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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