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Resource Topic: Virtual ward

NHS Shared Business Services (NHS SBS) framework agreement renewal enables direct commissioning of Hospital at Home services

We are pleased to announce we have been reappointed as a supplier on NHS Shared Business Services (NHS SBS) Patient Discharge and Mental Health Step Down Beds Services Framework Agreement. NHS partners can procure services with HomeLink Healthcare directly via the framework agreement.

 

New NHS SBS Framework Agreement

About the framework agreement

This NHS SBS framework agreement has been developed to reduce the demand on NHS Trusts by supporting with their adult patient discharge pathways. The framework agreement aims to:

  • facilitate transfer of patients from hospital beds to a more appropriate level of care
  • supply additional bed capacity within the NHS urgent care system infrastructure by relieving bed pressures within the local health economy
  • discharge patients meeting specific clinical criteria into an appropriate care setting, reducing instances of re-admission to hospital
  • allow patients to have personalised on-to-one support maintaining continuity of care
  • provide a dedicated pathway to hospital discharge management services.

HomeLink Healthcare is a supplier on the following Lots:

  • Lot 1: Discharge to Assess Services: facilitates patient discharge not only from emergency departments but also from the wider acute hospital and community care settings.
  • Lot 3: Virtual Ward Support Services: supplies a “secondary care” service within a patients care setting for up to 6 weeks. Patients are transferred to the Virtual Ward Support Service following referral from the Trusts’ clinical discharge teams on acceptance by service leads.

“Free to access, our ‘Patient Discharge and Mental Health Step Down Beds Services’ framework agreement is designed to support the transition of patients from hospital, reducing instances of pressure on acute hospital beds, Social Services and re-admissions. In turn, this enables health and care providers to free up capacity to deal with other patients. improve quality of care and health outcomes.” Elaine Alsop, Head of Category – Health, at NHS SBS.

Avoid delays and contract with us directly

NHS partners can use the NHS SBS Patient Discharge and Mental Health Step Down Beds Services framework agreement to directly award contracts to HomeLink Healthcare, saving time and money on the procurement process.

New services can be mobilised in 8-12 weeks. Act now to get a new service up and running within three months and at full capacity within around four months.

  1. Develop specification, business case, contracting options and supplier engagement: now!
  2. Contracting: one week
  3. Service mobilisation: twelve weeks
  4. Go live!
  5. Ramp up to full capacity: six weeks

Work with us

HomeLink Healthcare has been delivering Hospital at Home services since 2016. As a supplier to NHS SBS’s new framework agreement and its previous iteration which ran for four years from March 2019,  it has been used to procure a wide variety of pathways from a large number of organisations including Trusts and the Community Services.

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.

 

Release in-patient bed capacity this winter with Hospital at Home services

The case for Hospital at Home services is compelling. Seasonal resilience funding is often seen as a one-off. Why not use it to work with an experienced provider which has a track record of delivering results for the NHS and for patients. HomeLink Healthcare can also help with business planning now. This will speed up the process of delivery once funding is released.  

According to the Delivery Plan for Urgent and Emergency Services the winter crisis of 2022 saw hospitals fuller than pre-pandemic levels, with 19 out of every 20 beds occupied and 7.2 million patients on waiting lists. In January 2023, nearly 14,000 beds were occupied by patients who were fit to be discharged.  

This winter is expected to see similar challenges. With bed occupancy rates over 90%, hospitals are increasingly looking towards Hospital at Home services to free up beds ahead of winter. 

The case for Hospital at Home services is compelling

"Boosting care in the community and treating more people at home is key to recovery – it is better for patients and their families, as well as easing pressure on NHS services."
- Amanda Pritchard, NHS Chief Executive

NHS England sees Hospital at Home and Virtual Wards as a key solution to improving patient flow through A&E and reducing elective recovery waiting lists. According to statistics patients are five times less likely to acquire an infection and eight times less likely to experience functional decline on a Virtual Ward compared to an acute setting. Twenty-three per cent of these patients also achieve a more independent social care outcome. 

HomeLink Healthcare provides Hospital at Home services through a number of pathways including Early Supported Discharge, Discharge to Assess, Virtual Wards, Reablement, Rehabilitation, Anticipatory Care, and Bridging Packages of Care. 

Seasonal resilience funding can relieve the pressures and build a case for future roll-out 

As Hospital at Home services become more established, and increasing numbers of patients are seen at home, savings can be made through introducing fewer hospital beds and outsourcing less elective care procedures to the private sector.  

Setting up a Hospital at Home service doesn’t need to be difficult

A Hospital at Home service requires expert knowledge; integration with existing governance structures; staffing; and in the case of Virtual Wards, technology. We understand that this can be quite daunting, particularly at a time of such immense pressure.  

That is where HomeLink Healthcare comes in.  

  • EXPERTISE IN HOSPITAL AT HOME: We are 100% focused on delivering Hospital at Home services and have been since 2016. We have numerous clients and we deliver services in four of the seven NHS England regions. 
  • COMMITMENT TO QUALITY: We are clinician-run and everything we do is patient-centric. Our clients see us as ‘NHS like’ and in our most recent client survey we received 100% client satisfaction. 
  • NO NEED TO RECRUIT: We bring with us a multi-disciplinary team of compassionate, patient-focused nurses, therapists and healthcare support workers. 
  • TECH, OR NO TECH, NO PROBLEM: If you’re interested in a Virtual Ward, we can provide our own technology partner, or work with your existing technology supplier. 
  • FAST, EFFECTIVE MOBILISATION OF SERVICES: Services can be procured directly using the NHS Shared Business Services Patient Discharge and Mental Health Step Down Beds Services Framework. We use a PRINCE 2 project management approach, supported by a dedicated project manager and can get brand new services up and running within 12 weeks.  
  • WE WORK IN PARTNERSHIP: We bring our expertise and tried and tested ways of working and at the same time treat each relationship on a case-by-case basis. We have been shortlisted for three HSJ Partnership awards.  
  • REAL-TIME DATA: Advanced KPI reporting enables clients to see what is happening in real-time and share best practice. Data includes patients, visits, outcome measures and patient experience metrics 

We can help you to increase hospital discharges in time for winter

HomeLink Healthcare can get a brand new service up and running within 12 weeks. This means that if you act now, you can have new pathways in place by winter 2023/24.  

No funding yet? Don’t let that stop you from contacting us!

We know that funding for winter is on its way but that you might not know how much you will receive. To avoid unnecessary delay, and to make things easier for you during the procurement phase, our staff can carry out a no-obligation feasibility assessment now. The outputs from this can also be used to help pull together a business case. After funding levels have been agreed, we can adjust the numbers accordingly.  

View our case studies:

  • Last year we implemented new Bridging Packages of Care and Reablement pathways in Buckinghamshire. Discussions started in the summer before funding was in place, and the service commenced on 1 December 2022. The service saved 951 bed days its first 18 weeks. Read more here 
  • A patient in Norfolk gets home in time for Christmas thanks to the Virtual Ward. Read more here  
  • Hospital at Home services in Norfolk and Waveney save the equivalent of two hospital wards every day. Read more here.  

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. 

 

Case study: Feasibility assessment

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

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

The potential impact of implementing Hospital at Home services

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

Virtual Ward:

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

Bridging Packages of Care:

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

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

IV Therapy:

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

Applying this across the NHS

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

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

What is a feasibility assessment?

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

Contents of a feasibility assessment

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

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

7_Step_Process

Work with us 

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

Get in touch 

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

Admission avoidance case studies

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

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

NNUH Virtual Ward service helps respiratory patient avoid multiple hospital admissions  

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

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

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

Patient at QEH avoids hospital admission and multiple GP appointments 

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

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

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

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

Virtual wards: tech matters, but so do people

Emily Wells CNIO NNUHEmily Wells is the first Chief Nursing Information Officer to be appointed by Norfolk and Norwich University Hospitals NHS Foundation Trust and was the Digital Health CNIO of the Year in 2021. Here, she outlines her thoughts on how to develop a successful virtual ward, drawing on her Trust’s experience of working on new care pathways with HomeLink Healthcare.

NHS England recently issued a letter to give health and care services early sight of its thinking about the coming winter. One of its recommendations is to increase capacity by the equivalent of 7,000 beds, some of which will be on virtual wards.

The letter has renewed debate about the use of virtual wards, and whether they can be safe and effective. Norfolk and Norwich University Hospitals NHS Foundation Trust has considerable experience of setting up and operating this new model of care, during the Covid-19 pandemic and beyond.

Our experience is that they can release valuable bed days: by the end of September, more than 1,530 patients had been through the NNUH virtual ward, releasing more than 11,000 bed days. Just as importantly, they can deliver benefits to patients.

Patients can return home days or even weeks earlier, to recover in the comfort of their own surroundings, sleeping in their own bed, eating their own food, and being in the company of their family, friends and pets.

However, that only applies as long as they also feel safe and cared for. That means virtual wards need good planning and governance. They need to be supported by the right technology. And they may need something that is often overlooked, which is skilled staff to provide at home care. On the Norfolk and Norwich virtual ward, this is provided by HomeLink Healthcare.

Responding to the need for home IV therapy and new services for Covid-19

"There have been other benefits to working with a private provider. It’s not just that we would have struggled to recruit the staff required. HomeLink Healthcare understands the NHS and is committed to partnership working."

Our experience of working with this specialist provider of hospital at home services started in 2018. An audit had shown that there were many patients in hospital on IV therapy, who could have been treated at home if there had been a service available.

I worked closely with HomeLink Healthcare to define a pathway for these patients. We worked on the referral criteria and the governance to make sure the service was safe, and then we tested it and rolled it out in the first months of 2019.

Then, I moved into my current role, and in March 2020, Covid-19 arrived. In the first year of the pandemic, we were looking at how remote monitoring technology could support the Trust.

So, when the national ask came through to set up a virtual ward, we were able to respond at pace; initially to support Covid-19 patients who could be safely treated at home but quickly expanding to incorporate additional pathways.

We loaned patients devices that they could use for daily phone or video calls with staff and provided them with devices to measure temperature, pulse, blood pressure and oxygen saturation levels.

The virtual ward was very well received. Patients said that they found the technology easy to use and valued being in control of their routines. So, as we reset after the pandemic, we continue to expand the concept.

Today, the Virtual Ward looks after many patients who would ordinarily require a hospital bed. We have developed a ‘waiting for treatment’ pathway for patients who would otherwise have to remain in hospital. We can accept oncology and palliative care patients.

In fact, we have around 15 active pathways, and we are still exploring new uses for the concept. For example, we are looking to create a ‘front door’ service for patients who might otherwise be admitted after attending the Emergency Department. We know that if patients are admitted, they can deteriorate, so the idea is to turn them around and get them home again – while making sure that they still get the monitoring and treatment they need.

Successful virtual wards need the right tech – and the right hands-on care

"HomeLink Healthcare also has great reporting tools, so we know what is being delivered and what impact it is having."

In all of these cases, we are looking after patients who would ordinarily require a hospital bed and be inpatients. That means our virtual ward is part of the hospital. Patients are not discharged onto the ward; they remain under the care of a consultant and our virtual ward team.

We use Current Health to monitor the observations collected by the remote monitoring devices. We see the readings on a dashboard and have a ward round and do everything that we would do for them in hospital. And where patients need hands-on care, we use HomeLink Healthcare to provide it.

HomeLink Healthcare delivers IV therapy and a specialist wound care service known as VAC therapy. Its staff can carry out blood tests and observations. The technology gives us visibility of our patients, and if they show a sign of deterioration, we can ask HomeLink Healthcare to visit that patient – which might save us an admission to check on an alert.

Of course, we also work closely with our community provider, Norfolk Community Healthcare NHS Trust and existing services, such as the Aylsham Medical Day Unit, which provides a day-case medication, IV therapy, and other treatment service on-site.

Right at the start of our NNUH at Home development, we co-created an operational manual that was focused on safety. That really matters in our model, because if the consultants who remain responsible for patients are not confident that they will be safely and effectively cared for, they will not refer to it.

HomeLink Healthcare also has great reporting tools, so we know what is being delivered and what impact it is having. That business approach to things is very helpful, because it gives us visibility of where patients are being seen and what care they are receiving.

Supporting the NHS this winter, and working for patients

As we head into the winter, we will continue to develop our virtual ward and work within the Norfolk and Waveney Integrated Care System to join up a larger model of care across the system.

We started behind other health systems in terms of digital maturity, but these new services are performing exceptionally well; something that has been recognised by senior officials from NHS England and representative bodies.

That’s because we were able to focus on the governance, and finding the right model, supported by the right technology, and the right home care.

We know that virtual wards can deliver additional capacity to the NHS, but we also know that they can deliver a great service for patients. Most people would prefer to recover in their own homes, as long as they feel safe and well cared for; and virtual wards can deliver on both.

This article is also published in the following journals:

Building Better Healthcare Virtual Wards

HT World Virtual Wards

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. 

Chief Clinical Officer presented at RCNi virtual wards webinar in February

Jane Tobin, Chief Clinical Officer, HomeLink Healthcare

On 1st February Chief Clinical Officer, Jane Tobin, was one of the keynote speakers at the RCNi Virtual Ward webinar.

Jane presented to hundreds of nurses about the nurses role in the set up and delivery of a virtual ward.

The patient need is at the heart of the HomeLink Healthcare virtual ward. Jane discussed the nurses role in the setup of a virtual ward including co-design, development of clinical leadership and governance, pathway design and KPI development. She also talked about how the nurse is at the heart of the delivery of a virtual ward, covering off the different roles in-hospital and within the home. Embedded in the presentation is a video which shows a nurse delivering patient care on the virtual ward.

The session was very well received with lots of questions and interaction from the attendees.

You can watch the full presentation here: Virtual Wards, Lessons Learned

Jane’s presentation starts at 8 minutes 20 seconds.

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. 

Shortlisted for the HSJ Partnership Awards for the third time

HomeLink Healthcare is delighted to announce that for the third time we have been shortlisted for an HSJ Partnership Award in the ”Best Healthcare Provider Partnership with the NHS” category.

Following being shortlisted in 2020 and 2022, this year it is our Hospital at Home partnership with NHS Norfolk and Waveney Integrated Care Board (ICB) and NHS Trusts across Norfolk and Waveney ICS that has been shortlisted.

The national health and care sectors have faced innumerable pressures over the past 12 months. At the same time the standard and overriding positivity of the partnerships this year across Norfolk and Waveney highlight an enduring dedication to improving patient outcomes.

Being shortlisted for a HSJ Partnership Award shows confidence in this worthwhile project. It ensures that the team’s efforts and relentless work to improve the lives of our patients is nationally recognised.

The HSJ Partnership Awards recognise and honour the most effective partnerships, innovative projects and collaborations in the UK health system. This prestigious award programme, now in its sixth year, is not just a celebration of success stories but also a platform to shape the future of our new integrated health and care system.

Designed by NHS Trusts, NHS Norfolk and Waveney ICB and HomeLink Healthcare, our project was a testbed for Norfolk and Waveney ICS and independent sector collaboration. The project was set up to respond to exceptional capacity challenges and we have analysed how this approach could be used across the ICS footprint and beyond.

24,000 bed days have been saved at 45% of the equivalent inpatient cost.

The virtual ward and early supported discharge services being provided are enabled by technology. They are rated as excellent by patients and provided measurable system benefits. The partnership has been deemed a success and the scope and scale have been extended. The project now frees up the equivalent of two hospital wards every day.

The award judging panel comprised a diverse range of highly regarded figures across the NHS and wider healthcare sector. HomeLink Healthcare and our multiple partners across Norfolk and Waveney are delighted to be shortlisted as a finalist, despite tough competition from a pool of brilliant applications

The Hospital at Home partnership has been selected based on our combined diligence, ambition, and the positive impact that the project has had on both practitioners and patients within the health care industry.

Our partners on this project include Norfolk and Waveney ICS, James Paget University Hospitals NHS Foundation Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, and The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust.

Dr Frankie Swords, Medical Director, NHS Norfolk and Waveney, said:

“I am thrilled that this dynamic and innovative partnership has been recognised nationally as part of the 2023 HSJ Partnership Awards.

“The virtual wards in Norfolk and Waveney are going from strength to strength. Being able to provide effective and safe care virtually means we can not only discharge patients in a more timely way, it also supports their onward recovery journey, enabling people to recover in a more familiar setting to them, suited to their individual needs. I wish the partnership every success at the awards ceremony and look forward to this work developing even further.”

HSJ editor Alastair McLellan comments:

“We would like to congratulate HomeLink Healthcare on being nominated in the category of Best Healthcare Provider Partnership with the NHS ahead of HSJ Partnership Awards 2023. We are looking forward to welcoming them to the ceremony in March, to join us in recognising the very best collaborations and innovations in the healthcare sector. This year’s finalists are of an outstanding calibre and all of them are exceptionally dedicated to enhancing healthcare across the UK.”

The winners will be selected following a rigorous judging stage ahead of the HSJ Partnership Awards 2023 awards ceremony. The awards evening is expected to be attended by national healthcare leaders and professionals from both the NHS and private sector as well as figures from non-clinical backgrounds to celebrate innovation and collaboration in healthcare.

The selected winners will be announced during a private ceremony at Evolution London, on 23 March 2023. We wish the best of luck to all those involved!

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.

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.

NHS restoration and recovery – addressing the capacity challenge across an ICS

Many positive changes have come out of the NHS response to COVID-19. As our health and care systems address the complex challenge of a backlog of elective cases, the approach of Winter and further COVID-19 surges, what can be done to balance these competing demands on systems with limited capacity?

This article considers some timely, grounded and cost-effective options for the sustainable recovery and delivery of core NHS services while retaining the ability to respond to COVID-19.

Getting the right balance between, delivering a Recovery Plan, providing ‘normal’ NHS services and maintaining capacity for local surges in COVID-19 cases.To respond to the challenges in demand, additional capacity and resources are required, combined with new ways of working.

• Expanding the provision of home-based care will free up hospital capacity to help address these pressures, increasing the ability to deliver ‘ordinary’ health and care services.
• Home-based care has the additional advantage of reducing the risk of cross infection between COVID-19 positive and other patients
• Technology – the use of video consultations and remote monitoring are positive changes in models of care delivery which can be further developed to maximise efficiency and resources.

At Norfolk and Norwich University Hospitals NHS Foundation Trust patients have left hospital early and been safely treated at home – at half the cost of remaining in hospital

 How can the NHS provide for the pent-up demand for health and care services that have been delayed due to the COVID-19 outbreak?

NHS providers and commissioners need to take steps to provide timely and cost-effective care in excess of ‘pre-COVID-19’ capacity. Actions which could be ready for Winter 2020/21 include:

Optimising inpatient beds promoting safe, effective, efficient patient flow from hospital to home.

• Delivering models of Early Supported Discharge. Moving patients out of the acute setting sooner to complete care at home instead of in hospital.

  • Early supported discharge delivers not only step-down capacity but also effectively step-through capacity. Patients go home at D minus 4 or before, that would have stayed in hospital beds. This is also the case for bridging packages of care. Patients often go home after their discharge day (e.g. D plus 4) whereas a bridging service is able to rapidly move the patient home by providing care on their discharge day.

• Better planning of the route into and out of hospital. Prehabilitation (before surgery) and rehabilitation (post-surgery) reduces the length of stay in hospital and improves outcomes.
• Continue the joint working between NHS and private healthcare to enable changes to be implemented quickly.
• Value for money. Flexible capacity based on the patient at home is more cost efficient than capital spending on less flexible new ward building.

Patients are being rapidly discharged from hospital with a higher level of complexity.

At Imperial College Healthcare NHS Trust early supported discharge patients regained independence and avoided the need for hospital readmission through the use of a multi-disciplinary community team.

 Many of the changes to discharge practices, brought in to manage the peak in COVID-19 cases, are being retained for the long-term. As the number of patients discharged to community care returns to pre-COVID levels, appropriate care must be available for patients with longer termand more complex needs.

To address these needs a range of factors should be considered:

  • Care services delivered by multi-disciplinary teams can respond quickly to changes in patient’s acuity (step up and step down).
  • More complex patients require a workforce which has the capability of managing acute care at home. This is significantly different to care traditionally delivered by District Nurses and Community Nurses.
  • Technology enabled remote patient monitoring helps to support patients with a higher level of acuity.
  • A focus on quality and safety must be retained post discharge from hospital.
  • Promote physical and emotional wellbeing. Meeting extra demand for mental health services as a result of the societal and economic impacts of lockdown.
  • Utilise tried and tested models for out of hospital services that are quick to deploy, scalable and ready to meet complex patient needs. Ready for Winter.

As services normalise, how can the positive changes that have taken place as a result of the pandemic be retained?

NHS Hospital Trusts have been working hard with their community partners to improve the integration of services so that patients have a quicker and smoother transfer to the care they need at home, or close to home.

The independent sector has played a significant role in supporting the NHS across all parts of the healthcare system in responding to COVID 19. The relationship between the two sectors has radically changed during this period with great examples of partnership. It is important to ‘lock-in’ these changes for the next phase of the pandemic response and once service provision normalises.
• The 2-hour discharge pathway is a positive step, however, gaps are already emerging as former reasons for delay reappear and delayed discharge lists grow – this demonstrates a need for a quick reaction service to add to existing community capacity
• The rapid adoption of technology should be retained and built on. Mobile patient records, virtual MDT, remote monitoring and analytics of data from wearables should be encouraged
• Lock-in the attitude that there are ‘no acceptable delays in patient discharge. Meaningful measures will allow this to be tracked in acute and community settings.

What is the impact of delayed transfers from hospital to home?

At the James Paget University Hospitals NHS Foundation Trust patients have been discharged as soon as they are medically fit with ‘care bridging’, resulting in a median saving of five bed days per patient.

 Measures for 2020 are not available since the first part of the calendar year however in 2019 almost 60,000 NHS beds were ‘blocked’ every month by delayed transfers of care.

Patients are spending unnecessary nights in a hospital bed because of delays in services which would provide their care at home, or in another setting. Delayed discharge also results in deconditioning for patients, increased risk of infection and ultimately an increased cost of care.

What can be done?

Early supported discharge services and virtual wards offer a scalable way to provide patients with the care they need at home, instead of in hospital – a ‘Hospital at Home’. These services fill in the gap until established community services are available or offer types of home-based care not provided locally. Where already operated by the NHS and their partner organisations these services offer a safe and cost-effective option for patients who welcome the opportunity of an early return to the familiar surroundings of home.

What is Hospital at Home?

Hospital at Home provides a comprehensive ‘secondary care at home’ service, for example: IV therapies, wound care (including) negative pressure therapy, rehabilitation and bridging packages of care. The service recognises the needs of individual patients and considers diversity of the population with respect to cultural needs.

Our Hospital at Home service complements existing services integrating with NHS and local authority community provision. It responds quickly to allow medically stable patients to leave hospital or avoid admission, improving flow and releasing inpatient bed capacity.

• Clinical responsibility remains with patient’s consultant/GP, unless otherwise agreed. Interventions are prescribed by the accountable consultant/GP and delivered at home by the HomeLink Healthcare multi-disciplinary team
• The multi-disciplinary teams comprise of highly skilled and well-trained registered nurses, physiotherapists, occupational therapists and healthcare assistants
• A mobile electronic patient record (EPR) allows all staff involved in a patient’s care to access the care plan and care record in the field via a mobile app
• Telehealth devices can be used to monitor the patient’s vital signs between care visits (24/7)
• All patients have their holistic needs assessed prior to discharge and a clinical baseline established and Care Plan developed. At each visit patient needs are reassessed, changes monitored and recorded in the EPR. Home visits are conducted according to patient needs, including both nursing and therapy observations.
• For each patient flags and indicators for escalation are agreed and contained in the Care Plan identifying when additional medical review or escalation is required. When indicated by clinical need a multi-disciplinary team review will also be undertaken.

NNUH at Home, a hospital at home service created in partnership between HomeLink Healthcare and Norfolk and Norwich University Hospitals NHS Foundation Trust has saved over 5,000 bed days, with 100% patient satisfaction’, resulting in a median saving of five bed days per patient.

 

HomeLink Healthcare supports the delivery of core NHS and care services during the pandemic and beyond HomeLink Healthcare is an independent sector organisation partnering with the NHS to deliver home-based care to patients who would otherwise be in hospital, a Hospital at Home. We enable this with our safe, high quality and caring service, supported by technology and our skilled staff, delivering care at the right time in the right place. We are supporting the NHS with a flexible, responsive and agile approach to changing care needs during the COVID-19 pandemic and beyond.

Providing home-based care for patients reduced hospital bed nights and avoided admissions, lowering demand on stretched resources and risk of cross infection. We are continuing to work alongside our NHS partners to maximise the utilisation of inpatient beds by caring for patients at home as soon as they are medically suitable for our services.

HomeLink Healthcare are experts in designing, mobilising and delivering Hospital at Home Services. 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 virtual wards, call us on (020) 3137 5370 or contact us.  You can tell us about your situation, and we can tell you more about our experience of Hospital at Home and how we might be able to help you.

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

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