Transfer of Care Hub (TOCH)

Transfer of Care Hub (TOCH)

The Transfer of Care Hub (TOCH) is an integrated multi-disciplinary team of nurses, therapists, associate practitioners, social care professionals, administration support staff and discharge co-ordinators. The team works to ensure timely and safe discharge linking hospital and community services to ensure the best outcome for people leaving hospital.

We take a “Home First” approach sourcing packages of care delivered to people within their own homes, using Reablement, Rapid Response and domiciliary care agencies. We co-ordinate support required from each care community such as occupational and physiotherapy, district nurses and other specialist teams. This allows patients who require support following discharge to receive care in their own home. 

The Transfer of Care Hub also supports patients who require short-term community bed-based rehabilitation, recovery or assessment of long-term needs that can’t be met within their own home. Following a Discharge to Assess model, ongoing care and assessment is provided in care homes which have been commissioned by the Integrated Care Board (ICB). The Transfer of Care Hub will complete an assessment of your needs, ensuring you are discharged to a place of care that can best meet your needs. All the Discharge to Assess beds have access to community therapy and social care, to support your long-term discharge planning.

Referral Process 

Patients are referred to the Transfer of Care Hub via, hospital staff, and community hubs.