HOME FIRST: YOUR FUTURE NHS CARE AT HOME AND IN THE COMMUNITY

1 Home First: Your future NHS care at home and in the community Contents

1. Introduction Page 2

2. Health services currently Page 3

3. Opportunity for change Page 4

4. Your views count Page 10

5. Frequently Asked Questions (FAQs) Page 12

We want everyone in mid to Live Well 2 Home First: Your future NHS care at home and in the community

1 Introduction

Mid Essex Clinical Commissioning Back in 2014, Mid Essex CCG started a importantly, your experience and voice. Group is accountable for buying conversation with local people about the Locally, here in mid Essex, we want to healthcare services to meet future of health services as part of our introduce a new model of care – Home First consultation called “The Way Ahead”. – in 2018 that will aim to help more people the needs of the population of recover at home after a spell in hospital. approximately 387,000 people in the Two of the most common themes to emerge districts of Braintree, Maldon and the from those discussions have helped us shape At the same time, we want to make more use City of . our longer term plans for health services. of two state-of-the-art surgical theatres at Braintree Community Hospital. To do this, we These themes are: would need to change the way we use beds within this hospital. • Local people have shifted their expectations from what used to be an This booklet aims to explain our plans, why emphasis on hospital services to greater we want to make changes and what this could concerns about developing services in the mean for you. community and GP services in particular. It will tell you how you can get involved in • There was keen support for the discussions about our plans and how you can development of care at home or locally share your views. for older and frail people, people with long term conditions and end of life. In these areas there was close agreement between local views and the CCG’s transformational plans.

The way the NHS delivers care is changing all of the time because of developments in technology, advances in medicine and, most

We want everyone in mid Essex to Live Well 3 Home First: Your future NHS care at home and in the community

2 Health services currently

Within mid Essex, there are currently three • People in mid Essex have a lower length of There is medical evidence to suggest that the areas of healthcare where existing services stay in a community hospital bed than the longer a patient spends in hospital, the higher could be changed to improve outcomes for national average (23 versus 28 days) the risk of muscle decline. patients. • The cost of providing care in a community Being in hospital also impacts on a person’s 1. Community Hospital Beds hospital bed is different across mid Essex independence. Combined, these factors and but often higher than comparable care others may lead to an ‘artificial’ picture of what At the moment most people in mid Essex settings a person’s future health needs are. who need rehabilitation following a spell in an acute hospital are transferred to a community • Patients are not admitted to the community 3. Waits for Orthopaedic treatment hospital bed either within Braintree Community hospital closest to where they live – in fact Hospital, St Peter’s or . only 29% of patients cared for at Braintree There is a national target to treat all Community Hospital between April 2016 Orthopaedic patients referred for surgery Patients have their rehabilitation while on and June 2017 were registered with a within 18 weeks. these wards before they are discharged home Braintree GP or to another place of care. Figures from Mid Essex Hospital Trust showed 2. Continuing Healthcare (CHC) that in May 2017, more than 500 people in mid Local health partners have been reviewing the Essex have been waiting more than 18 weeks use of our community hospital beds and found: Continuing healthcare (or CHC as it is for Orthopaedic surgery. commonly known) is a free package of care, • If alternative options existed – either arranged and funded by the NHS, for people Additionally, data shows that for more than 12 to provide services at home or in an who have significant ongoing health needs. months (since September 2016) the waiting enhanced nursing home – only 7% of Generally the process of CHC assessment list for this type of surgery has not been below patients would have needed care in a can take up to four weeks – often longer. 400 people for waits of more than 18 weeks. community hospital bed. Many patients remain in hospital while they For more detailed information go to wait for CHC assessment even if they no http://bit.ly/2wYNyXw. longer clinically need to be in hospital.

We want everyone in mid Essex to Live Well 4 Home First: Your future NHS care at home and in the community

3 Opportunity for change

Home First person – there would not be ‘one plan for all’. We want everyone in mid Essex to Live Well and to have modern, fit-for-purpose The person will be supported by a range of healthcare. NHS-funded healthcare services – which could include therapists, nurses and doctors – for up Advances in healthcare are creating new to 28 days after leaving hospital. opportunities to improve care for people. Home First is a different way of providing At the end of this period, if the person has rehabilitation and support to help people ongoing healthcare needs they would still be recover after a spell in an acute hospital. able to have a CHC assessment but this would be based on a more accurate understanding It works on the principle of people being of the person’s abilities and needs. discharged from hospital, once they are medically fit, to a place that would enable The diagrams that follow over the next few their best recovery and only after a clinical pages help to show how rehabilitation and assessment to understand what and how recovery works now and how it could work care could be safely delivered. with a Home First service in future.

