Decision ref
0055 2024/25
Decision date
23/10/2024
Portfolio
Integrated Health and Social Care
Wards
All wards
Title
Implementation of Home First Model of Care in Peoples Services
Summary
The Home First model is designed as an approach that focuses on allowing patients to recover at home after an admission to hospital for medical care. It brings together different types of support to maintain independence and reduce unnecessary hospital stays. In this proposal it is requested that additional staffing resource is made available to enable implementation of the model.
Purpose
The purpose of this report is to explain the Home First Model of Practice outlining the reasoning behind the model and the impact of implementation on hospital discharges and potential cost savings against domiciliary care support costs. This is a person centred approach to care ensuring that people are given every opportunity to return home or stay in their home for longer.
Financial modelling has been undertaken and an options appraisal completed. The business case has been presented at Place Leadership Integrated Care Board and funding agreed by all members and partners.
Background
Originally the Home First model was designed as an approach that focuses on allowing patients to recover at home after an admission to hospital for medical care. It brings together different types of support to maintain independence and reduce unnecessary hospital stays. Hospital staff work closely with community and social care colleagues to plan for a patient's return home from the first day they arrive on the ward. In future practice Trusts will report on peoples “days away from home” rather than “Length of Stay”.
During the Covid pandemic the Discharge to Assess (D2A) model was introduced and the default pathway was to return patient’s home. However, alternative pathways are available for those who cannot directly go home but this is the priority pathway. The goal is to provide support or intermediate care at home for the majority of people, with assessments of longer-term needs occurring after discharge. The introduction of D2A meant that St Helens tripled the number of discharges from hospital due to the streamlined process.
To date this seems to have been a medical model of practice led by health partners (NHS England identifying key guidance and protocols) but Home First is not just a support mechanism for people needing support to be discharged from hospital. This can extend to those utilising urgent community response service, step down from transitional and intermediate care setting and those already living in the community who need preventative services. The emphasis should be on assessment of longer term needs to enable people to stay in their homes as safely and independently as possible.
Adopting a “Home First” mindset ensures healthcare and social care providers aim to reduce unnecessary hospital stays and over-prescription of care. Often, patient assessments conducted in hospitals lead to excessive care recommendations. Instead, assessing patients at home can help tailor care more appropriately in an environment where they feel most safe and secure. It is also a way to avoid hospital admissions allowing those with the most complex needs to stay at home.
The home first model ensures that going home is the default pathway. Staying in hospital longer than necessary negatively impacts patient outcomes. Prompt assessments and rapid access to care supports vulnerable people in our community to live at home in their preferred environment giving choice, independent and increased wellbeing.
Home First principles and benefits
Home First is for people who no longer need hospital but do need formal support to go home, i.e., the Pathway 1 (P1) route. Their long-term needs are assessed at home, rather than in a ward.
• Full assessments not needed on wards - emphasis on what’s needed for a safe discharge home.
• Less deconditioning waiting for assessment and / or package of care
• Lower levels of assessed care need when assessed at home, people tend to be more able in a
familiar environment.
• Lower levels of care needed following Home First support, due to effectiveness of therapy-led
interventions, multi-disciplinary care, and Reablement support.
Home First: Key AIMS
• Increase hospital Pathway 1’s.
• Reduce No Criteria to Reside (NCTR).
• Increase interactions with Urgent Community Response (UCR) services.
• Reduced pressure on domiciliary care.
• Fewer people needing care or at lower levels.
• People not having to wait for essential care.
• Best outcomes for independence.
• Putting people at the centre of their care.
• Enable access to other services where required.
The reablement model of practice is an approach that emphasizes supporting people to regain their skills and confidence after a period of illness or hospitalisation. Unlike traditional home care, which tends to be a “doing for” model, reablement follows a “doing with” approach. Here are the key points about reablement:
• Purpose: Reablement aims to maximize independence by removing environmental barriers and helping individuals regain practical skills and confidence.
• Service Delivery: Reablement services are usually provided in the person’s own home by a team of mainly social care professionals. The focus is on enabling people to manage daily tasks again after an illness.
• Collaboration: Reablement involves working closely with individuals, their families, friends, or carers. Conversations centre around the person’s goals and the necessary support to achieve those goals, based on the “what matters to you?” approach.
• Timeliness: The new community rehabilitation model aims to increase capacity and access to high-quality therapy-led rehabilitation assessments and interventions. It ensures timely, safe, and person-centred care for people discharged from acute settings and virtual wards.
• Maximizing Workforce: The model maximizes the use of therapy and Intermediate Care Support Workers based on expertise and skills required at different points in the rehabilitation pathway. It encourages multi-disciplinary, multi-agency collaboration and draws on existing good practices.
In summary, reablement focuses on empowering individuals to regain independence and confidence, promoting wellness, and enabling them to perform everyday tasks for themselves.
St Helens Reablement Services will facilitate a home first model of practice where service users leaving hospital will be enabled to return to their own homes whilst receiving rehabilitation and practical support.
Conclusion
Implementation of the Home First Model will play a major role in facilitating hospital discharges and maintaining people in their own homes. Keeping people in their own home with the support of Home First and linking into other services such as trust therapy, intermediate care therapy, Occupational Therapy, Home Improvement Agency Services, technology enable care, will enable a person centred approach to care whilst reducing pressures on hospital flow and in the medium term reduce pressures on social care domiciliary care budgets.
There are high numbers of people being discharged through the various pathways from hospital. Initial focus will be to support those being discharge through pathway 1 being supported by Home first and reablement services for a period of rehabilitation. If successful this will be extended to those in pathway 2 & 3 where intermediate care support or care home placement is identified.
The positive outcomes of this model is to ensure people remain in their homes for as long as they can, as independently as they can, and as safely as they can.
Risk Implications
Recruitment to the intermediate care support worker is key to the model and recruitment can be difficult. In order to mitigate risk it is proposed that adverts for posts will be included on the NHS recruitment website and a recruitment engagement session will be coordinated if recruitment proves unsuccessful through advertising only.
High demands placed on the service and being unable to meet the demands is a risk but will be monitored and reviewed through KPI data from both the Trust and LA. Resource will be continually reviewed. The introduction of the electronic rostering system should assist in streamlining staff allocation of work and ensure efficient use of staffs time.
Measures to Redress Risk
To advertise posts both on Council Website and Trust Website. Complete a recruitment engagement session if required.
Monitor demands on service through KPI reporting and the Access system (rotas and care planning electronic system).
Declarations Of Interest
None
Equality Impact Assessment
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More information
Please contact Ottilie Jones on 01744671652
