Issue - meetings

This paper aims to provide the Health and Wellbeing Select Committee with an outline overview of the Home First service model, which was implemented within Bath and North East Somerset in March 2017.

The Senior Commissioning Manager and the Commissioning Project Manager introduced this item by giving a presentation to the Select Committee. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Time is the currency

·  Time is the currency of health and social care

·  It is used to measure a range of aspects from waiting times, A&E Performance Times, DTOC’s to the length of social care visits.

·  However time is also the most important currency for our patient's. We know that the average patient admitted to hospital is within their last 1000 days.

The Last 1000 Days

·  If you had 1000 days remaining, how many would you choose to spend in hospital?

·  This thought has led to development of a social movement within the NHS called the Last 1000 days. This is about recognising that time is the most important thing for our patients and thus patient’s time must be important to those who care for them.

·  The Select Committee were shown video of a poem by a nurse called Molly Case, which was commissioned by NHS England that outlines the importance of this movement.

Home First

·  Home First (also known as discharge to assess) is based upon the principle that it is aimed, where safe, for all patients to be discharged home as soon as they no longer require care that can only be provided in an acute hospital bed.

·  Here Rehabilitation, Reablement and outstanding health and social care assessments can be undertaken at the right time and in the most appropriate environment for the patient to increase independence & fully assess their long term needs.

·  It ensures patients aren’t making decisions about their long term care needs whilst in crisis

·  If patients are unable to safely return home then temporary options need to exist to allow assessments to be undertaken in an environment which will best meet their needs.

Benefits

·  It reduces the risks associated with prolonged hospital stays such as increased risk of infection and functional decline.

·  It ensures patients independence & functioning is optimised, allowing for a true assessment of their long term care needs.

·  It improves patient flow through the hospital, ensuring patients are discharged in a timely manner, decreasing delayed transfers of care and improving A&E performance.

Home First Pathways

·  Whilst the rationale for Home First is clear, responsive pathways need to exist to support this principle.

·  Within B&NES it has been agreed with other system partners in Wiltshire and Somerset, that we will utilise a number pathway options for the RUH facing system. This ranges from patients needing no additional support to go home, to those who need support in long term care settings.

·  Within B&NES Pathway 1, home with additional support, has had the most significant work to date.

Home First Pathway 1

·  Within B&NES the Home First Service (Pathway 1) is delivered by the Integrated Reablement Team. The Reablement team  ...  view the full minutes text for item 27