This place could be home, an enhanced nursing home or a community hospital bed – whatever is the most appropriate place for that

We want everyone in mid Essex to Live Well 5 Home First: Your future NHS care at home and in the community

Community Hospital Pathways What happens now

Patient Patient Patient is Patient undergoes rehabilitation Patient is admitted completes admitted to discharged home to acute need to stay community • An “artifcial” environment that means patients not hospital in acute hospital bed rehabilitating in natural setting hospital • Patients may deteriorate more in this time • Using limited resources for people whose care could be delivered elsewhere equally, if not better

We want everyone in mid Essex to Live Well 6 Home First: Your future NHS care at home and in the community

Community Hospital Pathways Under Home First

Patient undergoes rehabilitation Patient is discharged from service Home More natural environment

Patient undergoes rehabilitation Patient Patient admitted completes Discharged to: to acute need to stay Patient is hospital in acute Enhanced discharged home hospital Nursing Home

Patient undergoes rehabilitation

Community Patient is Hospital Bed discharged home

We want everyone in mid Essex to Live Well 7 Home First: Your future NHS care at home and in the community

CHC Pathways What happens now

Patient in Referred for Checklist Full Funding Discharge acute CHC triggers assessment agreed arrangements Discharged hospital checking request for takes place. happen full CHC Funding required assessment and applied for

During this time patient does not really need to be in an acute setting because: • Patient’s condition deteriorates • Patient does not want to be there • Using limited resources unnecessarily

We want everyone in mid Essex to Live Well 8 Home First: Your future NHS care at home and in the community

CHC Pathways Under Home First

Home Rehabilitation and recovery • Up to 28 days • NHS funded Patient in Has brief • In more natural setting acute assessment Discharged to: Discharged with hospital to identify how CHC assessment Allows person to return to needs could Enhanced if still needed what is their best health be safely Nursing managed in Home Assessment likely to be another setting a true reflection of patients needs

Community Hospital Bed

We want everyone in mid Essex to Live Well 9 Home First: Your future NHS care at home and in the community

Clinicians and commissioners within the CCG We would like to use the theatres at Braintree have been working closely with many other Community Hospital for Orthopaedic surgery health and care providers over the past six and use beds on the Courtauld ward for months to look at how a Home First service surgical recovery. could work in mid Essex and how the service will be monitored and evaluated. Our other two community hospital sites across mid Essex – St Peter’s and Halstead – will We believe that more people could rehabilitate continue to have rehabilitation beds in the at home or in an enhanced nursing home same way that they do now. with a Home First service. We know that some people will still need to rehabilitate in a As we gather evidence on the use of the community hospital bed. Home First service, it will help the CCG and other health partners to shape thinking around The CCG wants to reinvest some of the the longer-term role of community hospital current money spent on community hospital beds in mid Essex. bed care into a Home First service launching next year (2018). There is a full FAQ section at the end of this booklet that may help you understand more At the same time, there is opportunity to use about Home First and our plans – some of our community hospital beds in a see page 12. different way.

We want everyone in mid Essex to Live Well 10 Home First: Your future NHS care at home and in the community

4 Your views count

We want to find out what you think about our plans for Home First and Braintree Community Hospital. There are a variety of ways to get involved in discussions, find out more and share views.

Information events

We’re holding several information and listening events across mid Essex. Each event will be attended by a range of health staff and aims to give you the chance to ask questions, share your views and find out more about our plans.

