Integrated Crisis Response Service

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 91 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and family members we spoke with said they had not raised any concerns relating to safety and expressed confidence in the service to keep them safe. People were aware of how to raise a concern. A person told us, “They gave me information at the beginning and so I knew who to contact if I was worried, but I didn’t need to.”

Systems and processes for reporting and monitoring safety incidents and accidents were fully understood by staff. A member of staff told us, “We have a form which is to be completed within 24 hours of the incident. Information collected includes the time, place and any supporting photographs. The completed form is forwarded to the health and safety team for triage (determine level of risk). If needed, referrals are made for support such as physiotherapy and temporary adjustments.”

Learning was shared following incidents. A member of staff told us, “If there’s anything to be aware of, we will be informed. Relevant information concerning accidents and incidents will be recorded on the system and office-based staff will ring us to de-brief. Where they are safety concerns, they normally send 2 staff.” A member of staff shared an example of where a member of ICRS had been physically assaulted by a family member of a person using the service. The required form had been completed, and the incident was reported to the relevant authorities. Following the incident a de-brief was held and a risk assessment put in place to mitigate future risk.

The registered manager evidenced their commitment to a proactive and positive culture of safety, facilitated by a robust and comprehensive analysis of concerns and incidents relating to safety. Senior managers and the provider’s health and safety team investigated all incidents with all events being triaged. For example, the 8 incidents reported in 2025 were all found to be low-harm events which had not required escalation to RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) and no repeated themes were identified. The analysis of the individual incidents identified a combination of contributory factors, and in response follow up actions were taken.

A key health care partner told us, “ICRS actively seeks input from system partners rather than managing risk in isolation. Clear documentation, sharing of assessment and regular updates enables informed decision making and co-ordinated care planning. This approach demonstrates a strong safety culture.”

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

People spoke positively of the referral process to the Integrated Crisis Response Service (ICRS), which showed how the collaborative approach between health and social care partners facilitated a smooth and timely referral process. A person told us, “We were referred via a paramedic. ICRS staff came out and explained that it was a short-term service for about 6 or 7 days.”

As part of the support provided, ICRS staff with the necessary experience and skills undertook a Care Act Assessment (an assessment undertaken by local authorities to identify a person’s support needs). This was then shared with partner agencies, where ongoing care and support had been identified. A person told us, “ICRS were with us for about 8 days and they passed on all the information to the new company, it was a very smooth process. The crisis team made everything easy for us.”

A social care partner told us, “ICRS liaise with various teams within the local authority to ensure any person transferring between services has a clear support plan, assessment and transfer summary so that care is continuous, and the service to which the person is being transferred to understands their situation and needs. ICRS works closely when arranging ongoing care where the need is identified, and because they have provided the initial period of support, they can supply a clear outline of the practical aspects of care delivery when requesting follow on care.”

The focus on high-impact crisis intervention to avoid hospital admission and provide hospital discharge support and response to falls resulted in 6,100 referrals to ICRS in 2025. A health care partner told us, “Strong working relationships with partner agencies support efficient pathways, with staff maintaining a clear understanding of the services available across the system. This shared awareness helps prevent delays in referrals and ensures people receive the right support at the right time. Where additional input is required, the service works collaboratively with partners to resolve barriers and coordinate care.”

A health care partner told us, “ICRS supports safe transitions and continuity of care through a rapid, coordinated approach to crisis intervention. The service provides a 2-hour response, completing an initial holistic assessment and implementing immediate interventions to stabilise risk and support people to remain safely at home wherever possible. While ICRS typically delivers short-term support (up to 72 hours) to stabilise a crisis, there is a strong focus on ensuring that any ongoing health or social care needs are identified early, and that onward support is in place prior to discharge from the service.” The provider’s data showed the 2-hour response time was consistently achieved in 2025.

Referrals to ICRS were received from a variety of partner agencies, including emergency and out of hours health care services, and social care partners. During the day referrals were managed by a dedicated member of the ICRS team, whilst at night referrals were made direct to front line staff, in most instances these were a request for assistance for them to attend a person who had fallen at home.

Multi-disciplinary team meetings were regularly held, which involved ICRS and the Reablement Provider Service, which supported a joint up approach to care. ICRS staff supported their colleagues within the reablement service by providing a second member of staff, where people required 2 staff to support them.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their family members expressed no concerns regarding their safety and spoke positively of the service and the kindness of staff which made them feel safe. A person told us, “I felt very safe, knowing that someone was coming each day.”

Staff raised safeguarding concerns, liaising with a range of services to protect people from discrimination, harm or abuse. This included services who supported people with mental health, and alcohol and drug support services.

