Partnership with HomeLink saves 20,000 bed days at James Paget Hospital

Thanks to a partnership with HomeLink Healthcare, The James Paget University Hospital NHS Foundation Trust has freed up nearly 20,000 bed days since they started working together four years ago. The service, known as Paget at Home, creates an additional ward of capacity every day, by providing treatment and care at home to patients who would otherwise have remained in hospital. The operational headroom created contributes to productivity benefits while the bed days are costing less than half the equivalent in-hospital care.

"Pro-active lead, excellent engagement with Trust colleagues and escalating concerns"
- James Paget Client Survey

The situation

Like almost all acute hospitals The James Paget was experiencing extreme capacity issues when they first commissioned our services back in March 2020. Fast forward to the end of 2023 and hospital bed capacity was 88%. This compared favourably to an average across all NHS hospitals of 90%, thanks in part to Paget at Home.

The solution

Paget at Home started as an Early Supported Discharge service which included clinical care at home and Bridging Packages of Care. It has developed over four years to cover a range of pathways including supporting the Virtual Ward, IV Therapy, Discharge to Assess and Reablement.

How does it work?

An on-site team pro-actively identify patients who are medically optimised or no longer meet the criteria to reside and enable same-day transfer / discharge home. Home based wrap-around care is provided by a HomeLink Healthcare multi-disciplinary team. The on-site team do the heavy lifting managing the on-going care, co-ordinating with consultants, referrers and community providers, minimising the impact on hospital staff.  The service is supported by a 24/7 on-call service.

As a clinician-led organisation, a commitment to quality care is at the heart of everything we do. For each new pathway HomeLink Healthcare carry out a feasibility assessment using hospital data. Clinical governance is co-produced, and pathways are rapidly prototyped, evaluated and rolled out, using technology as an enabler where appropriate. A comprehensive suite of KPIs is implemented, and real-time data allows the team to identify best practice quickly and apply corrective actions as necessary.

Services are commissioned using the NHS SBS Patient Discharge and Mental Health Step Down Beds Services Framework Agreement. Using the Framework means that the time to contract is shortened significantly compared to a full tender. This saves significant time and money and enables us to fully mobilise new services through a ‘test and learn’ phase to full ramp in 4-12 weeks.

"Excellent team and service, so happy I can be treated in my own home"
- Patient

The results

Increased capacity and improved patient flow: Over the last four years Paget at Home has supported over 1,000 patients and released over 20,000 bed days, saving an average of 20 bed days every day. This is the equivalent of almost a whole hospital ward. With a capacity of around 500 in-patient beds, these 20 ‘at home beds’ effectively increase hospital capacity by four percent.

Better patient outcomes: Patients reported, on average, a 21 percent improvement in clinical outcomes (EQ-5D-5L) by the end of their treatment. 99 percent also said they would recommend HomeLink/Paget at Home to Friends and Family. By supporting patients across a largely rural area our service also address inequalities in access to care.

Better patient outcomes

Cost effective: In 2022, James Paget calculated the average cost per hospital bed to be £450. The cost of our Hospital at Home services are currently under £200 per bed day. Even without factoring a cost increase, this is a 55 percent cost saving.

Implications for the future

Patients: Paget at Home and other HomeLink Healthcare Hospital at Home models ensure that patients spend much less time in hospital which reduces the risk of infections, deconditioning and depression. By being discharged as soon as they are medically optimised or medically fit, and starting rehabilitation immediately, they also have much better outcomes. Patients much prefer being treated in the comfort of their own homes and, as a result of all these factors, they are much more likely to return to their pre-hospital level of independence. Patients are less likely to be re-admitted into hospital and will need reduced ongoing care.

Patient flow: Patients needing complex treatments or multi-disciplinary care often remain in hospital for far longer than they need to. A recent study found that the average length of stay in hospital was 34.8% longer in 2022/23 compared to 2019/20*. HomeLink Healthcare’s feasibility assessments often reveal around a ward worth of patients across the hospital that could complete their recovery at home, with the right Hospital at Home provision in place.

If every hospital in the country could create an additional 4% capacity, as The James Paget has done, this could be used to reduce the occupancy levels from 90% to 86% (85% is widely considered the risk threshold).

