What’s next after the hospital?

Upon discharge, we work with care providers to offer ongoing support, proactively identify potential challenges, and minimise hospital readmission risk. Our teams remain in close communication with the person and their care providers until they are stable and ready to move to long-term support with a confident provider.

Why CTS Matters?

It matters because far too frequently, people leaving hospital have experienced significant trauma, and have challenges reintegrating into community living. CTS is a piece of the puzzle that works to overcome those barriers.

Here is how our Community Transition Service changes that.

Recently, our CTS team supported a transition home for someone, after 18 months in hospital, within just 6 weeks of stepping in. The result? A stable transition, and over £1.5M in costs saved. You can read more about it here.

CAN WE HELP YOU NEXT?

Our Responsibilities

Our Specialists

PROACT-SCIPr-UK® Accredited

Training care teams to deliver proactive, therapeutic support by using practical innovative strategies and reducing reliance on restrictive practices.”

How do we care for our team’s well-being and safety when incidents happen?

Here you can read more.

Proven Transition Framework

Hospital Setting

Create a team to match person’s unique needs and characteristics

In-Reach

Work together with the person as a part of their specialist support team.

Help to find suitable community support where people can thrive.

Transition

Ensure a smooth transition to a new home and provide all necessary support.

Work in partnership with the new provider to ensure the right match for each person.

Discharge

Gradually withdraw our support team.

Provide assistance and support to the person and the new provider until we ensure that the transition is safe and well established.

We work in partnership with Integrated Care Boards, local authorities, and other care providers for effective discharge support.

Outcomes

The care professionals we work with know there is a better way with us.

Lisa had spent almost three decades in a hospital – thirty long years where the idea of returning home might have seemed unimaginable. Yet today, that is her reality. We knew this was possible, and with the right human-centric support, she now lives in her own home, making choices and decisions that fit her needs.

Here is why.

The care professionals we work with know there is a better way with us.

Before Discharge

During Discharge

After Discharge

Read our transition journeys

Download Case Studies


Our Team

Sacha Frost

Regional Manager

I’ve worked in healthcare since I was 16 and, with over eight years at the company, I’m passionate about supporting others, driving growth, and making a positive impact while balancing family life and staying active

Jenny McGuire

Senior Care Co-ordinator

With 3 years in healthcare, I enjoy creating tailored care packages with the right team, supporting our internal team, and being the main point of contact for clinicians, with the most rewarding part of my role being smooth, successful transitions from hospital to home.

Hannah White

Care Coordinator

With nearly 5 years experience as a support worker and care coordinator, I love building strong relationships, visiting the individuals we support, and seeing the positive impact our care has on their lives.

Kierra Walker

Care Co-Ordinator

Since starting my healthcare career at 17, my commitment to person-centred care and making a difference in people’s lives has remained at the heart of my work.

Prevent Delays. Ensure Support.

We take it from here.

Our dedicated transition team ensures the care is continued without interruption and re-admission risk.

Contact Us or Make a Referral and See the Difference


Bristol Office Details

Working Time

24/7

Telephone

0345 894 2264 

Email

contactus@nurselinehealthcare.com

Location

2510 Aztec WestBristol BS32 4AQ