Staff demonstrated a good understanding of what would constitute a safeguarding concern, had an in-depth knowledge as to the forms of abuse, and were aware of the agencies to escalate information of concern to if required, including police and social services. A member of staff told us, “I will check with the office, in some cases I have rang the safeguarding number whilst onsite. We have relevant contact details for safeguarding concerns.” Staff had undertaken training in safeguarding children and adults, and this was regularly updated.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

People and family members spoke positively of how risk was mitigated by the staff of the Integrated Crisis Response Service and the impact this had on them. A person told us, “I was desperate and I googled for Social Services help, and I spoke to someone in social services. ICRS staff arrived the next day to do the assessment. From there help and support came quickly.” This provides an example as to how the referral process to ICRS from social care partners, works in a timely and seamless way in promoting people’s safety and wellbeing.

People and family members told us how they were involved in decisions relating to their care, which included when equipment was identified to support people’s safety and facilitate their independence. A person told us, “A member of staff came out, I was there and they ticked every box. They were so kind and did a risk assessment and made suggestions of aids and what were available. They put in place bath aids, seating in the shower, a frame with a table. They identified everything we needed.”

In some instances, ICRS based themselves within a hospital setting, and were able to respond immediately to a referral made by hospital staff. ICRS staff spoke with the person either in the accident and emergency department, or on a ward. ICRS staff were able to identify with people any concerns they had about returning home, and to agree the support ICRS staff could provide to reduce risk and support a person’s safe return to home. For example, a short-term package of care to provide assurance and support following their discharge from hospital. A person told us, “I was referred from the hospital, ICRS came in the same day.”

The ethos of the service was to mitigate risk to people by providing high impact crisis intervention, which operated 24 hours a day, 7 days a week. Referrals at night were directly received by ICRS staff on duty, with most requests for assistance at night being to attend people who had fallen at home and to conduct welfare checks. ICRS staff were provided with equipment and the required training, which enabled them to assist people from the floor, when assessed as being safe to do so. Protocols for assisting people were adhered to by staff, which included speaking with the person, identifying what had happened, and noting any obvious injuries, pain or discomfort. Staff throughout their involvement continually assessed any potential risk.

Statistics provide clear evidence of the negative impact on people’s health and well-being of remaining on the floor for long periods of time, known as a ‘long lie’, having fallen, and the increased potential of their having to be admitted to hospital. In 2025 the service received 1726 requests for assistance to people who had fallen at home, of which 72% of people remained independent following short-term support from ICRS, with only 4% having to be admitted to hospital, which demonstrates the effectiveness of the service and the positive impact on people’s health and well-being.

A social care key stakeholder told us, “ICRS acts as a responder service for telecare alerts when there are no other local responders able to respond. The service is also a designated responder for people who have fallen, able to attend to a person promptly and reduce the likelihood of a long lie.”

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

People and family members were unequivocal in their praise of the service, and the impact of collaboration between services, which resulted in their receiving equipment to maintain their safety and support their independence. A family member told us, “A member of staff came out and did a full assessment including equipment, we were given a commode to help in the short term.” A second family member said, “Staff came out the same day of the referral to assess, they had a big list of what we needed, hoist, hospital bed and commode, were all sorted out for us.”

A social care key stakeholder told us, “ICRS has, when needed, supported people by collecting equipment, and installing and demonstrating its use. This has allowed people to be supported without delay and without requiring other immediate care support.”

Collaborative working with key partners enables ICRS to refer people to physiotherapy and occupational health colleagues, in a timely manner, supporting good outcomes for people. A social care key stakeholder told us, “ICRS have close links with health partners and can obtain appropriate support quickly when this is identified. For example, their links with HomeFirst mean that they can initiate therapy input, access to equipment and aids for someone quickly to reduce risks and commence recovery.”

Records evidenced household risks were identified as part of the dynamic risk assessment process, which included considerations of people and staff safety. For example, parking arrangements, pets, and whether the home was fitted with a smoke or carbon monoxide alarm. The Integrated Crisis and Response Service referred potential fire risk concerns to the fire and rescue service. A member of staff told us, “We complete a dynamic risk assessment, which includes details including, key safe and access to a person’s home, lone working, fire risk, infestation, mobility needs, people’s preferences, pressure ulcers, assistive technology and equipment.”

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

People and family members were consistent in praising the staff of the service for their execution of their duties and their responsiveness, evidencing there were sufficient staff with the necessary skills and experience. A person told us, “I was discharged from hospital, and the ICRS came the same afternoon, and we decided what I would like help with. They asked all the questions and did a full assessment and offered me 3 support calls a day.”

