CASE STUDY: service evaluation & development
Wiltshire Council and Wiltshire NHS Clinical Commissioning Group (CCG)
Supporting hospital patients to return home earlier and to live independently
Better Care Fund
The Better Care Fund is a programme spanning the NHS and local government. It seeks to join-up health and care services, so that people are better able to manage their own health and wellbeing and live independently in their communities for as long as possible.
Delayed Transfers of Care
One of the areas where the Better Care Fund is typically used is to provide initiatives that aim to reduce the numbers of delayed transfers of care (DTOC). Transferring medically fit patients out of inpatient care to their own home in a timely fashion can be challenging to the healthcare system. Although deemed medically fit by the medical team, older patients may continue to have mobility issues, social issues and may also still require assistance with the activities of daily living. Despite this, they do not need, and often do not wish to remain in an acute hospital bed.
Home First initiative
Wiltshire Council and Wiltshire NHS CCG are committed to reducing the number of delayed transfers of care. They also saw the benefit of helping people to become as independent as possible, thereby decreasing the intensity of their ongoing package of care.
They were supported by the Better Care Fund to establish Home First – a new initiative that aimed to facilitate the early discharge of medically fit patients aged over 65 to their own home. Rehabilitation workers and therapists were employed to support people for up to 10 days after discharge from hospital. Patients were able to come home earlier while still receiving care and support, and this also allowed more time for longer-term packages of care to be put in place.
We evaluated the effectiveness of the Home First service from the point of view of patients, relatives, staff, and stakeholders. Over a four-month period, we gathered and analysed people’s experiences and views of using or providing the service.
We held focus groups, attended multi-disciplinary team meetings, visited local support groups, conducted one-to-one interviews, and ran an online survey, giving all of those who took part many ways to engage with the evaluation. Our report presented findings and made evidence-based recommendations. System leaders valued the deeper insight into the initiative and made plans to incorporate our recommendations into future development plans.
“It is gratifying to see that positive feedback from patients and their carers is in line with the outcomes that we are seeing in our daily practice and in our performance reports. The report highlights some areas where improvements are required, particularly information on Home First (both pre and post discharge) and the current administrative procedures. We will be addressing these areas as a matter of priority… We accept the recommendations and will be working with our partners in order to implement them.”
Wiltshire Health and Care