Sustainable additional capacity: If hospitals are to tackle increasing demand on Urgent and Emergency Departments, growing elective waiting lists and pressure on GPs they either need to increase hospital capacity (requiring more staff and additional wards) or treat more people at home.

As HomeLink Healthcare bring our own multi-disciplinary staff team, this avoids the recruitment challenges associated with resourcing additional capacity. This additional capacity, along with lower occupancy rates enables existing healthcare staff to focus on core delivery and allows time to plan for new patients and longer-term care.

Cost-savings: When occupancy levels are optimised** the cost of hospital at home services are significantly lower than the equivalent in-patient care. Improved patient outcomes mean smaller ongoing care packages, which are easier to source and lower in cost. The costs of building new hospital wards are also avoided.

Key stats (March 2020 – Feb 2024)

  • Over 1,000 patients have been treated at home
  • Patients spend on average 20 days fewer in hospital.
  • Patients reported an average 21% improvement in clinical outcomes
  • The service costs 45% compared to in-patient care
  • 99% of patients would highly recommend the service
  • 100% of client contacts said they would recommend us
  • SBS Framework allows new pathways to be mobilised in as little as 4 weeks

About HomeLink Healthcare

HomeLink Healthcare have been delivering Hospital at Home services since 2016 and provide a solution for the future. We deliver system benefits for ICBs, Trusts and the Community. Our services improve patient outcomes, improve patient flow, reduce waiting lists and save costs. In our recent survey 100% of client contacts said they would recommend us.

HomeLink Healthcare is a named supplier on the NHS SBS Patient Discharge and Mental Health Step Down Beds Services Framework Agreement. By using the framework, you can contract with us directly and we can get a new service up and running in around 12 weeks.

To discuss how HomeLink Healthcare could help your organisation, or to request a free Feasibility Assessment please get in touch.

Call 020 3137 5310 or email info@homelinkhealthcare.co.uk

 

* Newton / CCH report Finding a way home, November 2023

** HomeLink Healthcare virtual wards have a 97% occupancy rate compared to 70% across the NHS (Jan 2024)

Collaboration with four NHS organisations frees up two hospital wards every day

HomeLink Healthcare has been working across Norfolk & Waveney ICS alongside multiple NHS organisations to respond to exceptional capacity challenges.

"HomeLink gave us the ability to quickly respond to demand, flex up and down, and were invaluable in enabling us to meet varying complexity of needs”
- NHS Trust Chief Operating Officer

The partnership began in 2019 with Norfolk and Norwich University Hospital (NNUH). Today we also work with James Paget University Hospital, The Queen Elizabeth Hospital King’s Lynn, and Norfolk & Waveney ICB.

Hospital at Home services are delivered through a number of pathways: Virtual Wards, Reablement, Early Supported Discharge, and Discharge to Assess. Some pathways include patient monitoring. We also provide Bridging
Packages of Care.

This testbed for pan-ICS work in collaboration with an independent sector provider has been very successful. Services are rated excellent by patients, provide measurable system benefits and improved patient outcomes. Services are also delivered at 45% of the equivalent in-patient cost.

The scope and scale of the collaboration continues to expand across the ICS. Findings have been shared and used to inform models of care and to support delivery of NHS strategy and plans.

Setting the scene

"HomeLink Healthcare has an ongoing flexible collaborative approach; high-quality service provision with robust governance and transparent data and reporting”
- NHS Trust feedback

The Norfolk & Waveney Integrated Care System (ICS) covers a largely rural area in the East of England.

The widely dispersed population and long travel times, on mainly country roads, creates challenges in providing consistent community and home-based care.

In addition, the relatively isolated location makes it hard to attract and retain sufficient numbers of community nurses, physiotherapists and healthcare assistants.

Gaps in access to community care led to delays in discharging patients from hospital, with the inevitable impact on emergency admissions and electives.

In 2019 it was decided to engage with a specialist Hospital at Home service provider, HomeLink Healthcare, to provide pathways for patients who had no need to remain in hospital.

