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Resource Topic: Quality & governance

Virtual wards and how the independent sector can enable their success

Healthcare Support WorkerFollowing their success during the Covid-19 pandemic, NHS England has set challenging targets to roll-out virtual wards across the country. Jill Ireland, our Chief Executive and Clinical Director agrees with NHSE/I guidelines that integrated care systems should be looking to work in partnership with the independent sector. Jill argues that the independent sector has a lot to offer and that working with a specialist provider of hospital at home services is an excellent way for them to deliver successful services.

Covid-19 put almost intolerable pressure on the country, the NHS and communities; but one of the unexpected benefits of the pandemic was the realisation that many more patients can be cared for at home.

The pandemic provided an opportunity to try out new ways of working, and we saw the rapid roll-out of virtual multidisciplinary teams, virtual clinics and consultations, remote monitoring and virtual wards.

As the health and care system looks to recover and reset, NHS England and Improvement is looking to build on these developments to address some of the challenges posed by the huge backlog of elective care.

More than 6 million people are now waiting for treatment in England, and the list is rising by 100,000 people per month. With the hospital beds that are available under enormous pressure, NHS England is looking to virtual wards to create additional capacity.

Virtual ward targets, guidance, and funding

Virtual wards will only be successful if they combine partnership working, technology, and skilled clinical teams.

  NHSE/I has set a target for every integrated care system to create 40-50 virtual ward beds per 100,000 people in their population.

Guidance in April set out ‘enablers for success’ that stressed ICSs should not use virtual wards as an extension of traditional, community nursing services, which tend to support people with long-term conditions.

Instead, it said virtual wards should be used to provide hospital at home services; either ‘step up’ care (to prevent admissions to hospital) or ‘step down’ care (to support earlier discharge).

‘Enablers for success’ also advised ICSs to work in partnership with the independent sector to secure the skills and technology required and outlined how to bid for central funding.

NHSE/I is making £200 million available for virtual wards this year from its Service Development Fund on a match-funded basis. There will be an additional £250 million next year to test out ideas and after that it’s expected that these services will become ‘business as usual’.

The case for finding an expert partner

Virtual wards are an emerging space, which makes this guidance useful. It explains what NHSE/I means by ‘virtual ward’ (and what it doesn’t), sets out some clear expectations around the involvement of the independent sector, and establishes a clear direction of travel.

For HomeLink Healthcare, this is exciting. We were formed seven years ago to deliver Hospital at Home services and already run virtual wards in partnership with commissioners and Trusts in London and the East of England.

Despite this, we are sometimes challenged that NHS organisations can do this themselves. In some cases, of course, they can. However, as the ‘enablers’ guidance makes clear, virtual wards are being set up to provide additional capacity; not to stretch existing resources even more thinly.

Also, nursing acutely ill patients at home requires skill and experience. HomeLink Healthcare’s teams are built around clinicians with a backgrounds in both acute and community care, who are also experienced in handling the challenges of delivering clinical care in the home.

In addition, we have developed some really good reporting capabilities. We can report a suite of KPIs in almost real time, so commissioners have complete transparency about what we are doing and how we are doing it.

More than 6 million people are now waiting for treatment in England, and the list is rising by 100,000 people per month.

More capacity, better outcomes for patients

When the news broke about this big expansion of virtual wards, there was a criticism of the idea in the press and concern from professional bodies.

There was a feeling that patients should be in hospital and that delivering hospital-level care at home poses too great a risk to staff and patients alike.

It’s true that this model is not suitable for everybody. However, we work with our NHS partners to risk assess the patients who are referred to our services.

We know that what HomeLink Healthcare does is valued by patients and relatives, thanks to the feedback we receive through our Patient Experience questionnaire. We also have evidence that our patients can recover faster when they are treated in their own home than they would have done in hospital.

After all, few people want to spend time on a hospital ward. Most would prefer to be in their own environment, as long as they are well-supported.

So, I think that as we see virtual wards rolled out, we will see fewer challenges of this kind – as long as ICSs follow emerging best practice and deliver these new models of care in a safe and effective way.

No going back?

There are some pitfalls that could still derail this new policy. NHSE/I is funding virtual wards for the next two-years, so there is a danger that ICSs could see this as a ‘pilot’ project, when our experience is the best results come from running virtual wards at scale.

