400 local patients will benefit from a scheme that will help people with multiple health needs to live well at home for longer and stay out of hospital.
Hounslow Council and local NHS providers have teamed up to launch Hounslow Care Together (HCT), which will help residents who are frail or require extra health and care support.
The pilot will improve the level of care for a selected group of Hounslow residents who frequently need medical and social care and aims to reduce A&E attendances and GP visits. The results will then be assessed and a decision made on whether to roll the services out to more patients in the future.
The new service includes colleagues from the West London NHS Trust, Hounslow Council, the voluntary sector, and West Middlesex Hospital.
They will work in local neighbourhoods to deliver care that addresses patients’ needs closer to home and with more coordination between health and social care services. They work with people who frequently use GP, A&E, or hospital services.
Their work includes proactive home visits, developing and delivering care plans, urgent support, and helping patients to connect with local community groups.
Each team includes: a GP, a nurse case manager, a support worker, and a community health care worker.
They are supported by extended teams that include: an occupational therapist, a pharmacist, a social worker, housing support, and a community connector.
Councillor Lily Bath, Hounslow Council’s Cabinet Member for Adult Social Care, Public Health and Transformation, said:
Hounslow Care Together recognises that health is about more than healthcare. Bringing together teams from the NHS and Council care services means people get the best care at home. It is the biggest step we have taken towards true integration at the neighbourhood level.
Crucially, this is not the NHS working with the council, it is local government and health partners working as one. Joint funding through the Hounslow Borough Based Partnership signals shared accountability for outcomes, experience, and public value.
Dr Christopher Hilton, Chief Operating Officer (Local Services), West London NHS Trust, said:
Hounslow Care Together reflects the NHS Long Term vision for joined-up, out-of-hospital preventative care in local neighbourhoods. It’s about working as one system around the patient.
Martin Waddington, Director of Commissioning/Borough Director, Hounslow NWL ICB, said:
Too many residents experience fragmented care. Hounslow Care Together puts people, not processes, at the centre, building strong relationships with teams that work together locally.
