Evaluation of the Discharge to Assess initiative ‘Home First’ for a Clinical Commissioning Group

SPH was commissioned by a CCG to evaluate a ‘Discharge to Assess’ initiative aimed at reducing the secondary care inpatient length of stay of elderly frail people who no longer have any medical needs. Home First is the name given to these Discharge to Assess schemes that aim to safely support the transfer and short-term recuperation of elderly people home. Once people are at home and have recovered as much as possible of their day to day functioning they can be assessed, if necessary, for on-going home care or transfer to residential care. The evaluation SPH undertook was based on a mixed model of quantitative and qualitative measures. It provided a number of functions including:

  • Providing a detailed understanding of all aspects of the initiative for commissioners
  • Linking the original strategic objectives of the initiative with the day to day experience of people providing the service in managerial and operational roles and the challenges they face
  • Linking the original strategic objectives with activity and cost of the initiative
  • Recommending improvements and a plan for future evaluation

The key outcome of the evaluation was to inform the commissioning of the service in the longer term and identify immediate actions needed to strengthen the service in the short term in order for it to play a significant role in easing winter pressures at the local hospital NHS Trust.

For a more in depth look at the rationale behind Home First schemes see this article published by The Guardian on 10 October 2017: https://www.theguardian.com/social-care-network/2017/oct/10/home-first-model-aims-to-stop-patients-being-stranded-on-hospital-wards

The Local Government Association website signposts to national guidance and some examples of local initiatives: https://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience/overall-approach/discharge-to-assess

Case Studies

Health Needs Assessment for Children & Young People

SPH carried out a Health Needs Assessment for a local authority that was recommissioning its Healthy Child Programme (HCP). The purpose was to review whether existing provision and service configuration of the HCP was meeting the needs of children and young people) in the county, and to identify gaps and potential options for improvement. The Healthy Child Programme is a preventative programme which includes the Health Visiting and School Nursing Services, the Family Nurse Partnership (FNP) Programme and healthy start vouchers and vitamins, linking with childhood immunisation services, community paediatrics, speech and language, services for children with a learning disability and complex needs and child and adolescent mental health services (CAMHS), among others.  

 

The HNA was carried out jointly by NHS Solutions for Public Health and the local authority, with the epidemiological needs assessment and service description provided by the local authority. The report was compiled using a range of publicly available and locally collected epidemiological and service use data). In addition, SPH carried out a consultation of key corporate stakeholders as well as children and young people and their parents and carers. This included semi-structured interviews with key stakeholders in a range of organisations, a survey of a wider range of staff who work with children and young people and a survey of children and young people, their parents and cares which was distributed through the services.   

Testimonials