ICSs could also see virtual wards as a technology challenge, rather than a service redesign challenge. The ‘enablers’ guidance says virtual ward services should be ‘tech enabled’ – but they cannot be purely technology driven.

As the guidance itself says, virtual wards will only be successful if they combine partnership working, technology, and skilled clinical teams.

The technology required to support virtual wards is developing all the time and giving health and care professionals new telemetry to work with; and from a professional perspective, this is a very appealing way of working. In addition utlising technology can maximise face to face time with patients.

When many health and care organisations are struggling to recruit and retain staff, our teams welcome the challenge of delivering hospital-level care in patients’ homes.

The virtual ward model offers an opportunity for revisioning the healthcare model and I cannot imagine that the health and care system will return to how they were before Covid. There is a big opportunity to rethink how hospitals, community delivery and the patient journey work.

So, over the course of the next six to eight months, I think we will see virtual ward models refined. We will see evaluations conducted, so we create a test and learning environment.

We will see forward-thinking ICSs developing innovative partnerships with independent providers. And we will see that the end point is to deliver virtual wards at scale. NHSE/I has started an evolution, rather than a revolution; but this is the future.

This is the beginning of the change and we need to think about how much further we can go with these models.

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Work with us

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.

Finalists for Best Healthcare Provider Partnership with the NHS at HSJ Awards

NHS care at home project earns coveted award

Best Healthcare Provider Partnership with the NHSHomeLink Healthcare are delighted to announce that we were shortlisted as finalists at the prestigious Best Healthcare Provider Partnership with the NHS at the HSJ Partnership Awards at the Park Plaza, London.

We were up against some strong competition in this category, and we demonstrated that we delivered clear, and tangible financial benefits for the Trust, whilst providing significant patient outcomes very quickly due to the collaborative nature of our partnership with NHS teams.

So, how did we do it?

The challenge

COVID-19 caused pressures on the NHS, the likes of which had never been seen before.
To prevent delays in critical assessment and to ensure the safety of patients, many NHS Trusts and CCGs followed NHS England guidance to work with independent providers for additional support.

South East London CCG found HomeLink Healthcare through the National Framework of trusted providers, and formed a like-minded partnership, along with Guy’s and St Thomas’ NHS Foundation Trust, and Lewisham and Greenwich NHS Trust.

The solution

Project aims: To support community services severely impacted by COVID-19; increase capacity and reduce the strain on existing teams.

Working in partnership the teams from HomeLink Healthcare, the CCG and the Trusts devised and implemented a, ‘Care at Home’ pilot project that would support both NHS staff and patients. The size and scope of this project was unprecedented, but with HomeLink’s experience and dedicated teams, a clear communication plan, and a structured approach the project was swiftly mobilised in just four weeks.

Patients were discharged from the service four days earlier than predicted.

With HomeLink’s help, NHS capacity was bolstered by home visits, providing continuation of quality care for patients across the community. HomeLink was able to bridge the gap that had begun to form between Intermediate Care Teams and Community Teams due to the immense and growing pressures faced by each.

The pilot project carried out by HomeLink Healthcare and NHS partners in South East London was deemed so successful it was subsequently rolled out as a full service across three boroughs.

The results

As a result of the collaboration, intermediate care therapy patients were discharged from the service four days earlier than predicted. This had significant cost savings, provided bed days saved for redeployment, cut staffing cost and time, and moreover saw excellent patient outcomes.

Patients were treated and re-enabled at home, which increased independence and reduced the likelihood of ongoing problems or readmittance, thereby freeing up additional NHS resources further down the line.

The valuable extra support during this unprecedented challenge for the NHS eased immediate pressures so community nursing staff could rest and complete annual training, safe in the knowledge that their patients were being well cared for.

Feedback on the service was overwhelmingly positive with the service rated “excellent” by patients.

The collaborative care at home pilot had such impact that HomeLink were shortlisted as finalists for ‘Best Healthcare Provider Partnership with the NHS’ at the prestigious HSJ Partnership Awards.

The success of the service was determined through KPIs and positive outcome measures.

Stakeholder feedback reaffirmed that the service was implemented at pace and brought optimism and confidence that working with an independent provider such as HomeLink Healthcare could provide high-quality home-based care while increasing capacity and improving hospital flow. 

The nature of HomeLink’s streamlined service meant it could be implemented quickly, and swiftly provide real tangible benefits for NHS partners. HomeLink Healthcare is committed to working diligently and collaboratively as an extension of NHS services.

