Calderdale & Greater Huddersfield CCGs: Seamless Home from Hospital Service

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Calderdale & Greater Huddersfield CCGs are wishing to hold a market test for the Seamless Home from Hospital Service. To support safe and timely discharge from Calderdale Royal Hospital and Huddersfield Royal Infirmary or Intermediate Care facilities in both CCG areas; in addition those people who present at hospital and are deemed fit to be returned to home will be supported by the service. The service is available to adults aged 16 yrs and over and registered with a GP in either Calderdale or Greater Huddersfield. The service operates 7 days including evenings and bank holidays. Three types of service should be made available: transport only, transport and settling in and settling in only. It is anticipated that the majority of people will require an accessible minibus, two staff, a driver and a passenger assistant; provision needs to be made for wheelchairs, equipment and luggage. Passenger assistants will have essential items to keep patients warm and dry. Where the person needs a carry chair, either due to their condition or the number of steps at home, provision will be made available. The settling in element will ensure the person is safe and comfortable once at home. This will include a safe and warm check, preparing food and drink and/or ensuring the patient has essentials to prepare their own food and drink. Support workers will not offer personal care but will undertake a range of tasks including turning on heating, making beds, clearing out the fridge, shopping etc. An assessment of the person's home and support needs will be undertaken and may result in referrals for equipment and home adaptions, or to a range of public and voluntary sector support services. The service will make a follow up phone call to the patient 1-3 days after their return home to gauge if further support is required. This call may result in further referrals or a follow up visit. The person will not be discharged from the service until they are confident that they have sufficient support to live safely at home. The aim is to reduce re-admissions due to preventable causes.