Community rehab service enables faster discharge and recovery

Since late 2022, the HomeFirst service run by Wirral Community Health (WCHC) has supported over 1,000 discharges (both enhanced and therapy), providing better assessments and care options, leading to a significant increase in sustainable discharges from hospital.

Working with colleagues from Wirral University Teaching Hospital NHS FT and Wirral Council, the aim is for anyone discharged from hospital who requires an assessment of their long-term needs to be an automatic HomeFirst candidate in Wirral.

Delivered by the Community Integrated Response Team (CIRT), HomeFirst is a multidisciplinary and highly specialised team of therapists, care assistants and adult social care staff. Together they enable people to be discharged from hospital quickly and continue their recovery and rehabilitation in their own surroundings, regaining and significantly improving their ability to live as independently as possible for as long as possible.

Following hospital discharge, the HomeFirst team provide care and support for up to 6 weeks, though typically 2-3 weeks. Assessing the long-term care needs during this period, and in the person’s own home, gives the clearest picture of their reality and helps them to live as independently as possible.

The team is currently seeing around 130 people per month, plus a further 40 people discharged on the Home First therapy-only pathway - but there is an intention to increase capacity to more than 170 people per month, plus therapy-only patients. The service operates 7 days a week, from 8.00am - 7.30pm.

Impact to date

Performance metrics have improved particularly in relation to discharges and NC2R through partnerships and collaboration across Wirral.

In the last 12 months, HomeFirst has secured a huge reduction in the number of domiciliary care packages required from 270+ to less than 20.

The service has significantly improved outcomes for patients:

• 60% of HomeFirst patients continue to live in their normal place of residence with no additional formal care

• When people do need longer term care, the level of that care is typically lower following HomeFirst’s person-centred assessment.

Representatives from WCHC were also invited to present the HomeFirst Service at NHS Northwest’s Winter Event 2023, during which they shared key learnings, patients case studies and their data led approach to an audience of over 300 colleagues from across the region.

Further information

For more information about the HomeFirst Service please visit the Wirral Community health and Care website.