“Game-changing” Home First care model is leading the way across Scotland

Home First in Orkney has been described as a “leading” and “game-changing” new care model which supports people to live more independently and for longer in their own homes – which is what most people say they want.

Morven Gemmill, from NHS Orkney, said: “When I looked at the Home First evaluation, what the team in Orkney has done and are doing is leading across Scotland. There was shock at just how good the outcomes were for people that were severely frail – for 85 per cent of people who were severely frail to have their occupational performances outcomes improved is really staggering and a phenomenal achievement. I would like to congratulate the teams.”

Home First prevented four people in the county from having to leave their home to go into residential care.

Ruth Lea, the Council’s Occupational Therapy Lead – Adult Services, paid tribute to those involved in the project.

“Home First has been the most inspiring project I have worked on during my 30 year career. It has demonstrated the power of working in partnership with service users and demonstrated that even the frailest people in our community can meet their personal goals, improve their independence and live safe and fulfilling lives in their own homes. I commend the work of the team, in the dedication they have shown in developing and delivering this service.”

Service users and their families and carers, who provided feedback following the 12-month pilot have given their resounding backing to the model – and this is further endorsed by care staff and senior medical professionals within the NHS.

“I think it is a good service. I feel more independent at home; I can do more for myself since leaving hospital. Who would have thought I would be sitting here peeling my own tatties!” – service user

“When I look back at how I felt in hospital, I thought I would never manage at home, but look at me now...I have achieved so much” – service user

“I am so happy to be living in my own house. I want to stay here as long as possible. I didn’t think I would be able to come home a few times when I was in the hospital. I am glad I am home” – service user

The Home First team is to be permanently established and will be ultimately linked with Intermediate Community Therapy and the Mobile Responder Green Team to form an intermediate care hub with a single point of access.

Members of the Integration Joint Board were presented with the findings of the Home First pilot on Wednesday (20 April) and heard that the new model not only enabled folk to become more independent and remain in their own homes, but also resulted in less delayed discharges from hospital – benefiting both the service user and the system.

IJB Chair Issy Grieve said: “To see the statistics and outcomes that have come forward is hugely heartwarming. On behalf of the IJB I express our congratulations to the entire team for their commitment, drive and effort to bring this forward.”

The pilot ran from February 2021-Feb 2022 and during that time 53 appropriate patient referrals were received by the Home First team and, of these, 85% were “severely frail”.

What is Home First?

The Home First service is a discharge to assess model offering up to six weeks of reablement support to enable timely discharge from the hospital and the opportunity to assess patients in their own home.

The reablement approach supports people to do things for themselves, helping them to retain or regain their skills and confidence so they can learn to manage again after a period of illness or injury.

The person sets achievable goals with the team Occupational Therapist and care and support is delivered by a dedicated care at home team. Furthermore, they help to co-design adjustments to daily living where full recovery is not possible.

Some of the pilot scheme’s key findings:

• 71% reduction in days delayed in hospital awaiting home care;
• 530 hospital bed days avoided;
• 89 per cent of service users saw an improvement in their occupational performance outcomes at home;
• 28 people were referred to Home Care following a Home First assessment;
• there was a reduction in hours of support required following Home First reablement of 26.4%, with a number of individuals requiring no ongoing care support;
• personal goal improvements were made by service users in meal preparation (72%), mobility (62%) and personal care (59%).

Stephen Brown (Chief Officer), Integration Joint Board said: “The Home First pilot has demonstrated through a reablement approach we are able to avoid hospital bed days and release social service capacity and people who received the services saw an 89% improvement in their occupational performance, which is fantastic especially given the frailty of many of those being referred.

“As confidence grew among the referring professionals, the complexity of individuals referred to service increased. We do anticipate that if we could offer a reablement approach to all Care at Home referrals we have the potential to reduce dependency levels further.

“There is also evidence that reduction in ongoing support requirement is being maintained after discharge from the service, with some individuals continuing to make progress and care packages continuing to reduce.

“Given the demographic predications for the Orkney population, with a consequent likely increase in frailty levels, it is important that we maximise independence and maintain this for as long as possible. A reablement model supports this.

“To conclude, Home First has demonstrated the power of person centred, outcome-based care and shown that even the frailest people in our community can meet their personal goals, improve their independence and live safe and fulfilling lives in their own homes.”

Here’s what some family and carers had to say: “Very, very pleased with everything. In particular support from OT with weekly visits. The service has made a real difference in supporting my wife at home,” – Husband

“I thought it was an excellent service, it made a real difference to my mum. It also made a big difference to my daughter and families lives. We would be happy to provide feedback any time or endorsements to see this project continue – it really has been an excellent service,” - Son

“All very good, all excellent. He is walking a lot better and doing really well. He is helping wash and dries the dishes, sets the table and does most of his care himself. Homecare re-started his morning visit, and they were amazed at how well his is doing, one carer said it “made her day,” – wife

What did the Care at Home staff supporting the service users say: “I didn’t realise how important it was to try and encourage people to do things for themselves until I saw the benefits first hand.”

“I personally enjoy Home First, it’s rewarding watching service users progress really good once they are home, and with the goals they want to meet it encourages them more to be determined. Working closely with OT we get resources quickly”

What did other members of the multi-professional team say: “It is particularly pivotal in demonstrating the 'game changing' nature of what you are doing, by showing that the service is not only having the immediate and obvious impact of 'freeing up' hospital beds, but also easing the longer-term pressures on the system as a whole through the enabling approach reducing longer term care needs. This is such a powerful argument and shows the benefits to both 'the patients and the systems' of what you are doing. A win win!” – GP/Medical Director