In common with many systems, NNUH faced a longstanding need to create additional acute capacity that became more severe in 2020.

The benefits of the new services were closely monitored.

Key achievements

• A unique pan-ICS collaboration with the independent sector

• The partnership has saved 45,000 bed days (Jan 19 – Apr 23)

• Services were delivered at 45% of the in-patient cost (James Paget University Hospital, Jan 21- Aug 22)

• 17% improvement in self-reported clinical outcome measures (EQ-5D-5L Jan 19 – Feb 23)

• Today the service frees up the equivalent of two hospital wards every day (56 hospital beds)

• Over 99% of patients would highly recommend us (patients scoring us 8+ out of 10)

• Findings have been shared across the ICS and with NHS England

• The partnership was shortlisted for an HSJ partnership award in 2023

The collaborative approach

Initially, a ‘test and learn’ pilot was conducted at NNUH with the financial, patient and system benefits evaluation leading to conversations across the other acute hospitals, community providers, and Norfolk & Waveney ICS.

A Virtual Ward was developed at NNUH in 2019 and findings were used to improve subsequent service development.

Since 2020, we have worked with a team from the Trusts and ICB to design and create additional Hospital at Home services including treating patients with more complex needs. We have also provided short term wrap-around support to frail patients, to reduce hospital attendance, and to support independence. Taking a safety-first approach, we ensure that governance is paramount and that KPIs are built into the system.

Services were rapidly prototyped, evaluated and rolled out, using technology as an enabler where appropriate. A comprehensive suite of KPIs was implemented and real-time data allows the system to identify best practice quickly and apply this across the ICS.

HomeLink Healthcare provided a flexible regional workforce with a good understanding of the local geography. We worked with our NHS colleagues as one team and acted as a force multiplier in a hard-to-recruit region. The result was that capacity was always maintained and inequality in access to care was reduced.

Patients rate the service as ‘excellent’, and outcomes have been impressive. We use the EQ-5D-5L ‘self-reported clinical outcome measurement‘. We saw an average improvement of 17% between January 2019 and May 2023. Patients also demonstrated a positive improvement in the following five domains: mobility; self-care; usual activities; pain/discomfort; and anxiety and depression. We use an ongoing flexible ‘test and learn’ approach which ensures robust governance and continual service improvement. Operations manuals were co-designed specifically for each service and reduced service duplication saves the NHS time and money. New services can now be mobilised within as little as four weeks.

System benefits & the future

As four NHS organisations and an independent provider, we were combined early adopters of Hospital at Home services. We have worked from the start to share benefits across the ICS. The collaboration has shown how pan-ICS contracting results in better value for the NHS and an excellent patient experience and outcomes.

The scope and scale of the collaboration continues to expand across the ICS. Findings have been shared with NHS England, and Virtual Ward models align with and support NHS strategy and plans.

Get in touch 

To speak to a member of our team about our services, call us on (020) 3137 5370 or contact us. You can tell us about your situation, and we can tell you more about our experience and how we might be able to help you. 

Joined-up work demonstrates compassion and helps avoid two hospital admissions

HomeLink Healthcare accommodated a couple’s return to their own property following a hospital stay. Whilst providing a package of care for both parties, and IV treatment for the wife, we supported the couple through multiple additional issues which were not initially identified.

Whilst the multi-disciplinary team were constructing a longer-term plan, the HomeLink team recognised where and how the couple were struggling and prevented two hospital re-admissions.   

Aneta, who is her husband Jim’s main carer had been in James Paget University Hospital receiving treatment for an infection and fatigue. When Jim and Aneta were discharged from hospital on 30th October 2023, HomeLink Healthcare were asked to provide Aneta with a once-a-day package of care as well as IV therapy for six weeks. Jim also required a twice-a-day package of care. 

On the first visit HomeLink staff identified that both patients were struggling being at home and that Aneta had pain that was poorly controlled. Aneta’s pain was distressing Jim, which in turn upset his wife. The situation required more input that first expected.  

