York Teaching Hospital NHS Foundation Trust’s (YTHFT) ‘home first’ strategy has been developed in response to emerging national evidence that prolonged stays in hospital may do harm to older people if there is a delay their transfer or discharge home after their acute recovery phase is completed. 

Ultimately, the aim is to avoid a hospital admission wherever possible and ensure that if an admission is required, the length of stay is minimised. This will be made possible by investing in a wider range of services available in the community to support individuals to remain at home, support that the members of the Vale of York community has said that they want and need.

The background, rationale and proposal was discussed by partners from Healthwatch York, York Community and Voluntary Services (CVS), City of York Council, North Yorkshire County Council, Tees, Esk and Wear Valleys NHS Foundation Trust, Public Health, Primary Care and York Teaching Hospital NHS Foundation Trust  at the Integrated Transformation Board in May and July 2016. 

The proposed approach was based on a review by the national Emergency Care Improvement Programme (ECIP). At the time of the review, ECIP identified that 90% of the patients at Archways Community Unit did not need to be in an inpatient bed, and could be supported at home if appropriate home based services were in place.

Reinvesting resource from Archways into community based services will provide an alternative to a hospital bed. YTHFT’s strategy will see the services currently delivered from Archways Intermediate Care Unit provided through an expanded York Community Response Team and other appropriate support services*.

The proposal to move resource into the community is based upon conversations with public who have said that they would prefer to be supported at home.

The Community Response Team, already active in York, is a widely-skilled team that can provide nursing, therapy and social care assessments, rehabilitation support and treatment to patients. The team will be expanded to accommodate a greater number of patients.

Services available at Archways are not being stopped.  They will in fact be delivered in a different way, better way in a community setting. There will be some patients whose medical needs mean they still require an inpatient bed care and these patients will continue to receive this.

The proposal to deliver this type of care has been based on the following discussions.

• The health and social care system has committed as a system towards a ‘community first’ approach with greater integration of services and an increased emphasis on prevention and self-care (agreed at 23 June 2015, system workshop).

• The vision of out of hospital care and integration across the system was agreed as:

          “We will support and enable the population of Vale of York to improve their health
          and wellbeing by organising our services around the needs of the person, their
          family and the community to provide integrated care and support”.

• The reconfiguration aligns with all of the principles for Out of Hospital Services outlined within York Teaching Hospital, NHS Foundation Trust - Out of Hospital Care Strategy.

*Services currently delivered from Archways Intermediate Care Unit will, in the future, be provided through an expanded York Community Response Team and other appropriate system support resource; for example via outreach pharmacy, support from Advanced Care Practitioners  and the Community Discharge Liaison service or alternative community beds, if required.

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