More people in Oxfordshire are able to live happier and more independent lives following a stay in hospital thanks to a service known as “Home First”.

Home First is a collaboration involving local health and social care providers and Age UK Oxfordshire and aims to help people to regain their independence and return home following and illness or injury that required a hospital stay.

The innovative approach has meant that people become more able more quickly and are less reliant on care services. Over the four months from July 2020 the care hours needed by this group of people has reduced by over half.

Home First is a joint initiative by Oxfordshire County Council, Oxford University Hospitals NHS Foundation Trust, Oxford Health NHS Foundation Trust, and Age UK Oxfordshire, who work holistically using a strength-based approach maximising people’s ability to live independently in their own home.

A team of therapists, social workers, coordinators, reablement workers, and support workers collaborate to carry out assessments, then a seamless and comfortable return to the home environment.

A bespoke team approach occurs for each person, including:

  • Supporting discharge from hospital and preventing readmission;
  • Maximising the opportunity to understand patients as individuals, and what is important to them;
  • Encouraging support mechanisms such as family, friends, and community support to enhance the patient’s wellbeing.

We want our residents to be able to establish and sustain an independent and fulfilling life within their own homes. This is enabled with strength-based goal planning and therapeutic interventions.

As the county prepares for a busy time with winter pressures and continues to cope with COVID-19 restrictions, the importance of reablement based in resident’s homes is more relevant than ever. Just 10 days in hospital can lead to 10 years’ worth of aging in the muscles of somebody over the age of 80.

Sally Steele, system lead for Home First at Oxfordshire County Council, said: We know there are additional pressures this year with COVID-19 concerns plus winter flu. Home First supports residents by ensuring they can leave hospital and return to their own homes and safe spaces, as soon as they are able. Thanks to the collaborative approach and our hard-working team, people regain their independence because they receive support and intervention in the most appropriate and often happiest setting.

“By being and feeling informed, residents can have a much better idea of what their support will look like when they leave hospital and what they can expect. Home First helps to manage expectations about when people can go home, what’s needed to get them there, and how we can support them to achieve their goals towards independence.”

Sam Foster, Chief Nursing Officer at Oxford University Hospitals NHS Foundation Trust, said: “This collaborative approach is an essential part of making sure our patients receive the right care, in the right place.

“Once hospital care is complete, many people want to be back home as soon as possible, which is completely understandable. Being in hospital for longer than needed often leads to a deterioration in people’s general condition, and can even increase their long-term care needs.

“This home first approach not only makes sure people are confident and happy in their own homes, it also means that there is capacity in our hospitals for people who need to have more acute care.”

Sarah Hamblin, Allied Health Professions Clinical Lead Oxford Health NHS Foundation Trust, said: “Working together with our system partners in such a positive way has ensured that our patients return home to their community with the level of support and rehabilitation that they require.

“We have all brought our skills and knowledge to the partnership to deliver a service that works to develop goals with our patients to ensure that they can recover at home while re-building the skills and confidence they, their families and carers need to manage at home as independently as possible.”

Age UK Oxfordshire colleagues are there to make sure our patients feel assured and happy in their own homes.

Ruth Swift, Head of Community Development at Age UK Oxfordshire said:  “Age UK Oxfordshire is pleased to be working as part of the Home First team this winter. By working together as a whole system, we can add both our knowledge of the community support that exists across Oxfordshire as well as our creative thinking and practical support. We are excited to support people to feel safe and supported at home, to not feel alone and to be better linked in to all the support and opportunities that exist locally to them.”

Meanwhile, the pandemic has increased the opportunity for agile working and using assisted technology. Teams are using smart phones to order equipment quickly and efficiently. Whatsapp video calls are used to speak to movement and handling specialists so assessments can be observed, and recommendations can be made safely.

The County Council plan to commission more domiciliary care providers and agencies to broaden support for vulnerable people recovering from coronavirus while providing full PPE and training.

More information

  • Home First is based on a pilot project that launched in July 2020 to cover Banbury, Bicester, Kidlington, and Woodstock.
  • We are working hard to support clinically extremely vulnerable (CEV) residents – signposting them to the registration service and helping them access local support, both via our website and through our Customer Contact Centre. Adults’ Social Care teams are continuing to engage with CEV residents who they are already in contact with to ensure their ongoing needs are met.