Amanda Lloyd, System Transformation and Change Lead, NHS South East London Clinical Commissioning Group said:

“We recognised we had a window of opportunity to put something in place that would support both our front-line teams and our patients without delaying discharges from our busy acute hospital sites. I am proud that we achieved a safe, responsive and flexible service which meant patients received the ongoing support they needed, and staff felt able to regain some work-life balance after the efforts that Covid-19 had required.”

Jill Ireland, HomeLink Healthcare’s Chief Executive and Clinical Director said:

“The pilot service was so successful that it was commissioned as a full service and subsequently extended across neighbouring boroughs of Lambeth, Southwark and Lewisham, helping address inequalities in access to care in these areas.”

“The approach was designed to be flexible and agile so it could evolve throughout the duration of the project. With a ‘test, learn, develop’ ethos, future requirements and resources could be predicted and managed in line with learnings from the initial six weeks.”

“At the heart of the service was the co-creation of the clinical pathways between HomeLink Healthcare and NHS Partners. These were designed to meet patient’s community nursing and therapy needs, reduce waiting times for out of hospital care. The clinical pathways were underpinned by robust governance and escalation process. The success of the service was determined through KPIs and positive outcome measures. These ensured that not only patient care was delivered safely and effectively, but that they were also cost effective.”

“I’m very proud that we were able to contribute to, partner with and provide additional capacity for the NHS at such a particularly critical time.  We hope that by sharing the learnings from the partnership, other services, such as these can be commissioned in other localities for patient benefit.”

“Being shortlisted as a finalist for ‘Best Healthcare Provider Partnership with the NHS’ at the HSJ Partnership Awards is the icing on the cake. A testament to the hard work and collaboration of the whole team and an accolade of which we are very proud.”

Communication was key to successful collaboration, increasing NHS capacity and improving hospital flow.

HomeLink has the time and capacity to spend quality time with patients and deliver thoroughly holistic care.

99% of patients said they would recommend the service to friends and family.

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Find out more about the process of commissioning HomeLink Healthcare.

Get in touch

To speak to a member of our team about 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 of hospital at home and how we might be able to help you.

5 minutes with HomeLink Healthcare Co-Founder Dr. David Lomax, Imperial College Healthcare NHS Trust

This latest instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, asks our Co-Founder and Non-Executive Director Dr. David Lomax about his role within the company, the challenges created by the COVID-19 pandemic, and the opportunities that exist within the wider industry.

Tell us about your experience in the sector and how that has helped you develop the services offered by HomeLink Healthcare.

Dr David Lomax

I’ve been in medicine all my life. I went to medical school and qualified as a doctor and then completed my postgraduate training in anaesthesia and intensive care. From there I worked at the College of Anaesthetists in the ‘90s. Today, I remain a consultant at St Mary’s Hospital, part of Imperial NHS Trust.

All of which means that with HomeLink and a similar Hospital at Home organisation I founded previously called Medihome, I’ve had parallel careers for the last 20 years or so, which I’ve thoroughly enjoyed because of the variety in brings and the amazing people involved.

In fact, despite my medical experience I always had a slight entrepreneurial spirit and enjoyed the ‘business’ side of things, which is one reason the HomeLink journey has been so rewarding.

Of course, it has been a steep learning curve, but I think everyone on the team – especially those of us with backgrounds in the NHS – have made so much progress in establishing a new healthcare model and ensuring it works. It’s been a fascinating process.

When the pandemic hit in 2020 we were in a position to move quickly to help the NHS and others out.

The healthcare sector has faced significant challenges over the last 18 months – what role has HomeLink Healthcare played during the pandemic?

The introduction of the care in the home model, pre-Covid, meant that when the pandemic hit in 2020 we were in a position to move quickly to help the NHS and others out.

Of course, the terrible impact of COVID-19 presented challenges for everyone, but as we’ve moved towards what we all hope will be the end of the virus peak, there’s a huge opportunity for us to work with the NHS to help free up vital hospital beds and treat patients safely in their own home.

This has the double effect of helping to reduce the spread of the virus, while helping to avoid hospital readmissions – or admission to hospital at all. That objective is now key within the NHS as it looks to manage the backlog treatments, particularly elective surgeries.

Tell us about your own role at HomeLink Healthcare and you day-to-day responsibilities.

