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Frequently Asked Questions


To deliver an enhanced model of health and social care to support frail elderly patients, and those with multiple complex long term conditions in a planned, proactive and preventative way

We aim to:

  1. Develop skilled staff who can confidently look after residents with complex needs to improve their wellbeing and quality of life
  2. Work more closely together to plan better care for patients
  3. Be responsive – getting the right professional to the patient quickly, so they can avoid a hospital admission if they don’t need to go
  4. Improve our technology – so that clinicians can securely access patient records in their care home.

A long established partnership between East and North Hertfordshire Clinical Comissioning Group, Hertfordshire County Council and Hertfordshire Care Providers Association. This partnership brings together health, social care and care home owners and staff.


92 care homes in east and north Hertfordshire are taking part in Vanguard, focussing on a range of projects around developing confident staff, multidisciplinary teams, rapid response service and effective technology.


The programme is limited to care homes in the east and north of Hertfordshire (the East and North Hertfordshire Clinical Commissioning Group area), although some of the wrap-around services are available to all Hertfordshire residents over the age of 65.


We were awarded Vanguard status in August 2015 and the first cohort of care homes began training in April 2015.


Most of Hertfordshire’s care home residents are elderly, and many have complex health conditions.  On average, each resident takes seven prescribed medicines a day and is more than three times as likely to be admitted to hospital as another over 65-year-old in the county.  For residents, particularly those living with dementia, every hospital visit has the potential to be confusing and disorientating – particularly as around a quarter of hospital ‘admissions’ are for less than 24 hours.

The specialist training care home staff receive allows them to act more effectively and give them the confidence to prevent serious health problems arising.  Staff can identify potential risks earlier and flag them up with doctors, before residents’ conditions worsen. This can help to prevent hospital admissions.



  • 999 calls
  • A&E attendances
  • Emergency admissions to hospital
  • Short stays in hospital 
  • Calls to the out of hours GP service from care homes
  • ‘Delayed transfers of care’
  • Medication errors and problematic polypharmacy


  • People living healthier lives for longer in care homes 
  • Calls to NHS 111
  • Staff, residents and families reporting feeling satisfied with care
  • Care home staff choosing to stay longer in their jobs
  • People dying in their preferred location

HomeFirst is a new rapid response service which helps people stay well and independent. It operates in our Lower Lea Valley and North Hertfordshire 'locality' areas. 

The service supports older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care. Many people prefer to be supported in their own homes, close to friends or family carers, where it is easier to get back into familiar routines and an independent lifestyle once their medical crisis has eased.

  • HomeFirst brings together health and social care services to deliver:

✔ improved access to rapid support with care from the right professional
✔ better communication between people using services and health and social care professionals working as part of the same team
✔ reduced accident and emergency attendance and unplanned hospital admission or residential care
✔ rapid discharge from acute hospital


Champions receive training in one of six specialist areas:

  1. dementia
  2. nutrition
  3. engagement and wellbeing
  4. falls and fragility
  5. wound management
  6. health - including end of life, continence, neurological and respiratory conditions.

Care homes are paid £70 per resident per week for those residents who meet the agreed criteria as a 'complex care' resident.


Homes can choose how they spend the extra money. Some choose to enhance the pay of staff who have opted for extra training, or to provide cover for staff on training courses. Some use the money to fund improvements such as extra staffing at mealtimes, dementia-friendly crockery and coloured toilet seats and light switches.  In other homes, new resources like laptops or electronic care plans have been purchased.


The current day time staffing ratio within the 'fair cost of care' model is as follows:

Cost Assumption within model Calculation
Care Assistant Staffing ratio (day) Assumes staffing ratio of 1:6.5 in the day (12 hour shifts) 45 residents divided by 6.5 ratio = 7 staff x 12 hours x 7 days x £8.62ph divided by 45 residents = £112.63

If around 15% of residents may be eligible for the premium, that means of the 45 residents in the model, 37 are not eligible and 8 are. So: 

Rework the calculation above for 37 residents comes out as £111 per person per week for daytime care.

Re-do the calculation above for 8 residents at 1:4 care ratio = 8 residents divided by 4 ratio = 2 staff x 12 hours x 7 days x £8.62ph divided by 8 residents = £181.02

The difference between what’s in the model and what’s additional is therefore £181 minus £111 which is £70 pounds per person per week.

Since this model was agreed, we have been monitoring activity which could suggest a change to the above rationale.  For example, the Premium claim rate has generally been higher than that stated above, at about 29% of total residents.



  • with more involved care conditions
  • who are not eligible for Continuing Health Care
  • who have been identified as having more than one of the illnesses or needs in the list below:
    • Dementia
    • Falls Prevention
    • Nutrition
    • Wound Management
    • Health Care - end of life, continence, neurological and respiratory

Care homes are paid £70 per 'complex' resident per week. There are different justifications for which a resident can be claimed as being 'complex' that are related to the Champion training pathways (e.g. ‘nutrition’ or ‘dementia’). In order to be eligible, the Champion trained in that particular area must be in place at the home at the time of the claim, otherwise the £70 payment will be rejected for that particular resident. This was more of an issue when the payment of the Premium began last October, before some of the Champion training pathways had been completed. Now it is just an issue if one of the Champions leaves, but Hertfordshire Care Providers Association and the CCG work with the home when this happens to try to get a new Champion trained as quickly as possible.