A year long pilot project in Orkney, ‘Home First’ , supporting people to leave hospital earlier through reablement may well see the redesign of the islands Care at Home Service.

Orkney’s Integrated Joint Health and Social Care Board received an evaluation of the pilot scheme Home First. Click on this link to access the report: Home First Evaluation.

Phase one

The assessment of the scheme in 2021 reported to the Integrated Joint Health and Social Care Board for Orkney that before the Home First project was in place, people could have longer stays in hospital while waiting for assessment and packages of care to be in place from the Home Care service.

In early June 2021, the Home First scheme had supported 24 patient discharges with an average delay time in hospital awaiting a care package of 2.9 days. This was an 85% reduction in the waiting time for a care package. By freeing up hospital beds the evaluation of the scheme said that savings of £59,090 were made.

Home First 2022

The latest evaluation (2022) of the Home First scheme reported that it had :

supported 53 patients over the 12 month pilot. Of these, 85% were severely frail. People with this level of frailty will have significant issues with moving about; managing everyday tasks and they will have a number of other diagnoses – for example dementia, loss of sight and hearing, osteoporosis, multiple long term conditions.

Home First provides six weeks of support to enable people to leave hospital earlier and aftercare where they are assessed in their own home environment.

To provide the 7 day service the team of professionals included:

• 1 WTE Occupational Therapist.
• 120 hours care at home workers.
• 21 hours Social Work support.
• 15 hours rapid access physiotherapy support

Home First was affected by staff shortages in Care at Home from late October to December 2021.

During the running of the pilot scheme the complexity of needs of the people being referred increased as those delivering the model of care became more confident.

Orkney’s Care at Home Service

Orkney has an ageing demographic and in 2021 Care at Home received 234 referrals for support. The report puts forward the proposal that if the model used in Home First, of ‘reablement’, was extended to Care at Home then there could be fewer visits.

“if reablement was applied to the entire Care at Home caseload there is the potential for 852.5 visits less per week (44,330 visits less per annum) There will be associated travel time savings in addition.”

The evaluation further reports that between 15 February and 17 May 2021 there were an average of 28 people awaiting a Care at Home package across Mainland Orkney with 35 people awaiting a package at the start and 29 people waiting by 17 May 2021. The service was under stress and the Home First scheme was a solution by providing a reduction in time for people in acute beds in hospital and supporting them to live in their own home. It was decided that, the Home First Pilot service be extended to be in operation for one year including one full winter, until 31 March 2022.

The original scheme was only available for people living in Mainland and the 2021 evaluation acknowledged that solutions would need to be found for isles patients to access the service. ‘Attend Anywhere’ – video consulting technology was introduced and reablement training was delivered by an Occupational Therapist to Care at Home teams.

Some people did have to be readmitted to hospital due to falls and medical deterioration. Most of them were able to return to their home environment after a short stay in hospital. One person went into residential care.

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.

The Covid pandemic has brought many challenges to the delivery of Health and Care services in Orkney. In February 2022 Orkney Health and Care was allocated additional funding of £3.746 million from the Scottish Government to meet the extra costs arising from the pandemic.