I’m one of the Founders of HomeLink Healthcare, along with a few other ex-colleagues from our previous company Medihome, who passionately believed in the Hospital at Home model when we opened for business in 2016. We took all of our learnings from our time at Medihome and pulled our experiences together to create the best framework of Hospital at Home care possible at Homelink.

I brought in one of the early investors and to begin with was very hands-on, with lots of brainstorming and idea generation while we got our leadership team in place. Once our CEO & Clinical Director Jill Ireland was on board everything just took off, quickly attracting other investors and a board, at which point I stepped back from day-to-day operations.

Today, I’m a Non-Executive Director at HomeLink, supporting our highly-experienced Chairman and management team as and when required. It’s been a great honour to have been there at the start and to have seen the company and its people grow so quickly.

What are the main healthcare trends you expect to see in 2021/22?

Quite simply, I think we’re going to be left with huge waiting lists in the NHS as a result of COVID-19, so the priority is going to be working with our commissioners to help them find ways to work through that efficiently.

And while we’re doing that everyone will need to work hard to keep the virus itself at bay – the vaccination programme has been amazing in that respect and gives us all a solid platform to build on.

Part of the process involves keeping patients at home rather than in a hospital and that’s where our team can really make a difference – monitoring patients with chronic health conditions and people who are recovering post-COVID. The key is to avoid patients getting worse, spotting any deterioration very early and initiating treatment at home accordingly.

Tell us about the role technology can play in caring for patients at home.

Embracing technology to assist with care in the home is absolutely the way the world is moving, so we’re working hard to develop solutions in that area, with a few techniques already deployed successfully.

And then, of course, there are the great strides that are being made with artificial intelligence (AI), particularly when it comes to patient wearables and monitoring technology. That will help us both now and in the future.

In 2025 we’ll all be talking about…?

I would hope that the clinical tail of the pandemic will be gone, or at least disappearing into the distance. That said, the virus is going to affect individuals for a long time to come, particularly psychologically in terms of social distancing and concern over transmission, even with vaccines circulating. It’s going to change some people’s social behaviour within the community in that respect.

However, I think as far as the care we’ll be providing in the long term, the government agrees that the future of the NHS is home care, especially when it comes to improving social care.

I also think there’ll be opportunities to offer patients more types of treatments in the home, whether that’s administering drugs to treat chronic lung disease, or providing renal dialysis. Those are the kind of things we’re actively talking about and working on.

And don’t forget, technology will be at another level in five years time. The whole point, I think, is the way care is delivered is going to change. The GP’s role is going to change over the next decade, too, if you look at what Babylon is doing to help doctors consult with patients remotely via an app without a surgery visit.

I also think there’ll be opportunities to offer patients more types of treatments in the home, whether that’s administering drugs to treat chronic lung disease, or providing renal dialysis. Those are the kind of things we’re actively talking about and working on.

Which person in, or associated with, the industry would you most like to meet?

I’d like to meet Dr Ali Parsa at Babylon. I just like the way he innovates and the way he thinks is quite interesting. There’s probably a connection we could have as well in terms of what both our companies are trying to achieve. I’d also like to meet the new head of NHS England, Amanda Pritchard, to discuss many of the positive things we’ve been talking about here.

What is the most exciting thing about your job?

I just find it really exciting to see and interact with the people we’ve got working with us at HomeLink Healthcare – it’s such a great team, and I think all the frontline professionals who work for us enjoy it, too.

And the fact we’re supporting the NHS and doing such a good job helping our patients too is very rewarding.

5 minutes with Jill Ireland, Chief Executive and Clinical Director

This first instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, asks our CEO & Clinical Director Jill Ireland about her role within the company, the challenges created by the COVID-19 pandemic and the opportunities that exist within the wider industry.

Tell us about your role at HomeLink Healthcare and your day-to-day responsibilities. 

Jill IrelandI’m the CEO and Clinical Director, in addition to being one of the founding members of the organisation. Our aim for HomeLink Healthcare is to work in partnership with the NHS and to transform models of ‘hospital at home’ care

Day-to-day I have overall responsibility for the strategic direction, operational delivery clinical quality and safety within the organisation. At the core of our company is a clinical heartbeat – we are, above all, a clinically-led organisation.

The healthcare sector has faced significant challenges over the last 18 months – what role has HomeLink Healthcare played during the pandemic?

