“I can’t praise them enough to be honest”

1. “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 “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” “I can’t praise them enough to be honest”

2. Hertfordshire: Demographics Predicted Population Growth

3. 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

4. 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”

5. 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

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

8. Activity

9. Outcomes

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

13. HomeFirst GP Survey December 2014 – January 2015 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.

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

15. The most important views… https://vimeo.com/107233652

16. Patient and carer feedback ‘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’

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

18. Key areas for improvement • Multiple patient IT systems • Single management and governance • Culture eg, around risk tolerance • Embedding self-management

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