You can register by emailing [email protected] in advance with your preferred event or just come along:

Date Time Venue Tuesday 17th October 7.00pm to 9.00pm Braintree Baptist Church, Road, Blyths Meadow, Braintree, CM7 9DP Tuesday 7th November 7.00pm to 8.30pm The Plume Academy (Main Hall), Fambridge Road, Maldon, CM9 6AB Tuesday 14th November 6.30pm to 8.00pm Chapter House (Main Hall), Cathedral Walk, Chelmsford, CM1 1NX Wednesday 15th 1.30pm to 3.00pm Braintree Town Hall, Market Place, November Braintree, CM7 3YG Wednesday 22nd 7.00pm to 8.30pm Club Woodham, 5-7 Baron Road, November , CM3 5XQ

We want everyone in mid Essex to Live Well 11 Home First: Your future NHS care at home and in the community

Drop in sessions

You can also find out more at one of our informal drop-in sessions. Call in for a chat during the hours specified below:

Date Time Venue Monday 23rd October 10.00am to 3.00pm Main Atrium, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7ET Wednesday 22nd November 10.00am to 3.00pm Main Atrium, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7ET

Share your views

If you would like to share your views or ask questions and cannot attend any public events, please complete a questionnaire online at http://bit.ly/2y9XYWC or contact Rachel Harkes, Head of Communications and Engagement on 01245 459 414 or by emailing [email protected].

Information about Home First is available on the CCG website at http://bit.ly/2y9XYWC.

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5 FAQs

General Home First Questions Q. What evidence is there to show this will community by an integrated health and be better for patients? social care team Q. Why are you looking to change things? Medical evidence shows the more time people The NHS is constantly developing, improving spend in a hospital bed, muscle-strength and • Started initially with one patient per week and changing to make sure it offers the best general health can deteriorate. This can lead building up to 185 on average care possible. Using new technology and to longer periods of recovery and sometimes learning from how others deliver services, we the ability to recover is reduced. Locally, our neighbours – and want to make sure that we can help everyone Brentwood CCG – following consultation, locally in mid Essex Live Well and get the right We want to avoid this, help people to come out closed a 22-bedded community unit in April support when they need it. of hospital and either to home or into a place and replaced this with a new home-based where they can maximise their rehabilitation. intensive rehabilitation service. Initial feedback Since forming as a CCG four years ago, we’ve has been positive – a formal review is due carried out several consultations to ask you The idea of ‘Home First’ isn’t new – there are shortly. about your priorities for health and care. Back many areas across the country that have been in 2014, you told us that care closer to home delivering care under this type of arrangement In mid Essex, we have had an Early was a priority. for a while now. Supported Discharge service in place for people who have had a stroke. This is well Home First could be a way of helping more For example, South Warwickshire and established – running since 2014 – and people to return to their homes with support Sheffield have been using the principles of delivers a mix of rehabilitation, including while they rehabilitate and recover from illness Home First for the past three years. speech and language therapy, physiotherapy or injury. and occupational therapy. Outcomes have In Sheffield, results so far show: been positive. This type of approach to care supports the national direction of travel for the NHS and • 37% increase in patients who can be Q. Is this about making savings/cuts? fits into our more local plans for longer-term discharged on day of admission or day This is not about removing care for people, change – helping to ease pressure on hospital after but it is about making sure it is delivered in services and to support people within their the right way and the most appropriate place. local community. • All ongoing needs assessed in the We have to make sure that we are spending

We want everyone in mid Essex to Live Well 13 Home First: Your future NHS care at home and in the community money effectively to best support the health hospitals). We also know that providing community hospital bed. An enhanced nursing and care of local people – that is one of our care in any of our local community hospitals home will have clinical staff who give more statutory duties as a CCG. We hope these is much more expensive than if the same intensive care than provided in other care changes will allow us to do both. were delivered in a nursing home. Arguably, homes. therefore, we think there are better ways to We know that hospital care is expensive deliver care in a more cost effective way. Q. How will my care be funded? and not always the best place for people to The person will be supported by a range of receive care. By changing the way we use Q. How many community hospital beds will NHS-funded healthcare services which could community beds in Braintree we anticipate there be if you change to this new way of include therapists, nurses and doctors for that this will give us some savings to re-invest care – Home First? up to 28 days after leaving hospital. At the into providing more care at home. We are At the moment, our plans are to change the end of this period if the person has ongoing confident that this new arrangement would use of the 26 community beds at Braintree healthcare needs they would still be able to better enable the health system to cope with Community Hospital while we begin to use have a CHC assessment. levels of high demand. Home First. We want to use the beds for people having surgery. Q. Is this part of the planned changes Q. How many community hospital beds are under the Mid and South Essex STP? there in mid Essex and how much does it Q. Does this mean you are taking beds We are working with all of our partners across cost to keep these running? away from any of the hospitals or closing the wider mid and south Essex STP area At the moment there are approximately 70 beds? to ensure our plans and proposals align for community beds across three community We are not closing beds. The proposal is to hospital and community care. At the moment, hospital sites – St Peter’s in Maldon; Halstead change the use of the 26 community beds at these proposals are about making a very local Hospital and Braintree Community Hospital. Braintree Community Hospital. We would like change to health and care services in mid The ‘running costs’ of these beds vary as to use these beds for people having surgery. Essex (and in particular Braintree). We want some – for example at St Peter’s – are used to We believe this would also enable us to to find out from local people in Braintree and deliver a more intensive type of rehabilitation maximise the theatres at Braintree too. across our mid Essex patch how they feel and so it makes it difficult to give an ‘average about our plans. cost’. Q. How many more people will be treated at home with Home First? We do know, however, that most of the bed A recent audit found that if alternative options costs in the community exceed the national existed – either to provide services at home cost average (though there can be challenges or in an enhanced nursing home – only 7% in comparing like for like between different of patients would have needed care in a

