A compilation of real-world examples demonstrating how local authorities and integrated care systems have implemented Trusted Assessor models to improve hospital discharge, reduce waiting times for equipment, and support independent living. These case studies provide evidence of outcomes achieved and lessons learned from implementation.
Overview: the development of Trusted Assessor models
The Trusted Assessor role originated as a Department of Health initiative which aimed to reduce waiting times and get community equipment to service users more quickly, enabling a greater number of staff to provide low-level equipment and minor adaptations at point of need without an Occupational Therapy referral¹. The role has since evolved significantly, now encompassing assessment for both low-level equipment and major home adaptations, and operating across discharge hubs, reablement teams, care agencies, and housing services.
Case Study 1: Lincolnshire Care Home Trusted Assessor Pilot (2015 onwards)
Context and Challenge
Lincolnshire experienced significant delays in hospital discharge caused by care homes needing to complete in-person assessments of hospital patients before accepting placements. With hospitals and care homes often some distance apart, and care providers already stretched on staffing, travelling to hospital for assessments within short timeframes was consistently problematic, creating a bottleneck in the discharge system.
Solution Implemented
In 2015, the Lincolnshire Care Association created a dedicated Trusted Assessor role based permanently within the hospital discharge hub. This individual, trusted by all care homes in the system, conducted hospital-based assessments on behalf of multiple providers – eliminating the need for each home to send its own staff.²
Key activities:
Quantified outcomes — first full year of operation
Case study 2: Somerset Independent Trusted Assessor Service
Context
Somerset implemented an independent Trusted Assessor service employed via the Registered Care Providers Association (RCPA) to facilitate safe and timely care home placements from acute hospital settings.
Implementation approach
Rather than employing Trusted Assessors directly within NHS or local authority structures, Somerset commissioned an independent service working on behalf of all care home providers in the area. This maintained impartiality whilst ensuring standardised assessment processes.
Outcomes and impact
Case study 3: Cwm Taf Morgannwg Home First Service (Wales)
Service overview
A partnership between Cwm Taf Morgannwg University Health Board, Rhondda Cynon Taff County Borough Council, and Merthyr Tydfil County Borough Council established a Home First service with integrated Trusted Assessment capability.³ The role has been operational since 2017.
Service design
The multidisciplinary Home First Team includes:
The service operates seven days per week with Occupational Therapy and Physiotherapy access throughout the week to enable rapid response.
Trusted Assessment component
Trusted Assessment is embedded within the Home First Team to support:
Outcomes and impact
Case study 4: Croydon blended assessor model
Innovation in role design
Croydon developed an innovative ‘blended assessor’ role combining two formerly distinct positions—social worker and health band 6 discharge coordinator—into a single position with joint assessment responsibilities.⁴
Rationale
Traditional models required separate input from social care and health professionals, creating delays and duplication. The blended role simplifies assessment without sacrificing expertise from either sector.
Implementation success factors
Outcomes
Case Study 5: Age UK Home from Hospital with trusted assessment
Service model
Age UK’s Home from Hospital service operates Pathway 1 discharges using accredited Trusted Assessors to complete referrals to social care, enabling people to return home with third sector support prior to full assessment of ongoing care needs.⁴
Process
Benefits realised
Case study 6: Oxfordshire Association of Care Providers / Oxford University Hospitals NHS Foundation Trust (April 2024 – March 2025)
Service overview
The Oxfordshire Association of Care Providers (OACP) delivers a Trusted Assessor Service commissioned in partnership with Oxford University Hospitals NHS Foundation Trust. The service operates across multiple acute hospital sites in Oxfordshire, providing a single point of contact for care providers and comprehensive assessment support for hospital discharge.⁵
What the service does
Quantified outcomes – April 2024 to March 2025
927 assessments completed in a single year – an average of 4.73 assessments per working day.
Significance
The Oxfordshire model provides some of the most detailed quantified evidence available for the Trusted Assessor approach. The £2.2 million system saving in a single year, achieved through reducing delayed discharges and releasing care provider capacity, illustrates the significant return on investment possible when the model is embedded effectively in local discharge pathways. The 92% same-day or next-day response rate demonstrates the speed advantage over traditional individual provider visits.
