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Resource Topic: Patient experiences

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 much–needed 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.  

In-reach physiotherapy service in care homes benefits patients and hospitals

At a system level an in-reach re-ablement service is a safer and lower cost option for the ICB than providing 24/7 care and physiotherapy in the patient’s home.

In order to free up hospital beds and improve patient outcomes, Norfolk and Waveney Integrated Care Board (ICB) spot-purchase beds in care homes for patients who need up to four weeks’ re-ablement.

HomeLink Healthcare has been working in partnership with hospitals across Norfolk and Waveney since 2019 to provide Hospital at Home services. In February 2023 the ICB commissioned HomeLink Healthcare to provide an in-reach re-ablement service in care homes.

The in-reach reablement service means that patients from James Paget University NHS Hospital Trust can be discharged when they are deemed medically fit and would benefit from ongoing reablement before they are able to return home.

Virtual WardPatients are assessed by a HomeLink Healthcare physiotherapist in the care home within 72 hours of admission and start receiving physiotherapy and re-ablement immediately. The physiotherapist designs an individualised re-ablement programme, which is delivered by re-ablement support workers, and reviewed as needed by the physiotherapist. The team engage with and encourage care home staff to support patients with their exercises between visits.

The HomeLink Healthcare team attend the weekly multidisciplinary meetings to facilitate discharges and refer onto other community services including social services and community physiotherapy, ensuring patients ongoing care needs are met when they return home.

Patients returning home after receiving re-ablement services in a care home are typically more independent when they return home. As a result they need less ongoing support and smaller ongoing packages of care that than they would have needed without the service.  

On average patients in the Norfolk in-reach re-ablement service have seen 11% improvement in their mBarthel score and a 19% improvement in mobility in their self-reported EQ-5D-5L score.

At a system level, an in-reach reablement service is a safer and lower–cost option for the ICB than providing 24/7 care and physiotherapy in each patient’s home. 

Patient stories 

Sam:

Sam is a long-term smoker who lives alone in a second-floor flat. He had an acute kidney infection followed by COVID-19 as an in-patient. This resulted in him needing thrice-weekly kidney dialysis due to kidney disease. Prior to hospital admission Sam was fully mobile and independent in all activities of daily living.

Sam was discharged from hospital to a care home for re-ablement. Sam presented with shortness of breath on exertion which limited his ability to walk any distance and to climb stairs. He was also anxious about getting short of breath and lacked confidence about climbing stairs alone after a long hospital stay.

When Sam became medically fit for discharge, there were concerns around his ability to manage at home independently and Sam was therefore transferred to a care home to receive ongoing support. In the care home a HomeLink Healthcare physiotherapist assessed Sam within 24 hours of arrival and provided Sam with a series of stamina and muscle strengthening exercises. In between Sam’s therapy visits a HomeLink Healthcare re-ablement support worker carried out sessions to increase Sam’s confidence and also involved stair practise. This enabled him to improve his stamina and confidence following his illness which had led to Sam feeling deconditioned.

Sam was very pleased with his progress as he reported feeling stronger in general. Following completion of his re-ablement package he was able to manage the two flights of stairs required to be able to return home to his flat. The HomeLink Healthcare team ensured that a package of care was arranged to help with shopping.

Glen:

Glen had bilateral fractures of his pubic rami. This resulted in an enforced period of bedrest. He was unable to weight-bear and required a hoist to transfer. Glen’s past medical history included diabetes and long-term leg ulcers due to peripheral vascular disease and neuropathy.

Prior to his hospital admission Glen had been independently mobile with a frame and had been independent in all activities of daily living.  He lived with his partner, but in order to return to their new property, Glen needed to be independent with his bed mobility to support his toileting needs at night and his functional independence.

Glen was discharged from hospital into a care home for short-term re-ablement. When a HomeLink Healthcare physiotherapists assessed Glen in the care home he was starting to transfer a few steps with his frame with some support. Pain, along with the poor skin condition of his legs and toes, was however impacting on his rehabilitation.  The pain was addressed and the physiotherapist provided a course of strengthening exercises as well as bed mobility and functional activities such as accessing the bathroom and completing toilet transfers.

The physiotherapists along with a HomeLink Healthcare re-ablement support worker also worked on Glens balance within the limitations of toe pain and building stamina and confidence with his frame. Following the completion of his re-ablement package Glen became independently mobile with the frame and with bed transfers and toileting.