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Q. The waiting time for social care is really not leave hospital without all clinical needs However to allow for us to safely understand long and everyone knows this impacts on having been considered and arrangements what the impact may be for our local getting people out of hospital. How will made. If there is any doubt about the population, we are only proposing to make Home First improve this? clinical suitability or safety of a patient being the changes to a small proportion of current We have been working closely with colleagues discharged, they will remain in hospital until community hospital beds. We will still have across social care and our community such time as their individual circumstances community beds available for people who providers to come up with a model of care change. Patient safety will remain our focus. cannot go home or to an enhanced nursing that supports people in many ways to get home with Home First support. back to their optimum health. Where patients Q. Is this not increasing the risk of people go home from hospital with Home First, the being at home without care and support? Q. When winter hits, will there be enough care they receive is not the same as the People who would be helped under Home support in place? longer-term care packages they may require First would have an assessment before they Overall, we would be looking to make more for an ongoing health need i.e. Continuing leave hospital. This would consider all relevant ‘placements’ available to people needing Healthcare (CHC). We are working hard to factors needed to ensure that a patient does support with rehabilitation and recovery after confirm that the necessary infrastructure would not leave hospital without all clinical needs hospital – this care will just be delivered in be in place to meet need, so that we do not having been considered and arrangements different settings. For some people this will see an increase in delays in people leaving made. If there is any doubt about the be home, for others an enhanced nursing hospital. clinical suitability or safety of a patient being home and for some it will still be a community discharged, they will remain in hospital until hospital bed. If patients require longer-term care after their such time as their individual circumstances period of Home First recovery, there would be change. Our Home First plan is not about removing an opportunity to identify these patients early care for people, it is about making sure care on, so that we can streamline planning for the Q. How do we know this type of service – and support is delivered in the right way and in next stage of care ie CHC assessment. Home First – is safe and will work? the most appropriate place for individuals. It is Other areas in the UK have successfully not a ‘one care for all’ approach. Q. How can you be confident that people trialled models of Home First (or Discharge will get the care they need if you are to Assess as it is called in other areas). It is sending them home earlier/with only a brief also in line with national guidance on how to assessment? support patients to reach their optimal health The assessment that takes place before outcomes. people leave hospital will consider all relevant factors needed to ensure that a patient does