People’s needs, including protected characteristics as defined by the Equality Act, were considered as part of the assessment and when scheduling care calls, which ensured staff understood and were able to meet people’s communication, religious and cultural needs.

An ICRS member of staff whose role was to respond to referrals and schedule care calls told us, “During the day a co-ordinator is on duty, who takes the initial referral and schedules care calls. We respond to queries from the ICRS care staff, emergency duty team (social services) and people’s families, working between 7am and 10pm. When scheduling care calls, we only book a day in advance, due to things changing very quickly. We consider where a person requires 2 staff, if Elk (is an emergency lifting device that uses an air powered cushion designed to inflate and gradually lift a fallen person up off the floor.) or moving and handling equipment is required.” In some instances, care calls were scheduled for during the night between the hours of 10pm and 7am, either to provide personal care and support or to carry out a well-being check. In addition, front line staff responded within 2 hours to referrals and requests they received during the night.

Staff had undertaken specific and targeted training which enabled them to respond safely and effectively to people who were referred to the service, which included ‘Elk’ training. Staff were provided with equipment and training to carry out observations (checking oxygen levels, blood pressure and temperature) of people who had fallen.

Staff received training from a key health partner in assessing for injuries and undertaking observations such as blood pressure and temperature to support them in making safe decisions when responding to people who had fallen at home. A member of staff told us, “Training on responding to falls, provides information about when we should not move the person, for example when they have hurt their spine or pelvic area. Also, when it may be safe to mobilise a person and when to seek medical advice, by using the dedicated phone number we have.”

Records showed staff had undertaken training in a range of topics related to health, safety and welfare to enable them to respond in a crisis and with consideration to specific areas of need. For example, suicide and prevention training, and Oliver McGowan national learning disability and autism training.

The skill and knowledge of staff was recognised by key health and social care partners. A key health care partner said of staff, “All have been trained in Safeguarding, and I am aware they have been at the heart of some very complex and difficult cases. So highly skilled and motivated in risk assessment and in advocating for people in their care. What I find most impressive about their approach in this area is the ICRS leadership is so clear about the scope of staff practice – the developments in this area have been done incrementally with a focus on high quality training, and validation, supervision etc.”

Staff were recruited in a safe way. Appropriate checks were carried out prior to people commencing work to enable the provider to be confident suitable staff with the right skills and experienced were employed. Staff received the support they needed to deliver safe care; this included supervisions, appraisals and support to develop and learn. Staff confirmed they had regular supervision and had their care practices checked. Staff completed the Care Certificate (set of essential standards for health and social care support workers) as part of a structured induction and were encouraged to study for vocational qualifications in care and were proactively encouraged to undertake higher learning to enable them to progress within their career.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and family members confirmed staff followed infection control procedures by wearing personal protective equipment (PPE), which included gloves and aprons. A family member told us, “Staff always used PPE, gloves and aprons, and they were very clean and tidy. Another family member said, “Staff were gloves, aprons and shoe covers.”

Staff completed training in infection prevention and control, and observations of staff competency included assurance staff adhered to the provider’s infection prevention and control policy.

registered manager informed us infection prevention and control remained a core part of the service’s working practice. There were clear expectations for all staff and regular refreshers to maintain compliance, with the principles of minimising risk, promoting hygiene, and responding to emerging illness remained fully embedded in everyday practices.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were supported with taking their medicine if the assessment had identified this was an area of need. A person shared with us how the support they received impacted on them and their family. They told us, “Staff made sure I was back on track with all my medication. I had got to the stage where I didn’t give a damn, but staff helped me”. People also told us they were independent with managing their own medication. A person said, “I do my own medication, I like to be independent.”

People’s medication needs were considered as part of the assessment process and scheduling of care calls. An ICRS member of staff whose role was to respond to referrals and schedule care calls told us, “ICRS referrals come from a range of health and social care professionals and services, and include information as to people’s medication, including critical time medication.”

People’s medication was discussed with them as part of the dynamic risk assessment. Discussion with staff, and care records demonstrated ICRS liaised with health care professionals where concerns were identified with medication. For example, staff had identified a person was choosing not to take their medication and had, with the person’s consent, escalated their concerns with their G.P., requesting they carry out a review of the medicines prescribed, based on the person’s reason as to why they had stopped taking their medication.

ICRS made referrals for care technology, which included programmable equipment to remind people it was time to take their medicine. A member of staff told us, “We sometimes liaise with pharmacies to request an electronic dispenser for medication.”

Staff received training and had their competency in medicine management assessed.