One of the things we really pride ourselves as an organisation is being agile and responsive, which helps us work with our NHS commissioners in the most collaborative of ways. That stood us in good stead when COVID struck, especially in the early days when few people understood what was happening or what the impact might be.

For example, within a couple of weeks of the first lockdown, HomeLink Healthcare set up a COVID screening service in the East of England. Under normal circumstances, such a service would have taken several months to deliver. One of the impacts of COVID on the NHS and HomeLink Healthcare as part of the independent sector, has been the ability to stand shoulder to shoulder in the face of adversity.

What are the biggest opportunities in nursing and therapeutic care in the home sector as we move into a post-COVID world

I can certainly foresee a landscape where responsibility around health and illness rests more with the individual.

It goes without saying that COVID has impacted negatively on the lives of so many, but the pandemic has also been a catalyst for change. Within healthcare we’ve seen technology embraced like never before, particularly in the realm of wearable devices, remote monitoring with the NHS itself adapting almost overnight to new ways of working that had been in the pipeline for many years.

Some of those changes, I think, will stay with us. The use of technology for things like virtual patient visits and to support more ‘hospital at home’ type services is being driven by a growing realisation that you can manage patients with sub-acute needs within the community. This maximises the utilisation of a reduced hospital bed base.

From a patient experience perspective, that’s extremely positive news. And I can see that trend towards ‘at home’ services continuing.

And what are the biggest challenges in nursing and therapeutic care as we move into a post-COVID world?

I think the greatest challenge the NHS faces now is the growing backlog of patients needing elective surgery and that’s really a big problem for the NHS to be facing alongside ongoing concerns about possible new COVID variants and how they might impact patient care needs.

In addition, we’re very aware that many patients have experienced deterioration in health due to the length of time they’ve needed to wait for surgery during the pandemic, to the point where they’re no longer fit for the procedure. So, we’re doing some work looking at pre-habilitation and pre-surgical optimisation, which involves putting interventions in place for patients, particularly around therapies, so that an individuals physical condition is maintained or improved before they get into hospital.

And then, once the surgery is complete, we can move to support those patients in their recovery at home, rather than in hospital. That’s where our services can really step in and help maximise flow through those hospital inpatient beds.

Tell us about your experience in the sector and how that has helped you develop the services offered by HomeLink Healthcare.

Two-thirds of my career was spent working exclusively within the NHS, where I’ve always felt that there was an opportunity to do things differently. The NHS is a huge organisation, so facilitating and enabling change is like turning an oil tanker around. It’s difficult, but it can be done, which was one of the reasons why I stepped outside of the NHS to help facilitate change from a different perspective.

As a clinician and as a leader I always strive to provide the best care and patient experience possible.

The impact of COVID also means there’s now more acceptance of what the independent sector can offer the NHS in terms of support. A lot that comes down to trust and the realisation that an independent company can indeed work with the NHS and achieve great things as a partnership.

What kind of skills and knowledge are important for healthcare professionals with ambitions to forge a career in nursing and therapeutic care in the home?

Our existing clinical workforce is comprised of registered nurses, physiotherapists, and healthcare support workers. All our practitioners have a minimum of three years’ post-registration experience, which means we have very competent clinicians with a great balance of acute hospital and community expertise. The care that we deliver in our hospital at home services is necessarily a blend of both.

Organisationally, we work on a regional footprint, with practitioners rotating around different sites depending on patient geography.

From a logistics perspective, our planning systems ensure we can optimise patient facing time, while minimising travel time for staff. This geographical approach also means that practitioners, all of whom are based from home, can build up experience of working with different people at different hospitals, which is quite unusual and dynamic.

Our aim is to work in partnership with the NHS and to transform models of ‘hospital at home’ care.

In 2025 we’ll all be talking about…?

Regardless of COVID, we still have wider epidemiological changes to manage. We’re dealing with an ageing population, who are living longer with chronic disease. We have technology and new treatments coming onboard, but finite NHS resources. This means that, operationally, something needs to change. There isn’t a magic money tree to help the NHS cope with a growing demand that is becoming more and more expensive to deliver.

As a result, I think we’ll see a push towards more supported patient self-management. If you have diabetes, for example, there might be less reliance on GP visits when it comes to ongoing monitoring, I can certainly foresee a landscape where responsibility around health and illness rests more with the individual.

Who has had the most influence on your career?