Glen said that he felt the service had improved his strength and confidence. He also felt positive that he and his partner could manage on his return home.

Through attendance at the weekly multi-disciplinary meeting HomeLink Healthcare facilitated an Occupational Therapy Assessment, issue of equipment, and the provision of a package of care for personal care only. Glen was then able to return home safely.

About HomeLink Healthcare 

HomeLink Healthcare is a clinician-led, specialist Hospital at Home service provider.  We have been delivering safe, high-quality services to NHS patients in the place they call home since 2016. 

HomeLink Healthcare have successfully delivered this service in care homes in Norfolk and South East London and would we are able to replicate this service in other commissioned services where we provide a physiotherapy-led service. 

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.  

Physiotherapy at Home reduces care costs by over 65%

In Fred’s case this intensive physiotherapy resulted in a happier patient, roughly a 65% reduction in care and a saving in care costs of over £1,000 per month.

Fred (not his real name), who is in his 80s, lives at home with his wife. In recent years he has had multiple health problems and in September 2021 had a bad fall and was admitted to hospital. Fred’s son, says that his father then contracted Covid several times. At one point the family were called to the hospital as doctors thought Fred was near the end of his life. When, in April 2022, Fred was discharged home his Barthel score was 15, indicating total dependency. Care was provided by a domiciliary care agency and he needed two carers, three times a day, seven days a week. In May, Lewisham Adult Therapy Team (LATT) referred Fred to HomeLink Healthcare to provide physiotherapy support.  

Shirley Forson, HomeLink Healthcare’s Clinical and Operations Lead for Therapies, says: 

“We first supported Fred from May to mid-June and were commissioned to provide six double-handed physiotherapy sessions. The goal was to improve his sitting balance and to enable him to use a Sara Steady with the assistance of a single carer, as he was previously mobile with a Zimmer frame. At the end of six sessions he was discharged having made a small gain, but given the limited number of sessions he didn’t progress as much as he could have done.” 

"The more independent dad can get the better. Originally, he had two carers three times per day. Now one carer comes three times a day Monday to Friday and we don’t have anyone at the weekends."
- Fred’s son

Fred was then readmitted to hospital in June with an unrelated health condition. When, after 10 days, he was discharged and referred back to HomeLink Healthcare. His mobility had deteriorated and he was “totally bed bound”.  

Shirley says:  

“We completed another six double-handed sessions, lasting until mid-July, with the same goals as the first time. Again, progress was limited.” 

Fred was then hospitalised once more and when discharged in August, was referred back to HomeLink Healthcare for a third time. We then supported him for a longer period, discharging him on November 4th after 28 sessions. This time, there was real progress.  

Shirley reports that during this third referral:  

“Fred went from being bedbound, needing double handed support and assistance with everything, to using a walking frame on his own with just someone around to give him reassurance. He can get to the commode by himself and can now get to sitting on the bed on his own, whereas previously he needed two people to help. He can also transfer on and off the stairlift with one person’s assistance, so can once again access both levels of his house.”  

Fred’s Barthel score went from 15 to 74, indicating a massive change to quality of life and independence. Furthermore, his mood has improved and he feels better about his health. HomeLink Healthcare uses the EQ-5D-5L self-assessment, health related, quality of life questionnaire. This measures quality of life over five categories: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each category is rated out of 5, with a score of 5 indicating very poor  and a score of 1 being very good. Fred’s scores improved significantly across all 5 domains as shown in figure 1 below.  

Fred's EQ5D5L score Figure 1: Fred’s EQ-5D-5L score

Shirley says: 

“EQ-5D-5L also has an overall health rating, which asks ‘How good or bad do you feel about your health’ (0 = 0 terrible, 100 fantastic). Fred started at 30 and ended up at 100.”  

This is an atypical case. Shirley says that in the LATT service therapists usually only see patients three times due to staff availability and referrals to HomeLink Healthcare are typically limited to six sessions. It demonstrates, though, that a greater investment in therapy earlier on can improve patient outcomes and reduce costs in the longer term. 

Alex Negurita Community PhysiotherapistAlex Negurita, Community Physiotherapist for HomeLink Healthcare says: 

“Fred made huge improvements between his physiotherapy sessions. It helped that he was so motivated and he really engaged with the exercises in and between sessions. I was impressed with what he was able to achieve, and I am pleased to have been able to help him to become more independent. I wish him and his family the best of luck for the future.” 

