The challenges facing the NHS require fundamental change in how care is delivered. The “3 shifts” in the NHS refer to the three strategic changes planned for the health service: moving from hospital to community care, from analogue to digital, and from treatment to prevention.
The good news is these shifts are already underway, ensuring people receive the right care, in the right place and at the right time. At Sirona, our approach is aligned to support and enable them. Explore some of the examples below.
Analogue to Digital
Speech and Language Therapy – Care Home Swallow Self-Management project.
In 2022, the North Somerset Adult Community Speech and Language Therapy (SLT) team faced long waiting times due to frequent and often inappropriate swallow referrals from care homes. With extensive collaboration from Care Homes themselves, GPs and ANPs, the SLT service developed a swallowing self-management system with questionnaires, resources, and later an online platform supported by a dedicated advice email. This empowered care homes to manage simple swallowing issues safely without the need for referral to SLT.
The initiative has benefited everyone involved. Care homes and residents now receive immediate swallow support, training resources, and CQC-ready documentation. Referrers gain direct access to SLT advice, enabling prompt management without need to complete referral forms. When visits are required, the SLT team are able to deliver targeted and efficient visits.
The team has shared the process with external SLT colleagues across the South West, supporting several services to adopt a similar approach and avoid duplicating effort.
The goal is for all care homes across BNSSG, including ALD settings, to use the same platform, promoting equitable access to resources, consistent guidance, and improved efficiency, safety, and confidence for both care home staff and SLTs.
This is a great example of the way AHPs innovate to optimise quality and safety whilst also ensuring more effective use of limited resources.
Hospital to Community / Treatment to Prevention
Case Study: AHPs leading multidisciplinary, integrated working in and beyond Sirona
This story describes a case in which an elderly lady became acutely unwell and had a fall. Her daughter called 999 and after review, a referral was made from the Community Emergency Medicine Service to Sirona UCR and NHS@Home. After investigations and assessments were made, the NHS@Home practitioner made a referral to the INT therapy team who carried out a comprehensive assessment including a falls risk assessment advising on equipment and environmental changes. Sadly this lady did require admission to hospital for treatment, but the story illustrates how Collaboration between paramedics, Frailty-ACE, NHS@Home clinicians, and therapists ensured a joined-up pathway.
Hospital to Community
- Early referral to Frailty-ACE avoided immediate ED admission.
- NHS@Home provided rapid diagnostics, close monitoring, and safety-netting.
- Timely escalation to hospital was made when deterioration occurred.
Treatment to Prevention
- Referral to South INT team ensured ongoing support with falls prevention, mobility, and home safety
- Education and reassurance given to the daughter improved her ability to care and recognise deterioration.
This is an illustration of the value of AHP input within community teams — addressing not only the acute presentation but also long-term risk reduction.
Hospital to Community / Treatment to Prevention
MSK Community Appointment Days (CADs)
Since March 2025, Sirona’s MSK Physiotherapy team have been delivering MSK Community Appointment Days (CADs) in collaboration with NBT and UHBW. These were initially held as part of the community MSK GIRFT programme but are now in the process of being embedded as business as usual, with 9 collaborative MSK CADs having been delivered in the last 7 months.
CADs are a key step in meeting the NHS Long Term Plan’s ambitions to bring healthcare closer to home, reaching patients earlier, and making the healthy choice the easy choice. By delivering musculoskeletal assessments within community settings, these days make care more accessible and reduce the need for multiple appointments. They embody a personalised care approach through “what matters to you” conversations that focus on individual goals and priorities, helping to de-medicalise care and place the person, not the condition, at the centre of decision-making.
We have also been working in collaboration with VCSE providers and offering health checks at the CADS, creating a true “one-stop shop” for patients. Patients can directly access the support that is most helpful to them – whether that is rehabilitation advice, physical activity groups, support for long term condition management, wellbeing services, or lifestyle advice – reducing the need for onward referrals and additional waiting lists. By empowering patients and connecting them to community resources, MSK CADs promote independence, improve patient experience, and deliver care that is truly holistic and locally driven.
Hospital to Community
Speech and Language Therapy (SLT) Dysphagia Team – Children’s Services
In Speech and Language Therapy (SLT) Dysphagia team, we work closely with our acute hospital colleagues to ensure smooth transitions between hospital and the community. When babies in NICU have swallowing difficulties, the hospital SLT service assesses them and provides support during their stay. When it is time for the babies to be discharged, the team refer to us and also liaises with us directly so we are fully updated on the babies’ needs. We see 0-2-year-olds within 4 weeks of referral, often sooner, so we are able to be very responsive. We are also able to refer back to the hospital team for outpatient videofluoroscopy assessments to add to the clinical assessment picture. Similarly, if a child under our care goes into hospital, we are able to liaise with the hospital SLT team to ensure their feeding needs are met whilst they are an in-patient.
Treatment to Prevention
Posture Management Pathway for Adults with Learning Disabilities
Physiotherapists and Occupational Therapists in the learning disability team are now offering a proactive, preventative pathway for people with postural management needs. These are people with profound and multiple learning disabilities who require 24-hour postural support to prevent aspiration, pressure injury and pain.
- People with complex posture needs are now reviewed jointly by a Physiotherapist and an Occupational Therapist every 18 months. Each review looks at body shape, movement, equipment needs, and whether any onward referrals are needed.
- This new, joined-up approach helps us to spot problems early and avoid emergencies, improve people’s day-to-day wellbeing and improve comfort and quality of life. In the longer term, it will also lower healthcare costs by avoiding surgeries, hospital stays, or extra equipment.
