How one health and care system is developing a Home First approach

In a guest blog, Shak Rafiq of NHS Leeds Clinical Commissioning Group (CCG) reveals the challenges involved in introducing improved patient flows across the city’s health and social care system.

Home First is a significant behaviour change programme. The ambition is to introduce a city-wide ethos where the emphasis across the health and social care system is to care for people at home whenever we can, or if they are admitted to hospital, get them back home again as soon as possible.

There are two reasons why we are establishing the Home First programme. The initiative forms part of a local and national drive to improve patient flow within the health and care system. That means ensuring that we have an efficient system so that a patient can leave hospital as soon as they are well enough, reducing the risk to them of secondary infections, while freeing up beds.

Allied to that is a revised approach to people with chronic health conditions. These include older patients who are frail and vulnerable to falls, as well as those with long-term illnesses. How can we care for them at home, or within the community, so they don’t need to be admitted to hospital?

We’ve always sought to reduce the time patients are in hospital, because we know an unnecessarily extended stay has an impact on their health. But the need to do this has become more pressing as, along with all parts of the NHS, we face significantly increased demand. And in 2018 both the Care Quality Commission and health consultants Newton Europe found that delayed patient discharge was an area that we needed to work on in Leeds, while acknowledging the strengths of our inter-agency relationships.

Better for patients

The project is at an early stage. We want it to be a solution co-produced with key stakeholders including patients and health and social care workers. As the communications lead, I know how important it is for us to both get the message right, and to communicate it to people at the right time.

Our approach in Leeds is to get people home as soon as possible or keeping people well at home so they don’t get admitted in the first place – not as a money saving exercise, but because it’s better for them. It mustn’t appear like some sort of health conveyor belt. This is very much a patient-centred approach, but looking at each individual and asking how they could stay at home for longer, wherever home might be.

Equally it is no use waiting for a patient to be admitted to hospital before adopting the Home First approach. We need to prepare the ground long before that so that the public are aware of our emphasis on efficient patient flows, and why that is important for their health and wellbeing. They need to be aware that in Leeds, we work to keep you at home for as long as possible, or to get you back home sooner.

There is some fantastic work already happening in Leeds. We have social workers supporting frontline hospital staff for example. But there are information gaps that can contribute to delayed discharge – a patient may be well enough to leave the ward but hospital staff are unsure where to send them for re-ablement support, for example.

Supporting staff

We need to introduce systems that support decision-making staff across the health and social care system. That joined-up approach is critical – for example, it might mean care home staff working more closely alongside GPs.

We began to develop Home First with an event which is helping us to shape the key messages, and identifying who the key influencers are who can help us deliver those messages to the wider Leeds public.

Qa Research had worked with us on previous occasions to identify issues and challenges within the health and social care system. And in this case their deliberative way of working was more suited to our needs than more traditional research routes.

This time we asked Qa to help us find out what people thought of the whole ethos of Home First – how do they feel about us encouraging people to stay at home for longer or go home sooner? What are their concerns about the approach? And what should be our key messages when communicating what the programme is all about?

Key insights

One key insight that emerged from that work was that some people thought Home First was a service rather than an approach. So now we have to think carefully about how we pitch it so people understand that it is a city-wide ethos and way of working, rather than a new service.

Home First is a change in the way we work to deliver health care and the expectation of people, both to the 850,000 residents in the Leeds area, and to the many patients who come into the area for treatment in our teaching hospitals trust, which is one of the largest in Europe. We will be developing the concept internally in the first half of 2020 before considering how we translate that into a public-facing campaign.

We have made excellent progress in our Home First plan. It will take time to develop a concerted effort across the health and care system and then translate that to our local population. But the rewards, in terms of better patient wellbeing, more efficient treatment and reduced pressure on staff, will be well worth the effort.

Shak Rafiq is Communications Manager at NHS Leeds CCG

Photograph: Healthcare Professionals on iStock


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