Small steps and big changes

Progress was easy to see, as each time Pat could do more than the previous visit, which was only a few days earlier. By the final session she was able to walk to her front door and back, without a frame.

In Autumn 2022 Lewisham Adult Therapy Team (LATT) referred Pat (not her real name), aged 65 to HomeLink Healthcare for six 45-minute sessions of physiotherapy, including an initial assessment. She had just been discharged from hospital with Type 2 respiratory failure. Furthermore, she had a complicated medical history including breast cancer, obstructive sleep apnoea, type 2 diabetes, asthma, and a TIA that weakened her left side. When discharged from hospital Pat was bedbound.

Samantha Rusike, a HomeLink Healthcare Physiotherapist, says:

“Pat was in hospital for three and a half weeks, and HomeLink Healthcare saw her after discharge from hospital. Pat was in a downstairs room with a hospital bed, a walking frame, a commode, a wheelchair and a new sleep apnoea machine. She could get up and sit on the edge of the bed and stand up onto the walking frame at this point her daughter was doing strip washes for her mother in bed. Pat wanted to walk independently and get to the downstairs bathroom.”

During the initial assessment session Pat could walk with her frame for about two metres if somebody followed her with a wheelchair. She would then become very tired and would need to rest and use her inhaler before moving again. The HomeLink Healthcare Physiotherapist, Samantha, worked with Pat, and together a co-produced physiotherapy programme was developed to build up Pat’s exercise tolerance. As well as practising in the sessions, Pat was given exercises to do in her own time. Pat’s daughter was encouraged to attend most of the sessions and supported her mother to do the exercises in between sessions.

In many physiotherapy services, a patient is seen once and given some exercises, and then not seen again for sometimes up to a month. The impact of the physiotherapy depends a lot on whether the patient can maintain the exercise plan. In this case, twice weekly visits helped establish a rapport between Pat, her daughter and Samantha. At each session Samantha encouraged Pat to walk further and do more exercises. Progress was easy to see, as each time Pat could do more than the previous visit, which was only a few days earlier. By the final session she was able to walk to her front door and back, without a frame. She was also showering, with her daughter’s support.

Samantha says: “When patients have one session a month and then don’t do much, it’s hard to monitor and see the progress. When they are seen twice a week it is easy to see if someone hasn’t done their exercises or if they are struggling and need their programme modified.”

As part of the initial referral, HomeLink Healthcare was asked to assess what extra equipment Pat needed. For example, she wanted a bed lever so she could pull herself up. But by the end of the sessions she didn’t need this or any extra equipment. She was more confident moving about the house and more independent with washing.

Pat says:

“When Samantha came she helped me walk much further than I had walked in 4-5 years. My daughter is trying to carry on Samantha’s great work. Some days I am really tired, but my daughter and my two-year old granddaughter egg me on to do the exercises. Having encouragement makes you want to do things. I’m much better at walking now – I can do lots of things myself. I can get up from the bed by myself (no help needed) and I can use the commode on my own (in hospital I had to use a bed pan).”

Pat’s daughter adds:

“Samantha was really encouraging and patient with mum. When mum reached a small goal, she added something else. The small encouragement meant a lot.”

These changes in Pat’s life might seem like small steps, but they have had a big impact on her independence and wellbeing. Pat reflects “I nearly died when I was in hospital and I am so grateful to everyone at the NHS and HomeLink who helped me to get to where I am today. That’s why I want everyone to see my story and how the NHS and HomeLink Healthcare helped me” she says.

Within a few weeks Pat got to the stage where she could be discharged from the community physiotherapy team’s list. The impact on patient flow would be significant if that outcome were multiplied across many more people.

Samantha concludes:

“We have very few patients coming back for a 2nd time because of the level of initial input we can give. HomeLink Healthcare can help with these patients over five or six sessions, so that they don’t have to come back again.”

Case study: Partnership with Buckinghamshire Healthcare NHS Trust

For some time, delays in discharging patients from Amersham Hospital in Buckinghamshire meant the hospital’s in-patient bed base was at capacity, with beds occupied by patients medically fit for discharge. This led to problems with patient flow and reduced availability of ‘step down’ care in the hospitals. It also created a continuous back log of patients for the NHS Trust’s intermediate care teams, thus delaying patients return to home.