On 2nd November the couple were waiting social worker allocation and a concern with safeguarding was also raised.  The visiting HomeLink nurse went to the patient’s medical practice, raised concerns with the GP and organised a complex needs assessment joint visit with the GP for both parties, concentrating on pain management for Aneta. HomeLink staff stayed for longer than the allotted time with the couple offering support, caring and liaising with the multi-disciplinary team to resolve the concerns. It was decided that extra visits would be allocated to the patients to ensure they were safe and supported. 

On 3rd November Aneta had developed a urinary retention due to the pain and required re-catheterisation by the community nurses.  The medical consultant at James Paget University Hospital asked for our team to continue to monitor for mobility decline. An urgent MRI was booked.  

On 10th November following daily contact with visiting staff, the HomeLink Clinical Lead visited the patients at home with their GP and Social Worker.  Aneta’s pain management was reviewed and changed to a transdermal pain patch. The Social Worker suggested the use of respite care for the couple to allow the wife to recuperate whilst not needing to care for her husband.  

HomeLink continued to support the couple until respite care was sourced, reducing the number of visits required over time.  

This story demonstrates HomeLink Healthcare’s commitment to providing a safe, effective, caring, responsive and well-led service. The staff involved demonstrated our values of Compassion; Commitment to Quality Care and Collaboration. It also shows how providing excellent multi-disciplinary support through one provider enhances the patient experience and provides system benefits to the NHS through admission avoidance which in turn improves hospital flow and saves the NHS money. 

Find out more about the features of a HomeLink Healthcare Hospital at Home service 

Get in touch 

To speak to a member of our team about our services, call us on (020) 3137 5370 or contact us. You can tell us about your situation, and we can tell you more about our experience and how we might be able to help you. 

NEW White Paper: Virtual Wards – Achieving the Ambition, Delivering the Benefits

This Virtual Ward white paper, written by independent healthcare & digital strategy consultant Tracey Barr, explores how well the NHS is doing against its Virtual Wards ambitions. It looks at capacity and occupancy across the country and suggests what needs to happen next. 

Virtual Wards are a crucial part of NHS plans to increase capacity and tackle the increasing operational pressures facing the NHS.  

What is a Virtual Ward? What benefits will they deliver? How well is the NHS doing in delivering on its ambition for Virtual Wards?  

This paper looks to answer these questions and provides a case study of how HomeLink Healthcare, has been working in collaboration with NHS organisations in an Integrated Care Board (ICB) in the East of England to develop and implement a Virtual Ward programme that is tailored to the local context and needs of its local population.  

Click here to read the Virtual Ward white paper.

About the Author

Tracey Barr is an independent strategy consultant specialising in healthcare and digital with over 30 years’ experience. Tracey has rich knowledge of the UK healthcare market, gained from working in senior roles in the NHS and BUPA, as a strategy consultant with LEK and Arthur Andersen and as an independent strategic advisor to healthcare policy makers, commissioners, providers, investors, charities and digital health companies.

HomeLink Healthcare Virtual Wards 

We report a suite of virtual ward key performance indicators (KPIs) in real-time, so commissioners have complete transparency about what we are doing and how we are doing it.  Find out more about the process of working with HomeLink Healthcare to set up or support the delivery of your Virtual Ward or other Hospital at Home service.

Get in touch 

To speak to a member of our team about Virtual Wards, call us on (020) 3137 5370 or contact us. You can tell us about your situation, and we can tell you more about our experience of hospital at home and virtual wards and how we might be able to help you. 

HomeLink Healthcare feature twice in IHPN Community Services Report ‘What does good look like?’.

We are proud to have two case studies featured in the Independent Healthcare Providers Network (IHPN) Community Health Services report ‘What does good look like?’. The report includes an overview of community health services in England, along with sixteen case studies from IHPN member organisations.

 

The report explains how moving more services into the community, and out of hospital, is core to the NHS Long Term Plan. It says that it has never been more important to see community healthcare services as the essential building block to a modern, responsive health service. The report showcases how community health service providers, including HomeLink Healthcare, are bringing much needed capacity to the NHS and delivering innovation as well as improved productivity and patient outcomes. The case studies depicted in the report show ‘what good looks like’ and ‘the art of the possible’.

 

The case studies about addressing capacity issues in Buckinghamshire Health Trust and Norfolk and Waveney ICB are featured as below.

