At the Health Innovation Network (HIN), we’re open about what we do and we share what we learn. In 2018, we published an extensive evaluation of the Red Bag Hospital Transfer Pathway in three south London boroughs.


A high proportion of admissions and readmissions to hospitals are from residents in care homes. The Red Bag Hospital Transfer Pathway, originally developed by the Sutton Homes of Care Vanguard (an NHS England New Care Models programme) in 2015, aims to improve communication between care home, ambulance and hospital staff – to improve the quality of care for care home residents conveyed to hospital in an emergency. The pathway is a link that supports care homes, the ambulance service and the local hospital to meet the requirements of the NICE guidance on transition between inpatient hospital setting and care homes.
In 2016, we identified an opportunity to spread the Sutton Vanguard’s successful Red Bag innovation to other south London Boroughs. So, we worked with CCGs, Local Authorities, Care Homes, hospitals and the London Ambulance Service to spread the Red Bag initiative to the rest of south London.

The aim of the evaluation was to understand how well this innovation, which was very successful in Sutton, had spread to other parts of south London, specifically Lambeth, Kingston and Richmond. It was undertaken using a mixed methods case study approach.

“We still get phone calls from the hospital, but it’s happening less now with the red bag. It’s an excellent system – it tells the hospital we have a system and they know we’re sending paperwork in. I’ve never had a problem”

Care Home Manager, Richmond


Out of 90 survey responses from care home, London Ambulance Service and hospital staff, over two-thirds of respondents believed that the Hospital Transfer Pathway had improved communication between partners. Over half of care home managers reported the pathway had improved the transfer process for residents.

However, hospital staff, paramedics and care home managers also highlighted challenges with the pathway that came through in the evaluation. Standardised Red Bag documentation was sometimes missing or incomplete when residents were transferred to hospital or lacked discharge information when residents were discharged back to the care home. Particular difficulties in locating and retrieving bags that had become lost at hospital were identified. In addition, high turnover of staff and during busy winter months both care homes and hospitals faced challenges with successfully communicating the pathway.

We found that when the pathway was not adhered to – either in the care home or hospital setting – this caused practical difficulties. These issues need to be resolved to optimise the pathway and fully realise the benefits.

We published the full evaluation to share our learning with others. You can access it here: