Resource Topic: Staff experiences

In this latest instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, we ask our Head of Clinical and Operational Services, April Thompson, about her role within the company, the challenges created by the COVID-19 pandemic, and the opportunities for Hospital at Home services that exist within the wider industry.

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

I’m the Head of Clinical and Operational Services for HomeLink, which encompasses the management and recruitment responsibility for all therapy staff within the company or for anyone who may join us, plus overseeing professional health work groups.

In addition to that, I help look after one of the services we’re delivering at Guy’s and St Thomas’ NHS Foundation Trust, providing sub-acute therapy to patients in their own home. Day-to-day I’m responsible for all the overall running of the project which includes the scheduling of the visits, and clinical support for the staff who are delivering care as part of the project.

Most recently, I’ve also assumed management responsibilities for CQC as part of HomeLink, providing support and and general oversight of all the services we provide to patients.

I think a huge positive of working at HomeLink is that you can get involved in several activity streams across the company and, in doing so, help and support others.

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

In the early days of COVID-19 we were probably a lot more reactive in terms of the services we were supporting NHS trusts with. But now we have an opportunity to think differently about how we can take some of the changes and adaptations that occurred during that time and apply them going forward to create both permanent and new solutions.

Clearly the pandemic compelled everyone, including HomeLink, to start using Teams and Zoom to help with internal communication, but it has greatly advanced progress when it comes to the remote monitoring of patients.

For us, that means using techniques like using remote tele-monitoring for virtual visits with patients who have the capability to support that in the home. Such methods also help to cut through some of the red tape that was present pre-COVID-19. Now there’s more emphasis on collaborative working between stakeholders to speed up the provision of patient care in the home environment.

Overall, there have been some hugely positive changes to working practices over the last 18 months when it comes to hospital at home services, and hopefully some of those will be sustained going forward. There are now undoubtedly significant backlogs in certain areas of the NHS as a result of COVID-19 delaying planned treatments. I’d like to think what we’ve learned can help clear a path back to normality and help the NHS to get back on its feet. There are certainly more challenges yet to come on that front.

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

I have quite broad clinical experience. I’m a physiotherapist by profession, working primarily in respiratory care before I joined HomeLink Healthcare, and that remains my main interest in terms of practical skills.

I was very much ‘on the ground’ in previous roles, before stepping into research with secondments focused on how we can improve the care given to patients in respiratory settings, such as looking at ventilator equipment and NIV (Non-Invasive Ventilation). After that, I joined another company in the hospital at home sector as an operational lead for one of its acute services, including deploying a virtual model for subacute care for people in the community.

I then returned to the NHS in a senior role as Head of Therapies in an acute hospital Trust. In that role I managed more than 120 staff. I would work alongside the bed management team to help expedite patient discharges safely, in order to free up hospital beds and help patient flow through the Trust.

That role gave me a fantastic grounding in terms of understanding operational pressures in the NHS and the impact a lack of bed space can have in the community – it really helped me grasp what’s required for both efficient bed management and patient safety.

Applying the learnings from that acute setting into my current role at HomeLink means I can work with our NHS commissioners on improving patient flow, analysing the different care pathways, and facing up to the challenges presented from an acute and community setting.

What is the biggest priority for the industry in 2021/22?

At HomeLink, we’re focused on providing community-based, domiciliary, subacute therapies. I think the impact of COVID-19 means we’re seeing patients coming home from hospital with far more complex needs.

We also have several cohorts of patient types. Many patients that were admitted to hospital during the pandemic (and in normal times) have come out weaker and more deconditioned, primarily because they haven’t had much inpatient therapy due to stretched resources.

There are also patients who have been indirectly affected by COVID-19 by having their treatment interrupted and physio delayed. Then we have patients who are still awaiting elective surgeries and who need therapeutic input before procedures are carried out to give them a better outcome afterwards.

So, all of that together means a holistic approach to hospital at home services is now very much required.

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?

I’m directly involved in recruitment for the therapy staff and healthcare support workers when required. At the very top line, we’re creating a culture of ‘re-ablement’ and supporting patients to become more independent. The role of a health care support worker has changed recently – it’s no longer so much a case of doing things for patients, but instead engaging them to take an active part in their recovery and care plans.

Because there’s been such an increase in demand for social care, and different packages of care, it has become more important to try and give patients that bit of independence to help themselves. Not just for their own quality-of-life, but also to ensure that resource is available to help others who truly do need extra levels of at home care.

We’re very much looking to recruit qualified staff with a broad range of skills and experiences. Having acute hospital experience is probably a key requirement – that helps staff identify patients at home who may be deteriorating, who may not be doing quite so well, or who need an advocate. Picking up on those signs as early as we can is essential to prevent re-admissions. Ultimately, the main thing we want our staff to do is to put patients first.

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?

We’re on the lookout for people with specific skillsets, who may have worked in a hospital previously but are also comfortable working remotely with people in their own homes, without all the backup you would find on a ward, like a crash trolley and senior doctors or consultants. It’s a different requirement and a different mentality – being able to function in tricky situations without being phased or panicked is crucial.

That said, as a values-based organisation, if we find the right person without the necessary ‘in the home’ experience, we can help them adjust to that new environment and then teach them new skills through mentoring and training.

In fact, training and mentoring are extremely important when it comes to our clinical staff. HomeLink Healthcare offers quite a range of services in what we call a ‘package of care’ that can vary greatly by individual patient. They might require physiotherapy. They might need help getting back to their baselines, which is really important for people who have spent a prolonged period in a hospital bed as people lose muscle mass and a lot of the time personal grooming goes out of the window. Those are things we can help put right once the patient is home.

What technology is going to have the biggest impact on nursing and therapeutic care in the home this coming year?

When you look at the NHS in terms of its priorities for the next year or two, I think it’s overwhelmingly about getting things back up and running. For example, delayed cancer treatments and all the pathways that have been put on hold because of the pandemic, plus the return of elective surgery. All those elements need to be restarted and I don’t necessarily think the way in which it was running before is how it’s going to look going forward.

So again, we need to think in terms of what we can do pre-admission to help patients to achieve the best outcomes. For example, where patients would normally come into hospital to have all their pre-appointments and assessments completed before surgery, can those be delivered at home using technology and out of hospital services?

We’ve worked on pilot projects before using technology to remotely monitor patient vital signs in the home setting. That includes a live dashboard, looking at patient respiration rates, saturation levels, blood pressure, temperature and more. It was a challenge to implement but showed a clear way forward in terms of what’s possible.

Ultimately, I think adopting a blended approach of remote monitoring where appropriate, plus having community nurses visiting patients at home to review in person and quantify data, will really help build confidence in the use of technology.

We’re continually assessing how we can use technology to better provision the care that we provide and the efficiencies that are then created. The goal is always to make sure care is delivered on time, at the right time, in the right place and with the right staff.

In 2025 we’ll all be talking about…?

I think we’ll probably still be talking about hospital pressures and bed flow, plus reflecting on COVID-19 and its impact. Hopefully in five years’ time technology will mean we’re able to offer new models and services that right now we just can’t envisage – things can change so quickly given the pace that digital advancements take place.

In this latest instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, we ask our Chief Clinical Officer Jane Tobin 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.

My official title is Chief Clinical Officer and I’ve been with HomeLink since 2016, having worked with our CEO Jill Ireland previously in another healthcare company. My role is strategic and focused on establishing the clinical roadmaps for our services once they’re up and running: making sure our teams run effectively; that we have the right skills; planning recruitment; and onboarding new starters. There’s naturally an element of training and development too – we encourage our staff to grow and learn new skills along with the company itself.

My background is very much entrenched in community-based healthcare. I started my career as a District Nurse working mostly in and around London, which is where a lot of our teams are based now. In fact, when I was a District Nurse, the role was very much about combining health and social care. While those elements have since been separated within the NHS, it is essentially how we work here at HomeLink today, which I enjoy very much.

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

The impact of the pandemic has been multifaceted at HomeLink, like at most organisations, encompassing both emotional and practical considerations. Operationally, we were quite a dispersed group of people pre-COVID, working in different parts of the country. But, like everyone else, we learned quite quickly that you can meet and collaborate extremely effectively using tools such as Microsoft Teams. That virtual interaction during lockdown has given us back so much more time to focus on the development of services, opposed to travelling up and down motorways to meet with each other physically.

In terms of how the pandemic affected the work we do with our NHS commissioners and patients, our first task very early on was to help set up a COVID testing facility at James Paget University Hospitals NHS Foundation Trust in Great Yarmouth. However, quite quickly after that we needed to prepare for the longer-term implications of COVID on patients, including rehabilitation in the home – one of the priorities for the NHS during this time has been to free up hospital beds as fast as possible, which we can absolutely support.

In Southeast London, where we’re working with hospitals right now, we spend a lot of time supporting NHS staff who have worked all the way through the pandemic – particularly district nursing staff who are, quite frankly, exhausted.

This also brings us to the other main impact of COVID within the NHS – the growing list of people who weren’t able to visit hospital during the lockdowns and who are now quite sick or in pain as a result. So many routine procedures were put on hold and now the waiting lists for elective surgeries are much longer than before. At HomeLink we want to help our NHS commissioners manage that backlog by helping them move people out of hospital and back home as quickly as medically possible. Even now some people are scared of going into hospital, so we could be living with the impact of delayed treatments for a long time to come. Luckily there are solutions at hand.

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

It sounds counter intuitive, but the pandemic has actually been a catalyst for a lot of positive change in terms of patient care because the rule books had to be changed. The challenge now is to not immediately fall back into old, bad habits post-COVID.

I think how we are working to care for patients during the pandemic is closer to how we used to work years ago when I was a District Nurse – the health and social care elements very much intertwined. In many ways it’s a natural and obvious thing. This coming together of disciplines also ties into the complementary skill sets within HomeLink’s management structure; Jill’s background is one of oncology and acute care, whereas mine is primary care in the community.

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.

As a District Nurse, I was always used to receiving somebody back home and dealing with a lot of unknowns; the way a patient presents in hospital can be very different to how they present in their own home. So, I don’t think anything particularly shocked me in that sense during the pandemic – it was more about how quickly the move towards hospital at home happened.

Also, as a community nurse your skillsets are usually a little broader than hospital-based nurses. You need to be more flexible and work within the parameters of how people live in their homes and accept their treatment. Plus, soft skills are hugely important when it comes to liaising with family members or friends who also may be present in the home environment. There can been unique dynamics and different requirements at play compared to the relatively controlled environment of a ward.

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?

We’re on the lookout for people with specific skillsets, who may have worked in a hospital previously but are also comfortable working remotely with people in their own homes, without all the backup you would find on a ward, like a crash trolley and senior doctors or consultants. It’s a different requirement and a different mentality – being able to function in tricky situations without being phased or panicked is crucial.

That said, as a values-based organisation, if we find the right person without the necessary ‘in the home’ experience, we can help them adjust to that new environment and then teach them new skills through mentoring and training.

In fact, training and mentoring are extremely important when it comes to our clinical staff. HomeLink offers quite a range of services in what we call a ‘package of care’ that can vary greatly by individual patient. They might require physiotherapy. They might need help getting back to their baselines, which is really important for people who have spent a prolonged period in a hospital bed as people lose muscle mass and a lot of the time personal grooming goes out of the window. Those are things we can help put right once the patient is home.

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

As we look into 2022 and beyond, I think we’re going to see the NHS require increased levels of district nursing care from the private sector. The impact of COVID and the backlogs on acute and elective surgeries mean hospitals will soon be bulging at the seams if they’re not already.

That means patients shouldn’t be spending any more time in hospital than they must – we should have the resources in place to get them home as soon as possible. That’s particularly true with elective procedures – the hips, knees and things like that. I’m a great believer in admission avoidance, particularly with elderly people, who we should be trying to help and support in the home as much as possible when it comes to physio and other rehab.

Tell us about how technology is driving the work you do at HomeLink Healthcare.

At HomeLink our clinical staff work from iPads when on the move or in a patient’s home, which is all the time. We are already a paperless company. A key tool for us is the Mobizio digital care management system, which allows us to electronically record all patient interactions, encompassing digital care plans and forms, eMAR, family & funder access, automated alerts and visit logs.

The platform gives us access to invaluable real time patient data and, from there, you can layer up digital workflows, such as video calls with doctors while we’re with a patient or submitting images of wounds or injuries for assessment. That’s a huge opportunity to speed up patient care and something that’s obviously in a GP’s or consultant’s interest too. Plus, NHS staff are able to look at our records to gain more insight into an individual patient’s condition. A likely evolution of this we be companies like HomeLink being granted reciprocal access to NHS patient records.

Wearables are going to be key to the evolution of the hospital at home model, whether that’s data gleaned from a patient’s Fitbit device or a patch on their arm that monitors sats, blood pressure, temperature, etc. The first generation of wearables were quite bulky – a bit like wearing a phone and a charger on your arm. But the latest solutions, which we’ve been helping to trial, collect vital signs data via a small pad attached to the arm, with a team monitoring it remotely 24 hours a day in real time, alerting clinical staff as required.

These kinds of technologies give people, who would otherwise spend all their lives in hospital, an opportunity to be at home. Sometimes it isn’t that long before they have to go back in again, but wearables will give the NHS and our own staff the chance to monitor patients closely without them physically being in a hospital bed. And there are huge patient wellbeing and mental health benefits with that approach.