“I can’t praise them enough to be honest” “I felt I was looked after at home much better than I would have been in hospital where I feel they wouldn’t have had time for me” “Most importantly, we patients prefer and hope to be at home not in hospital, so I think this service is the way of the future.” HomeFirst

Hertfordshire: Demographics Predicted Population Growth

Integration in Hertfordshire One of the largest and most ambitious Better Care Fund programmes in the country - £240m pooled budget Other integrated services also in operation: Integrated Access Early Stroke Discharge Community Navigators Excellent relationships among partners High levels of aspiration and trust built on early success of HomeFirst

What is it? “new model of community care delivering a fully integrated service combining health and social care which will provide the right treatment at the right time in the right place”

Background Lower Lea Valley – November 2012 –74,900 population –Urban locality outskirts of London –Small geographical area North Herts - July 2014 –127,100 population –Rural locality in north of county –Very large geographical area

Professionals District nurses Physiotherapists Occupational therapists Mental health nurses Social workers Dedicated homecare workers Admin

Activity Lower Lea ValleyNorth Herts Rapid response Case management Supported dischargeN/A30-40

Outcomes Lower Lea ValleyNorth Herts Rapid response within 60 minutes 96.2%96.1% Case Management ALOS 50 days41 days Supportive discharge ALOS N/A7.2 days

HomeFirst GP Survey December 2014 – January 2015 were extremely likely or likely to recommend the service to family or friends agreed or strongly agreed that HF provided high quality patient centred care agreed or strongly agreed that HF supported patients to self manage their conditions more effectively. 97% 95% 96%

99% agreed or strongly agreed that HF has improved the availability of community services in this area. 94% agreed or strongly agreed that HF has promoted joint working between HCT, social care and primary care. 96% agreed or strongly agreed that they are clear what HF does and how to refer to it. HomeFirst GP Survey December 2014 – January 2015

The HomeFirst service has reduced my workload 73% of GPs agreed or strongly agreed 7% of GPs disagreed or strongly disagreed

The most important views…

‘In my experience the service was first class’ ‘I was extremely impressed with this service – everyone was kind and considerate & put me at ease, which in turn helped me regain my confidence’ ‘All the Home First team were so caring and understanding without these lovely ladies I could not have managed. I thank you from the bottom of my heart each and every one of them’ Patient and carer feedback

Key lessons 1.GP leadership and engagement key 2.Strong leadership across partners 3.Invest upfront in induction and training 4.Need 5 months min adverts to go-live

Key areas for improvement 1.Multiple patient IT systems 2.Single management and governance 3.Culture eg, around risk tolerance 4.Embedding self-management

What next? Roll out to remaining 4 localities Care homes Telecare Clinical Pharmacist Isobel Hospice Health psychologists for self-management Interface geriatricians