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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 Essex 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 Chelmsford. 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 Halstead. 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.

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