About this action

Patients from marginalised communities experience higher emergency and readmission rates. Comprehensive and holistic approaches addressing both social and medical can break cycles of crisis and admission. Approaches to implementation: - Map admission patterns to identify Focus Patients at highest risk - Develop partnerships across health, social care, and voluntary sectors - Create integrated discharge planning involving community support - Establish peer support networks for condition management - Address social factors that undermine self-care - Provide intensive support during high-risk transition periods - Share successful models across the system Key benefits: Reduces inequalities in emergency admissions by providing wrap-around community support that addresses both medical and social factors affecting health.