Buckinghamshire Health NHS Trust (BHT) commissioned HomeLink Healthcare to provide Early Supported Discharge, Rehabilitation and Bridging Package of Care to support with delayed discharges.

"I’ve worked with a lot of providers and HomeLink Healthcare are a very professional organisation. Every member of my team have said how respectful and courteous your staff are. It has been a pleasure to work with a partner who does exactly what they say they will”
- Jenny Ricketts, Director of Community Transformation

During the initial stages of our discussions in Summer 2022, funding was not yet in place and the type and amount of support the hospital were looking for had not yet been defined.

HomeLink Healthcare carried out a free Point of Prevalence survey, walking the ward and consulting with the ward nursing team to estimate the percentage of patients we could transfer into our care. We discussed and reviewed the potential solutions with BHT and in partnership created a bespoke service that would best impact patient flow and support BHT’s intermediate care teams.

We agreed on an Early Supported Discharge and Rehabilitation pathways, both of which included the option for Bridging Package of Care and made a formal service proposal. Six weeks later we started mobilisation against a fixed price and set of agreed outcomes.

Typically, the mobilisation process for brand new services takes eight to 12 weeks. In this instance it took nine weeks.

HomeLink Healthcare uses PRINCE 2 project management approach, led by a dedicated Project Manager. This focuses on working in partnership to move initiatives through predefined stages across seven workstreams: service and pathway design; clinical governance; information governance; IT; contract and finance; communications; and workforce.

An average of nine hospital bed days saved per patient

An initial kick-off meeting with the full HomeLink Healthcare and BHT team set out the parameters and timescales of the project. This was followed by individual meetings between HomeLink and BHTs workstream leads. Weekly checks were held between the two project leads.

The first patient was referred to us on 1st December 2022 and as with all new services, we went through a four-week, post go-live intensive programme of checks and support. We always start small to ensure the service is delivering as planned in a safe and effective manner. ‘HyperCare’ ensures that the service is delivering to schedule and on track to meet all outcome-based measures.

When the service launched, we aimed to complete 20 visits in the first week and ramp up to full capacity over the following weeks. Over the first six weeks we overperformed, completing 115% of the required visits.

This service saved 951 bed days in the first 18 weeks.

After 18 weeks we had saved 951 bed day, an average of 53 bed days per week. Getting people out of hospital sooner than they would ordinarily have been able to has had a significant improvement on patient flow in both Amersham Hospital and Olympic Lodge (a step down facility).

"The staff have been brilliant, I am going to miss everyone!”
- Patient feedback

Peggy, age 94, was referred to us on 1st December following a fall. We started care on the same day which meant that Peggy could leave hospital four days earlier than she would have been able to had she had to wait for her social care package.

 

 

 

Work with us

Find out more about 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, 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 supporting our NHS partners and how we might be able to help you. 

Virtual ward and VAC pump therapies: a patient’s experience

A new VAC pump therapy pathway has been co-produced with our partners at Norfolk and Norwich University Hospital (NNUH) to align with the virtual ward already in place, enabling patients to receive treatment in their home, freeing up hospital beds to improve patient flow and capacity.

One of the first patients on the pathway, Christine Bartram, shares her experience of hospital at home with the NNUH at Home service enabling her to leave hospital sooner than expected and recover in the comfort of her own home.

Why the pathway was developed:

Tissue Viability Nurse Specialists (TVNs) at Norfolk and Norwich University Hospital identified a gap in the service provisions in the community, resulting in patients remaining in hospital.

Having worked in partnership with the NNUH for some time offering a wide range of clinical interventions in patients’ homes we were approached to provide VAC pump therapy to patients at home for acute or chronic wound care.

The Virtual Ward at NNUH initially provided monitoring and by partnering with HomeLink Healthcare patients have been able to receive in-person visits from experienced clinical teams in their own home.

The new service was developed to align with the existing virtual ward service already provided at the hospital.

Due to the collaborative nature of the partnership the new pathway was quickly mobilised and since then the service has been rolled out which has allowed many more patients to receive VAC treatments at home rather than in hospital resulting in shorter lengths of stay in hospital and increased patient flow and capacity.