Undoubtedly the most influential people on my career were two ward sisters who I worked with just after I qualified.

They were inspirational women, leaders of their time and brilliant teachers. We all need great mentors.

Which person in, or associated with, the industry would you most like to meet?

NHS Chief Executive Amanda Pritchard. With my clinical head and heart, I would love to discuss how we can do things differently in healthcare –we’re on the cusp of doing just that. I would encourage her not to be afraid of accelerating change by embracing alternative ways of delivering patient-centred care that doesn’t necessarily require building new hospitals. I would encourage her to consider ‘Hospital without Walls’.

What’s the most exciting thing about your job?

Everything. I’m at the point in my career where I’ve had lots of experience from many different roles working within the NHS. For me, my current role is an opportunity to put all of that learning together to create something new. As a team at HomeLink Healthcare, we are totally committed to doing the right thing for patients, harnessing our clinical heartbeat to make change happen. I love it.

What’s the best advice you’ve ever been given?

Undoubtedly, to be true to yourself and to not be afraid to take risks. Don’t let the fear hold you back.

ISO 9001 annual recertification passed with flying colours

BSI Assurance MarkAt HomeLink Healthcare we are meticulous about quality assurance, it’s essential when you provide clinical care services to NHS patients in their homes. However, our focus on standards goes beyond those required by the CQC (Care Quality Commission).

That’s why we are pleased to announce that we have passed our annual recertification of ISO 9001, particularly as our assessor from the British Standards Institute did not make any recommendations for improvement, a rare event.

What is ISO 9001?

ISO 9001 is an internationally recognised quality management system that monitors and manages quality across an organisation and helps identify opportunities for improvement. The standard covers a wide range of topics including:

There were no recommendations for improvement in HomeLink Healthcare's quality standards - which is a rare event!

  • Quality Policy
  • Risk Management
  • Continuous Improvement Opportunities
  • Change Management
  • Communication
  • Managing of supply chain
  • Service Performance
  • Customer Satisfaction

For us, the recertification is not a once a year audit process but the opportunity to demonstrate how we have adopted the ISO9001 standard to identify and pursue opportunities to improve how HomeLink delivers its services to patients and to maintain safe, efficient and effective back-office systems.

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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.

HomeLink Healthcare renews important cyber security standard, Cyber Essentials Plus

We understand the importance of protecting our IT systems from cyber-attack and are committed to securing our systems in line with the National Cyber Security Centre’s guidelines.

We have taken steps to guard against the most common cyber-security threats including:

  • Securing connectivity
  • Ensuring our devices and software remain secure
  • Controlling access to data and services
  • Protecting systems from viruses and other malware
  • Keeping our devices and software up to date

Ensuring our devices and software remain secure

To demonstrate our commitment to this, we are proud to announce our certification in Cyber Essentials Plus. This means our Cyber Security measures have been independently verified by security experts and recognised by the IASME certification body.

Enhancing at-home intravenous antibiotic therapy with remote patient monitoring

NNUH at HomeHomeLink Healthcare based in England, UK, provide expert nursing and therapeutic care within the homes of patients who have been referred from NHS or private healthcare providers.

One of HomeLink Healthcare’s NHS partners is Norfolk and Norwich University Hospital. Both organisations have come together to create NNUH at Home – a multidisciplinary team that delivers clinical care services in the home and other community settings, including nursing homes. The development of this team has allowed clinically stable patients to receive treatment and complete care in the comfort of their own home.

IVAB TherapyInterventions

One of the services provided by this team is the administration of intravenous antibiotics (known as IVABs.) IVABs are administered, as prescribed, to patients at home by a visiting nurse, with treatment lasting from a few days to several weeks or months, depending on the nature of the infection.

By providing this service, the trust can transition IVAB therapy from the hospital to the home, which affords improvements in patient flow and patient satisfaction.

Challenges of in-home IVAB Therapy

Traditionally, a patient’s clinical response to IVAB therapy is monitored by the measurement of vital signs and through blood sample analysis. Within a home environment, a nurse will measure a patient’s vital signs during the same visit as IVAB administration. Depending on the patient’s prescription, this can vary from one to four times per day.

Due to the intermittent nature of vitals recording, hospital clinicians can often delay the discharge of patients receiving IVAB therapy into the community as they are concerned potential health deterioration will not be detected soon enough in the home, resulting in hospital readmission.