Case study 7: NHS Midlands and Lancashire – retrospective CHC assessments (2020–2021)
The challenge
The NHS Continuing Healthcare (CHC) Framework was suspended from March to August 2020 due to COVID-19, with all care facilitating hospital discharge or preventing admission during that period automatically funded by the NHS without formal assessment. When the framework resumed in August 2020, a mandatory deadline of 31 March 2021 was set for completing retrospective ‘deferred assessments’ of all those patients – over 5,000 individuals across five Integrated Care Systems in the NHS Midlands and Lancashire region.⁶
Solution: Trusted Assessor model deployed at scale
Faced with a seven-month window to assess more than 5,000 individuals – while simultaneously managing ongoing discharge pressures – the system deployed a Trusted Assessor model drawing on multi-agency partnerships:
Outcomes
Summary of key outcomes across case studies
| Outcome domain | Evidence from case studies |
| Reduced discharge delays | Consistent finding across all case studies; 92% of Oxfordshire referrals dealt with same day or next day (2024-25) |
| Assessment volume | 340 assessments in Lincolnshire’s first year (2015-16); 927 in Oxfordshire in 2024-25; 5,000+ CHC assessments completed in 7 months (NHS Midlands & Lancashire) |
| System financial savings | £2.2m saved for the Oxfordshire health and care system in 2024-25 alone |
| Provider capacity released | At least 4,000 hours of care provider time saved in Oxfordshire in 2024-25, freeing staff for direct care |
| Assessment duplication eliminated | Single assessment accepted by multiple organisations across all case studies; 63% of Oxfordshire referrals made directly by providers rather than via hospital teams |
| Safe discharge facilitated | 304 of 340 assessments resulted in successful discharge in Lincolnshire’s first year (89%); appropriate care placement confirmed across Somerset, Cwm Taf Morgannwg |
| Partnership working strengthened | Multi-agency collaboration delivering shared objectives across all examples; national CHC award nomination (NHS Midlands & Lancashire) |
Critical success factors identified across case studies
Analysis of these implementations reveals consistent factors contributing to successful Trusted Assessor models:
1. Clear governance and agreements
2. Strong partnership working
3. Appropriate training and competency
4. Embedded within discharge systems
5. Clinical leadership and buy-in
Implementation challenges and learning points
While these case studies demonstrate positive outcomes, implementation is not without challenges. Common issues identified include:
Resource and capacity constraints
Systems require adequate community capacity to accept discharged patients. Without sufficient reablement beds, homecare availability, or care home capacity, even excellent Trusted Assessment cannot resolve system bottlenecks. The Cwm Taf Morgannwg model addresses this through integrated service provision including seven-day reablement.
Communication and information sharing
Digital systems that enable seamless information sharing between organisations support Trusted Assessor effectiveness. Where systems are not integrated, ensuring all parties receive assessment information promptly requires attention to process design.
Maintaining person-centred focus
Evidence from Kent’s Discharge to Assess evaluation highlighted risks of Trusted Assessment being understood ‘primarily as a tool for reducing discharge delays rather than one for facilitating discharge and providing individualised support.’⁷ Successful implementations maintain focus on appropriate, person-centred outcomes rather than purely flow metrics.
Conclusion: evidence for Trusted Assessor effectiveness
These case studies provide substantial evidence that Trusted Assessor models, when properly implemented with appropriate governance and training, deliver:
Success requires attention to governance frameworks, adequate training, system capacity, and maintaining person-centred principles alongside efficiency objectives. The models described demonstrate various approaches – from independent services to embedded multidisciplinary teams to innovative blended roles – indicating that Trusted Assessment can be configured to suit local circumstances whilst delivering consistent benefits.
For local authorities and ICBs considering Trusted Assessor implementation, these case studies provide both evidence of effectiveness and practical insights into factors supporting successful adoption.
References
1. Disabled Living Foundation / Living Made Easy. Trusted Assessor Training. Available at: livingmadeeasy.org.uk/dlf-training. See also: Foundations (Home Improvement Agency). Trusted Assessor: Overview and History. Available at: foundations.org.uk
2. Living Made Easy. Trusted Assessors: A key to reducing hospital discharge time. Available at: livingmadeeasy.org.uk
3. NHS Wales. Trusted Assessor Case Studies. Available at: performanceandimprovement.nhs.wales
4. Department of Health and Social Care. Hospital discharge and community support guidance. January 2024. Available at: www.gov.uk/government/publications/hospital-discharge-and-community-support-guidance
5. Oxfordshire Association of Care Providers (OACP). Trusted Assessor Service: Outcomes 2024-25. Available at: www.oacp.org.uk/trusted-assessors
6. NHS Midlands and Lancashire. Clearing a 5,000-patient backlog of continuing healthcare assessments. June 2024.
7. Gadsby EW, Wistow G, Billings J. A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent. Critical Public Health. 2022;32(5):743-755.
Case studies compiled February 2026