A Patient’s Journey: Meet Christine

Christine Bartram, 65, was one of the first patients to receive VAC pump therapy from HomeLink Healthcare.

VAC pump therapy treatment decreases air pressure on acute or chronic wounds which can help wounds to heal more quickly. Christine’s requirement was post-knee replacement surgery.

Stories like Christine’s are why we do what we do.

The team looking after Christine had an important goal when planning her care pathway: to get her discharged and home in time for Christmas, with a care pathway in place. They succeeded – to everyone’s delight.

Christine shares her experience of hospital at home with NNUH at Home

I had a full knee replacement, and received some additional treatment a few weeks later. I was in hospital for a week for the follow up treatment and during that time I had a vacuum pack to draw all the stuff out of the wound.

I went in on Friday, and with the help of NNUH at Home, I came out and was back home the following Friday. I came home with the virtual team of nurses, and a nurse from HomeLink Healthcare came in twice a week to do the dressing. It was absolutely brilliant.

Being able to leave hospital early helped me recover much quicker because you couldn’t have visitors in hospital and I am a people person! I like to see my family and my friends and neighbours. And I could do that at home. Obviously, there were added concerns about being in hospital because of Covid as well, and I was very careful while there. I didn’t want to be in hospital, but I had to be.

My transfer from hospital to home was really smooth. I was kept informed the whole time. The HomeLink nurses phoned morning and evening, and they even phoned on Christmas Day which I was very impressed by!

I was sent home with the vacuum pack, and I was given an iPad, and I had a band on my arm that read my temperature and the oxygen levels in my blood which were monitored by the virtual ward nurses. I was given a cuff to measure my blood pressure every day, and that was recorded as well. So, if there were any spikes or anything, the team would phone me. There weren’t any but that was really reassuring and made me feel safe.

All of the nurses were great and very friendly. I spoke to a few – some video called me and some I spoke to on the phone. Sometimes it was the same nurse, and sometimes it was a different one. They were all very nice, and concerned about how I was doing. I had two different nurses who came to do the dressings and they were brilliant as well. In one instance, where I had been dressed but the next day the vacuum didn’t seem to be working properly, the nurse came out and did it again the next day. That was really good.

I received high quality care from all of the nurses, the same quality as I received in the hospital. The dressing was only done by two different nurses so you build up a bit of a friendship with them as well. And they were on hand if I needed any of them. I could phone and there was always someone there, 24 hours a day. And I was told if I ever needed to go back into hospital, there was a bed for me and I wouldn’t have to go through the system of A & E, I’d just go straight back to the ward, which again was reassuring.

Being in your own home is much better than being in hospital. Covid is one of the reasons: you feel there’s always a possibility that you’re going to be with strangers that you wouldn’t normally come into contact with. Whereas at home, it’s your family and people that you know well. You definitely recover better by being in your own bed, eating your own food – you can have your meals when you want and things like that. Family and friends visited me, which wasn’t possible in hospital.

I really think this is the way forward – to me, the system was fabulous. I never dreamt that there was anything like that available. I didn’t have a problem once I got home and everyone was so helpful. I tell everybody about this – what happened – and I cannot say how pleased I am to have been able to take part in it. It was really ideal for me.

It was a fantastic service that I received and I can’t fault it at all. I’d definitely be keen to use the service again. My experience of hospital at home was A1, it was brilliant – it really was. To someone considering using this service I’d say: don’t have any hesitation at all.

_____________________________________________________________________________________________________________

Find out more about the process of commissioning HomeLink Healthcare to set up a virtual ward.

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 virtual wards and how we might be able to help you.

Working across the divide – hospital or home?

I love working in the community – my early career was spent looking after people at home and my belief is that is where people should be unless they are really sick. It’s always been a bit of a dilemma – Are people better off as patients on a hospital ward or as individuals in their own home? Can they really be looked after as well at home? What about infections? How will they manage?

The answer is yes, not for everything, of course there are patients that need to be in hospital but we can certainly support people to recover at home, readjust back to their own homes, kitchens and sitting rooms with confidence where they can eat their own food and manage their own lives, and above all sleep in their own beds.

Older people, in particular, decondition so quickly in hospital – they lose muscle mass and confidence; they pick up hospital bugs and end up staying for ages.

Caring for people at home is a privilege, watching them become more confident and independent, often makes what may seem like a daunting experience a relatively easy and uncomplicated one.