 

You can read the full report here IHPN Community Health Services report 2023.

Find out more about HomeLink Healthcare’s Hospital at Home services.

Get in touch 

To speak to a member of our team about our services or to book a free feasibility assessment, call us on (020) 3137 5370 or contact us.  

NHS England and IHPN visit HomeLink Healthcare service

Sam Sherrington, Deputy Director for Community Nursing at NHS England, Dawn Hodgkins and Danielle Henry from The Independent Healthcare Providers Network came to visit us at St. Mary’s Hospital in Paddington to see how HomeLink Healthcare services work in practice.

“What we have seen here today in HomeLink is a very dynamic, solutions focused way in which we are trying to address problems around discharge”. – Sam Sherrington, NHS England

Here is a short video with Sam and Dawn reflecting on the importance of the service and some of the great things they’d observed from the HomeLink Healthcare service – the partnership between independent sector and the NHS, the innovation and quality of service, and the care, dedication and expertise of the clinicians – nurses, therapists and more – working to deliver for patients.

 

Find out more about HomeLink Healthcare’s Hospital at Home services.

Get in touch 

To speak to a member of our team about our services or to book a free feasibility assessment, call us on (020) 3137 5370 or contact us.  

Case study: Feasibility assessment

A recent feasibility assessment concluded that implementing Hospital at Home services would free up significant numbers of inpatient beds.

In September 2023 HomeLink Healthcare’s experienced clinicians spent two days with an NHS Trust. We discussed the Trust’s current challenges, and ‘walked the wards’ to identify opportunities to discharge patients. We carried out a detailed feasibility assessment across seven wards  in surgery and medicine. These wards accommodated around a third of the hospital’s 700 beds.

The potential impact of implementing Hospital at Home services

A Virtual Ward would free up a full ward of beds in the hospital.

Virtual Ward:

Our team identified 25 patients from different specialties that could have been treated at home on a Virtual Ward.

Bridging Packages of Care:

HomeLink Healthcare Bridging Packages of care would have released an additional 16 beds (or reduced the average length of stay by 4.5 day for each patient awaiting a package of care).

A further 16 patients were identified as being medically fit for discharge and were waiting to return home with a package of care. On average it was taking the Trust four to five days to arrange this care with local providers. HomeLink Healthcare respond to referrals within two hours and can facilitate a return to patients’ homes on the same or next working day.

IV Therapy:

The Trust’s OPAT team were taking patients on longer IV prescriptions, however any patient requiring short courses were kept on the ward even though they were medically stable and could be treated at home. This is causing bed blocking and could be alleviated with administration of IV therapy in the community. HomeLink Healthcare has been providing this type of service to other NHS Trusts since 2019.

Applying this across the NHS

NHS hospitals frequently run at above 95 percent bed occupancy levels which impacts on hospital flow. Our feasibility study highlights the impact that Hospital at Home services can have. HomeLink Healthcare Hospital at Home services:

  • improve patient flow as well as patient experience and outcomes.
  • typically cost half the equivalent in-hospital care (James Paget University Hospital data).
  • help hospitals avoid recruitment challenges, we bring our own staff.
  • can avoid the need for capital expenditure on new wards.

What is a feasibility assessment?

As part of our consultative process, HomeLink Healthcare offer prospective clients a no-obligation, free feasibility assessment. The assessment provides a snapshot, at a given time, of the patients that could be treated at home. As a result, it provides a good indication of how many hospital beds could be freed up. The feasibility assessment helps prospective clients to build a business case for Hospital at Home services.

Contents of a feasibility assessment

  • During a pre-visit call we discuss your current situation and concerns with patient flow.
  • We then carry out a desk-based review of relevant documentation.
  • Our experienced clinicians visit your senior management and clinical teams on-site to discuss the current challenges.
  • We ‘walk the ward’ with your teams to identify opportunities to discharge patients and how we can help you.
  • You can ask us in-depth questions about our Hospital at Home service delivery and governance.
  • We collate and summarise findings from this survey and present this back to you within two weeks of the visit. The assessment will include a solution-based proposal with suggested staffing model (HomeLink Healthcare provide our own staff) and outcome-based measures.