Integration of Remote Patient Monitoring (RPM)

To help reduce avoidable hospital readmissions and further expedite discharge, NNUH at Home recently incorporated Current Health’s remote patient monitoring (RPM) solution into their at-home IVAB therapy pathway.

The development of NNUH at Home has allowed clinically stable patients to receive treatment and complete care in the comfort of their own home.

With the availability of continuous vitals data and alerts to health deterioration, the solution provides NNUH at Home with the clinical insight they need to safely monitor patients and detect the early signs of infection.
Furthermore, the broad range of parameters measured simultaneously and continuously provides greater contextual data compared to intermittent measurements which can allow more informed decisions and better diagnoses.

This was exemplified recently when one patient receiving IVAB therapy at home, exhibited a high pulse rate and repeatedly had a spiked body temperature in the evening. Ordinally, this would be a cause of concern for the patient’s care team, resulting in hospital readmission. However, following the new pathway, a virtual multidisciplinary team meeting was conducted where vital signs trends and recent blood results were analysed. Using the data, it was established due to the absence of oxygen desaturation and hypotension that this patient was not septic, allowing the patient to complete therapy at home under the supervision of the care team. Utilising data in this way was reassuring both to the hospital team and the patient.

Conclusions

The replication of inpatient monitoring within patients’ homes has provided much reassurance to not only patients but the consultant teams that remain accountable for their care.

It is anticipated that the implementation of this technology-enabled pathway will result in a greater number of IVAB referrals to NNUH at Home which will further improve patient flow, freeing inpatient beds for those requiring acute care.

In partnership with the hospital, the team aim to develop further remote care pathways for COPD and CHF to further maximise bed capacity, increase patient choice and realise cost savings.

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

Healthcare data: helping us to deliver safe, quality care to patients

I hear all too often that it takes some organisations weeks, in some cases over a month, to prepare accurate management information reports and that usually boils down to the lack of trust in the data that is made available this purpose. Typically, with timescales like this, the opportunity to act on any learnings discovered from the reports has somewhat passed, making them almost unfit for purpose.

Business Intelligence (BI) is nothing new, but like machine learning and AI, it is only useful if the data quality is there to start with. ‘Rubbish in, rubbish out’ is the term quite often used to explain why reports are inaccurate.
There are several great BI products and tools available that when setup correctly, can help to present Key Performance Indicators (KPIs) and reports in real-time using BI dashboards.

So, we are all familiar with the term ‘dashboard’ on a car and how we rely on this to tell us when something is wrong This fundamentally allows us to make an informed decision on whether to keep driving or to take alternative action. Well, KPI and reporting dashboards provide us with exactly this, the ability to make decisions on how we ‘steer’ an organisation and whether we should continue as planned or take a ‘detour’.

Leveraging high quality data combined with real-time BI dashboards provides us with the ability to deliver high-quality care for patients, effective and efficient services adapting and responding to the changing needs of both our patients as well as the overall service.

After all it’s important we understand what is working well within a service and areas for improvement, continuously reviewing and improving, meeting expectations of both patients and commissioners.

Leveraging high quality data combined with real-time BI dashboards provides us with the ability to deliver high-quality care for patients
HomeLink Healthcare understand the importance of having high quality, timely and accurate management information

So how do we improve data quality?

From experience this is achieved by incorporating data quality and integrity checks as part of Standard Operating Procedures (SOPs) combined with both the integration and implementation of a BI solution. such as Microsoft Power BI or Tableau.

Audits are quite often seen as a good method to check data quality and although these will continue to have their place, they can only identify issues with data quality after the event which leaves the risk of poor data quality driving live reports and dashboards. One of the key benefits of having live dashboards is that teams recording the data can now visualise the data aggregated in a different way. When built correctly, these live dashboards provide the same team the ability to quickly identify an issue with the data through a data quality dashboard. By incorporating these checks as part of SOPs we can ensure identification of data quality issues is a lot faster than through traditional methods, improving the data quality of the dashboards and KPIs which are immediately available to key stakeholders.

We at HomeLink Healthcare understand the importance of having high quality, timely and accurate management information available when it’s needed and work closely with our customers and partners to adapt reporting and KPIs throughout the life of a contract to deliver a safe, high quality, effective and efficient service at all times, helping to improve patient flow.

Nigel Clark, Chief Information Officer, HomeLink Healthcare

www.homelinkhealthcare.co.uk

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

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