When patients are medically fit, HomeLink Healthcare works with patients and their families and carers to ensure their return home is as smooth as possible, assessing them in hospital, meeting them at home, finding out what they need, visiting them more often at first, providing nursing care and physiotherapy to make sure they are safe. We will even go shopping with them, if that their goal to ensure they have the confidence to pick up their lives as best they can.

Older people, in particular, decondition so quickly in hospital
Caring for people at home is a privilege

HomeLink Healthcare works closely with the hospital too so if there are any problems patients will have access to the support they need and if necessary, can return to be reviewed, it’s like a ward, except the patient is at home. We also work with GP’s to keep some patients at home instead of going to hospital in the first place.

One of our patients recently commented ‘HomeLink is a fantastic service which delivers very high standards of care and the only disadvantage is that I have now been transferred over and feel that the quality of care is not as good “Not a patch on HomeLink’.

Jane Tobin,Head of Clinical Development at Homelink Healthcare

Supporting the flow of patient care from hospital to home

81% of all patients are being discharged on or before their expected discharge date.

HomeLink Healthcare has been providing clinical care in the home with Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHT) since January 2019, to release in-patient bed capacity and improve patient choice. The two organisations have co-created the service, NNUH at Home, creating additional capacity and promoting improvements in patient flow from hospital to home. A key feature of NNUH at Home is that it compliments and integrates with existing services, rather than replicating those already in place.

During this time nearly 1,700 bed days have been saved – over 50 beds per week – and has also resulted in outstanding patient satisfaction with 100% of patients saying they would recommend NNUH at Home to their friends and family.

The situation

Delayed transfers of care (DTOC) are a problem for the NHS, and July 2019 saw 139,900 across England – 4,513 people delayed every day. Patients awaiting further non-acute NHS care were one of the biggest reasons for these delays, accounting for 25,100 delayed days (29.6% of all NHS delays).

DTOC can cause considerable distress and unnecessarily long stays in hospital for patients, not to mention the increased risk of infection, low mood and reduced motivation, ultimately affecting their recovery and chances of hospital readmission. DTOC patients also contribute to increased bed occupancy rates, this is in addition to those patients who may not be medically fit for discharge but could continue their sub-acute care at home.

In England, from April to June 2019, overnight beds were measured at an average occupancy rate of 90%, which is not in line with suggested maximum safe bed occupancy levels, currently set at 85%, therefore more needs to be done to address this problem.

Delayed transfers and high bed occupancy rates have a wider impact on the health system, causing delays in A&E and elective care cancellations, as a reduced number of beds will be available for other patients. Early supported discharge (ESD) and virtual wards can help address these problems by assisting the flow of patients from hospital to another setting for continuation of care and treatment.

Finding the solution

NNUH at Home contributed to the trust reducing delayed bed days by 18% (2019 vs 2018).

 NNUHT is committed to reducing DTOC and the need for escalation beds, promoting effective and efficient patient flow, minimising delays and maximising utilisation of hospital beds. Several programmes of work have been initiated to bring financial and operational efficiencies into the trust.

Analysis of hospital data during winter pressures planning in summer 2018 indicated there were opportunities at NNUHT to improve patient flow and relieve pressure on beds.

In a bid to realise efficiencies, in September 2018 NNUHT established a partnership with HomeLink Healthcare, a CQC registered company experienced in home-based clinical care, to deliver and evaluate ESD and virtual ward services. This became NNUH at Home.

NNUH at Home service initially focused on two patient pathways:

+ Early supported discharge (ESD), which provides bridging packages of care, so patients who are medically fit can be discharged from hospital. The NNUH at Home team provides care until longer term community services are available.

+ The virtual ward, which provides clinical care at home for patients who are medically stable and can finish treatment at home, while remaining under the care of the hospital consultant. For example, Intravenous Therapy, Blood Monitoring, Physiotherapy, Rehabilitation or Wound Care.

Developing NNUH at Home together

“I am very appreciative of the care, support and advice I received by experienced staff, which in turn gave me confidence to deal with my health issues. Having support in the community did not feel at all obtrusive”. NNUH at Home patient.

Collaboration was key for successful implementation of NNUH at Home. Teams across the trust, HomeLink Healthcare, community services and commissioners worked alongside one another to agree the service design prior to service delivery. Overseen by the NNUH at Home project board, the governance and safety protocols, referral, escalation and discharge processes, were jointly agreed during the 12-week service mobilisation phase.