The feasibility study forms part of our seven step end-to-end process:

7_Step_Process

Work with us 

Find out more about HomeLink Healthcare’s Hospital at Home services and the process of commissioning HomeLink Healthcare to set up a hospital at home service. 

Get in touch 

To speak to a member of our team about our services or to book a free feasibility assessment, call us on (020) 3137 5370 or contact us.  

Admission avoidance case studies

HomeLink Healthcare’s Admission Avoidance pathway is helping the NHS to avoid emergency admissions, which in turn improves hospital flow, patient outcomes and saves the NHS money.

The case studies below provide examples of the types of patients we are able to support along with the wider benefits to patients and the NHS.

NNUH Virtual Ward service helps respiratory patient avoid multiple hospital admissions  

Ron, aged 75, has an extensive medical history including moderately severe bronchiectasis (diagnosed in 1969), emphysema and diverticulosis.  Ron has open access to the respiratory team at the Norfolk and Norwich University Hospital due to his condition. He has received care from HomeLink Healthcare on a number of occasions over the last year for recurrent exacerbations of his bronchiectasis.  

On one occasion Ron was referred for thrice daily antibiotics, midline care and weekly blood tests to assess the effectiveness of treatment.  He was facing a long stay in hospital at a time when his wife was in the terminal stage of an illnessSadly, at this time and when she Ron’s wife was receiving end of life care. Sadly , and during his 14 days’ treatment, his wife passed away.  

HomeLink Healthcare work collaboratively with the respiratory team in the hospital for bronchiectasis patients and Ron is one of a number of patients who we provide treatment to on a Virtual Ward in their own homes.  

Patient at QEH avoids hospital admission and multiple GP appointments 

Brian, aged 68, has Type 2 diabetes which is controlled by tablets. Brian stood on a stone which penetrated through  his footwear and lodged into the ball of his foot. He couldn’t feel pain or discomfort and was unaware of the injury which his wife noticed. The GP referred Brian to the diabetic foot clinic at the Queen Elizabeth Hospital, Kings Lynn (QEH) where an X-ray indicated an infection in the bone.  

Patients who are deemed fit to avoid hospital admission are referred by Consultants and specialist nurses in the Outpatient team to the QEH at Home team (a partnership between the hospital and HomeLink Healthcare). The Consultant referred Brian to us so that we could administer IV antibiotics at home three times a day. During these visits we also provided wound care and blood testing as required. As well as avoiding a hospital admission, the service freed up capacity in his GP practice, where he would otherwise have needed three appointments a week with the GP practice nurse.  

After five days, the Consultant reviewed the results and advised for antibiotics to continue for a further seven days with ongoing wound care and blood tests.  

Brian was very happy to be treated at home as he had experienced two hospital admissions for surgery in the last six months. He remained under QEH at Home care to complete his treatment enabling him to avoid another hospital admission that would have blocked a muchneeded bed for weeks. 

The wider benefits for Admission Avoidance patients 

By treating patients like Ron and Brian at home we are able to prevent recurrent hospital admissions, improve patient experience and help improve patient flow. 

Bed days saved: On average HomeLink Healthcare Virtual Wards save 9 hospital bed days per patient. In Ron’s case this service saved the hospital 14 bed days and in Brian’s it was 12 days.   

Better patient experience and outcomes: Research by the British Geriatrics Society shows that there are similar outcomes for those allocated to hospital at home versus hospital admission for the main outcome of living at home. The research found a reduction in admission to new long-term residential care and high levels of patient satisfaction for hospital at home.  

HomeLink Healthcare’s own clients report a self-reported average 9.3% improvement in all health outcomes. 98% of HomeLink Healthcare’s patients would highly recommend our services to their friends and family. 

Work with us 

Find out more about HomeLink Healthcare’s Hospital at Home services and the process of commissioning HomeLink Healthcare to set up a hospital at home service. 

Get in touch 

To speak to a member of our team about our services or to book a FREE feasibility study, call us on (020) 3137 5370 or contact us.  

Got a question? Contact us on (020) 3137 5370

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