Developing a Home First mindset

Ruth Lake, Leicester City Council

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Overview

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Leicester City Context

Developing a Collective Concern

Working Together

From DTOC to Home First

System Development

Impact & Key Messages

The Leicester Context

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The Health and Care Context

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Highly deprived city with poor health & life outcomes

• Highly diverse (52.6% BME) with ill health at an early age

• Health literacy of c.7 years of age

• High acute use compared to peers

• Poor perceptions of primary care access

…but we are a City genuinely open to

innovation. We can deliver the most unexpected

results in the most challenging of circumstances.

Started our journey in a poor DTOC position

Failing national standards

Growing acute and care pressures

People having a substandard experience

Developing a Collective Concern

• Senior Recognition that we needed to do better

• BCF as a catalyst

• Agreeing simple objectives to address the concern

• Open book approach

• Fundamental and early belief that people have homes to

go to and beds to stay in

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Understanding the Reality

DATA,

DATA,

DATA

• Collect and challenge

• Find the common truth

• Questions are as helpful as answers

• Use performance data to evaluate service effectiveness – open and

transparent

• Pick off problems, move on and review

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Working together

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From BCF to Integrated Systems of Care

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BCF

Services that made a difference

Integrated Crisis Response Service

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• Over 6000 urgent referrals per annum

• 25% = falls management

• 25% = pre-admission discharge avoidance

• Typically 1700 falls cases – 28 minute response

• 9% required further hospital assessment

• 1565 cases shared with health services

• 75% require no further services after intervention

• Exceptional patient satisfaction rates

• https://vimeo.com/album/2414935

(password = lcc001)

• A ‘can do’ culture

Services that made a difference

Health Transfers Service

• Dedicated hospital SW plus reablement function

• Redesign of existing resources: Ward linked staff

• Proactive – find people before notification

• HomeFirst – why not home; why not today

• Reduced acute delays to minimum

• 70% discharges without statutory notification

• April 2017 – Integrated Discharge Team across Leicester

/ Leicestershire (HICM 3 / 6)

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Services that made a difference

Integrated Care Team – Mental Health

• Improving access to MH support within primary care

• Cognitive assessments / Treatment of depression / Anxiety management

including CBT techniques.

• Close liaison with other disciplines e.g. care navigators / social

services/district nurses

• Quicker access (15 days) and reduction of inappropriate referrals to

secondary MH

• 67% of patients have returned to the care of their GP

• 15% of patients have been referred to Memory Services for assessment of

suspected Dementia

• 18% of discharge outcomes were due to various other reasons e.g. patient

refused/CMHT referral/patient died/Psychiatrist opinion required

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System Development

Building of trust and confidence -

• Addressing capacity gaps strategically: Community

Services Redesign

• Developing stretch models: Readmission avoidance,

support to self funders, trusted assessment

• Resolving process barriers: DH2A, Shared Care Panels

• Maximising new expectations: PCNs, Social Prescribing,

Ageing Well12

Addressing Capacity Gaps

• HF not as effective as it could be

• Nursing and therapy gaps

• Delineation of teams

• Misfit with PCN

Community Services Redesign

across LLR

8 hubs

Core CCG investment

Designed to deliver HF

Locality Decision Unit13

Stretch Models

• Integrated Discharge Team – new roles e.g. LA physio

• Enabled AHP relationship building across acute and

community

• Trusted assessment – key to reducing process

• Telephone referral and post-discharge assessment

• Care Navigators – stretched to targeted readmissions

avoidance

• Self funders – wicked issue – ‘no ones job’

• LA extension of role using additional (non-core funding)

• Hoarding and Substance Misuse

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Resolving process barriers

• CHC pathway – from +30% DST in acute to below 7%

• BCF funding to PDSA a DH2A model – case managed

and effective – better outcomes

• Joint funding – slow, frustrating and poor experience

• Shared Care Panels – rapid triage by CCG nurse and LA

manager

• Quick access to the right package

• Expanding use of SystmOne

• Co-location

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Our Integrated Home First Offer

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Maximising the opportunities of new

expectations

Ageing Well

• Accelerator site status confirmed

• System already specified to deliver 2H / 2D

• Some services meeting these consistently

• Data expectations a challenge but work in progress

• Using accelerator funding to proof test, meet current

capacity gaps pending strategic commissioning and

support OD / workforce development

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So What?

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Emergency Admissions

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DTOC rates

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BCF Targets

All 8.05 / ASC 0.03

Effectiveness of Reablement

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National Audit of Intermediate Care 2018 and 2019

Greatest decrease in the Sunderland score from entry to exit of any intermediate care programme audited

(26.0 to 13.1)

Average response time of 1 day

75% of average national unit cost

Admissions to LT Care

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Challenging in 2019/20 but:• Not from acute hospitals or reablement outcomes

• Includes growing number of ex-self funders

• Impact of environmental factors

Key Messages

Every system is different but:

The simpler the vision or aim, the easier it is to socialise

The power of relationships cannot be underestimated – for good or bad

Distributed leadership is key to change – including people who use

services

Physical proximity makes a real difference

Plan to never stop – you can’t eat the whole elephant in one go…

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Any Questions?

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