Working cohesively with NNUHT’s current process was fundamental to avoid any unnecessary duplication of services, safe, effective and efficient utilisation of the capacity provided by the NNUH at Home pathways.

The NNUH at Home clinicians became part of the trust team, fully embedding by attending multidisciplinary team and bed meetings.

A service designed with patients in mind

NNUH at Home patients are given the choice to spend less time in hospital and receive care at home. They are safe in the knowledge that if there are complications while at home, there is a nurse on the end of a phone 24 hours a day, available to triage clinical concerns.

Patients appreciate the support NNUH at Home provides, valuing its punctuality, efficiency and knowledgeable and caring staff. Family members are grateful for having their loved ones at home, not to mention the amount of time and money saved on countless journeys to hospital.

These sentiments were echoed in the Family and Friends test with 100% of patients stating they would definitely recommend the service to others.

NNUH at Home pathway

Easing pressure at NNUHT

NHS England data shows that over the six-month period from January to June 2019 since HomeLink Healthcare went live at NNUHT there was an 18% reduction in delayed bed days compared to 2018.

Jon Green, Director of Transformation at NNUHT, said: “Thank you to the team at HomeLink who have supported us through the implementation phase of NNUH at Home, providing us with expert advice so the service has seamlessly integrated with the trust. Collaborating with clinical, operational and community teams was essential to the success of the programme and HomeLink were fundamental in enabling this to happen.

It is our mission at NNUHT to support care closer to home, improve patient experience and encourage the best recovery possible, following a period of ill health. We envisage continuing this fantastic work allowing even more patients to recover in the comfort of their own home, safe in the knowledge that they are receiving care of the highest quality.”

In order to continually deliver service improvements and implement learnings, HLHC gathers data from their systems at NNUHT and evaluates this against key performance indicators to measure the effectiveness of the service.

Proving the success

Initial results show NNUH at Home provides safe, efficient and cost-effective capacity, as well as an excellent patient experience. Strong cross organisation working relationships, the skill-mix of the community-based and an on-site team were instrumental in achieving these results. NNUHT has since committed to further working with HomeLink Healthcare, following the success of this programme.

 

 

Work with us

Find out more about 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 Hospital at Home 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.

 

I can get my coffee just how I like it, but can I get my healthcare just how I like it too?

"Many patients I have had the privilege to care for, often with life limiting and chronic illness, have wanted to complete their treatment and receive care at home."

Every day we are bombarded with myriad choices. A quick visit to a coffee shop, and we are faced with tens of alternatives about how we would we like our favourite beverage: are you drinking in or taking out , small, medium, large, with or without milk, full fat, semi skimmed, skimmed, soya or almond milk, double or single shot, medium or strong blend, not to mention syrup … and the choices go on. Yet when we have needs regarding ongoing healthcare our choices are much more limited. The NHS in all its glory does an amazing job, and I should know, I’ve worked with the NHS for over 30 years and experienced the brilliant care it can provide first-hand. However, acute hospitals seem to have a centrifugal effect, acting as a magnet, pulling people in and holding them there. The pull into the acute hospital is often for very good reason. But, once the need to be ‘hospitalised’ has passed the choices regarding how and when we leave hospital, how ongoing care needs can be met, and the choices surrounding the who, what, where and when of ongoing care is limited. This needs to change.

Many patients I have had the privilege to care for, often with life limiting and chronic illness, have wanted to complete their treatment and receive care at home. The reality is that despite policy calls for new models of care, and more clinical home care, real choice remains limited. This needs to alter. I’ve been very fortunate in being able to address the need for change, and with a team of likeminded healthcare professionals and senior managers HomeLink Healthcare was born.

The aim of HomeLink Healthcare is to readdresses the balance, to work with the NHS to deliver new models of care and to free up hospital capacity for those who need it most. Delivering a service offering real choice for patients and access to hospital at home care. We are not a bunch of entrepreneurs seeking to asset strip the NHS, but rather a group of likeminded people inspired to do things differently, to save the NHS money, to reinvest in services which need it most, to help drive efficiency, and to offer great value, high quality home based clinical care.

Jill Ireland, Managing and Clinical Director HomeLink Healthcare

 

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

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