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Braintree Community Hospital appropriate care. This could be local to their First, it will help the CCG and other health Questions home or further away. This means that people and care partners to shape thinking around living in Braintree will already be travelling the longer-term role of community hospital to Chelmsford or for care and beds. For this reason, the final funding Q. Why are you looking to change the use treatments. application and consultation for the Maldon of beds at Braintree and not one of the health hub will not go ahead until after this other community hospitals? An audit of patients using Braintree public engagement on Home First, the model There are two state-of-the-art theatres within Community Hospital carried out between June introduced and potential impact on current Braintree Community Hospital that could be 2016 and April 2017 showed only 29% were care is understood. In the meantime, we are used more effectively. We currently have long registered with a Braintree GP. working with Maldon colleagues to prepare waiting times for Orthopaedic surgery in mid possible plans for where services may go Essex and could use these theatres for that Q. How will this potential change benefit within the health hub, dependent on the type of treatment. people in Braintree? outcome of Home First. We anticipate that Home First will be able to Q. GP services in Braintree are already give more people care in their actual home Q. What will happen to staff working in our really stretched. Will these changes put which means no travel as well as potentially community hospitals? more pressure on GPs? using beds in Braintree Community Hospital Staff working on the community wards and We are looking at all of the operational for more surgery – potentially giving people involved in CHC assessments are incredibly requirements that may be necessary for in Braintree the opportunity to have other valued. We are looking to ensure that staff our Home First plans and changes to beds procedures carried out more locally and not at are retained and continue to provide excellent at Braintree Community Hospital so that Broomfield Hospital. clinical care, albeit this could be in a different it doesn’t place further burden on existing setting. We feel that this represents an community services. As part of this, we Other Hospital-Related Questions exciting opportunity to work differently with our are discussing plans with GPs and other patients, to see them achieve better health community based healthcare professionals to outcomes and be a part of delivering a modern identify and manage any potential impacts. Q. Will this affect the plans for St Peter’s Hospital or the health hub in Maldon? type of healthcare. We are keen to ensure that all plans across Q. If people in Braintree need a community the system are aligned, whilst at the same Q. What happens after 28 days of receiving bed, this means they will have to travel time listening carefully to feedback from Home First care and support? further for this. How is that fair? partners and the public about their local If patients require longer term health care At the moment, all patients are placed in a then they will be put forward for a continuing ward or hospital most suited to their needs community hospitals. As we gather evidence on the use of Home healthcare (CHC) assessment. However, so that they receive the best and most we expect that, by having an opportunity

We want everyone in mid Essex to Live Well 16 Home First: Your future NHS care at home and in the community to recover in a more natural setting, most CHC-Related Questions People who would be helped under Home patients would actually see an improvement First would have an assessment before they in their condition and may not trigger a CHC leave hospital. This would consider all relevant Q. Will this way of working delay people assessment at all. factors needed to ensure that a patient does having a CHC assessment? Home First will mean people are not spending not leave hospital without all clinical needs Q. Is this going to cost me anything? unnecessary time in hospital waiting for having been considered and arrangements The period of time a patient may spend the CHC process to take place. Instead, made. at home or in a nursing home, whilst on patients will be safely discharged to another the Home First pathway, would be NHS setting, where they will undergo appropriate If there is any doubt about the clinical funded. The funding of any future healthcare rehabilitation. This would mean that there suitability or safety of a patient being requirements would be determined as per would be no ‘lost’ time during any waits, in discharged, they will remain in hospital until standard CHC assessment criteria. contrast to what can happen at the moment such time as their individual circumstances when waiting in hospital. Instead, during that change. Q. When will you know whether this time, patients would be supported to reach works and what it may mean for the other their best level of ability. So although there is Q. There is a legal right to a CHC community hospitals? more rehab time built into Home First (up to 28 assessment. Is this plan stopping that? We want to make sure that we have enough days), the CHC assessment, when it happens time to fully understand how the Home First and if indeed it is still needed, would be a There is a legal right and this plan does not model may work in mid Essex. As such, we more accurate picture of a person’s ongoing seek to prevent it. However, this plan would would need to gauge how the model develops needs. make any CHC assessment a truer picture before we make any plans to further outline of that person’s genuine need. All patients the use of the other community beds. We also If, during the recovery and rehab time, it would still have the opportunity to request a recognise that people value their community becomes apparent that a person ought to be CHC assessment, but we are confident that hospitals. We are therefore very mindful of assessed for CHC earlier than 28 days, this most people and their families would welcome not rushing into any decisions, and being able could be arranged, but will be dependent on this taking place after there has been a to clearly explain what would replace any each patient and their individual circumstances proper period of recovery. This would mean community beds if further changes happened. and ability to rehabilitate. the patient would ultimately remain more independent for longer, rather than potentially starting to follow a process that would Q. How can we be confident that people inadvertently limit their health outcomes and will receive the care they need quick future capabilities. enough if they are going home for assessment?

We want everyone in mid Essex to Live Well

Get in touch

If you would like to request a printed copy of the engagement document and questionnaire or an alternative format i.e large font, Braille then please get in touch.

01245 398 750

[email protected] www.midessexccg.nhs.uk

@MidEssexCCG

/CCGMidEssex Wren House, Hedgerows Business Park, Colchester Road, Chelmsford, Essex, CM2 5PF

We look forward to hearing from you.