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.

Changing attitudes towards hospital and healthcare means more patients are being treated at home

Covid-19 sent shock waves through Britain’s national health service, exposing fragilities, underlining insecurities, and pushing many hospitals to the brink. The pandemic has both exacerbated existing issues and added fresh challenges.

There are many lessons to be learnt from the pandemic. In healthcare, every answer points to the need to care for more people at home.

Even before coronavirus swept through the UK, the NHS was struggling. Overwhelmed hospital capacities, protracted A&E waits and staff shortages signalled a looming crisis. The NHS was rapidly mobilised in response. Non-urgent care was scaled back, elective surgeries were cancelled. Infection control measures added to mounting capacity challenges: fewer beds spaced further apart.

There are many lessons to be learnt from the pandemic. In healthcare, every answer points to the need to care for more people at home.

Since 2016, HomeLink Healthcare has been collaborating with various partners to combat these challenges. How do we do this?

  • With multidisciplinary teams that provide expert home care
  • By embracing technological advances and digital healthcare
  • By creating bespoke services that complement and ease existing systems.

Changing attitudes towards hospital and healthcare

Attitudes towards healthcare have been changing for some time. Covid-19 has accelerated this change, giving more urgency to desires to be treated at home, and released as early as possible from hospital wards. People,
understandably, fear going to hospital. They are frightened of catching the virus, apprehensive of strict visiting rules, unwilling to contribute to pressure on the NHS. Since the start of the pandemic, A&E visits have plummeted by 50% and half the usual numbers of patients are attending hospital with heart attacks. GP visits have dropped by similarly dramatic proportions.

A report in July by health policy consultants, Incisive Health, found that around half of the British public were reluctant to go to hospital due to fears of catching coronavirus and being a burden on the NHS. Patients of all ages stated they would prefer phone calls to face-to-face appointments for non-urgent medical advice. Their fears are not unfounded. In May 2020 NHS England’s first estimate of the size of the problem found up to 20% of people with Covid-19 at hospital had caught it while at hospital. Data from October shows hospital-acquired infections remain persistently high.

The pandemic is also reshaping how people spend their last days. Most Britons, in usual times, pass away in hospitals and nursing homes; only about 25% at home. Even before the virus, this was beginning to shift in the West. The epidemic has reinforced that trend. Since early June, the percentage of people who have died at home has been 30-40 points above the five-year average in England and Wales.

A holistic view of healthcare: empowering our patients

“This is a really good service that should be expanded. It enabled me to come home two weeks earlier which was better for my well-being and saved the cost of my being in hospital. The nurses were very friendly and considerate.

It’s a well-known fact: people recover better, and faster, at home. Elderly patients, in particular, deteriorate rapidly in hospital, quickly losing functionality and independence, with the added risk of catching infections. Yet myths about home-based care as an alternative to the hospital persist. Are the nurses of the same standard? Is it a second-rate service? How sterile and safe can treatments really be?

In our experience, home-based care isn’t just as good as hospital care – it can be better. Our expert multidisciplinary team – specialist nurses, physiotherapists, – deliver a wrap-around of high-level care to each patient. The quality is reflected in the time and attention we allocate to each visit. Our nurses take the time to settle patients in and get to know them. What the care looks like is different for each patient – depending on their medical, emotional and physical needs. It might be taking their dog for a walk. Cooking them their favourite meal. Chatting to them about their hobbies. And we’ve found our patients recover more easily at home. It makes sense. They can eat their own food; sleep in their own bed; cuddle their partner, hamster, dog. They can be mobile and independent.

Our approval ratings show patients agree. Working with Norfolk and Norwich University Hospitals Foundation Trust (NNUHFT) on our joint service, NNUHFT at Home, we’ve had outstanding patient satisfaction: 100% would recommend.

Before coronavirus, almost every hospital in the UK was grappling with limited capacity. The pandemic has made this exponentially worse.

In 2019, the average overnight bed occupancy rate was 90% – regularly exceeding 95% in winter – well above the maximum safe levels of 85%. Delayed transfers of care meant almost 60,000 NHS beds were ‘blocked’ every month. These delays cause distress, unnecessarily long hospital stays, increased risks of infection, delays in A&E and elective care cancellations.

At the same time, the total number of NHS England hospital beds has more than halved over the past 30 years – from around 300,000 in 1987/88 to 141,000 in 2018/19 – while the number of patients treated increases year-on-year. The UK has less acute beds per population than many comparable health systems. In November 2019, reports warned that hospital beds were at a record low.

There have been calls for radical transformations to address these capacity challenges. Analysis in May 2020 from health care experts found that over the next few years there will need to be a number of long-term changes to how routine care is delivered and more important roles for the independent sector. Cutting bed occupancy rates by reducing length of stay and increasing capacity elsewhere in the system are recurring themes in government and NHS England initiatives – seen in the NHS Five Year Forward View and the NHS Long Term Plan.

Virtual wards and early supported discharge

At HomeLink Healthcare, we work with hospitals and commissioners to alleviate capacity by ensuring people are not in hospital unless they need to be and smoothing the transition from hospital to home.

Under our early supported discharge programme, patients are moved from acute settings to complete care at home rapidly and safely. HomeLink Healthcare specialists and hospital staff select patients from wards, who are assessed on a number of criteria, including their acuity and home environment. We then work alongside the hospital and local providers to create comprehensive, individualised care plans for each patient.

Patients are assessed within two hours, with swift interventions to avoid hospital admission.

With our Admission Avoidance model, patients are referred by their GPs and an assessment is carried out within two hours of referral, with interventions implemented swiftly to avoid hospital admission.

While care is provided at home by our expert team, the patients remain under the supervision of their hospital consultant or GP – creating virtual wards that can provide capacity at scale. At the end of their acute care pathway, patients are discharged to their GP or on-going community care. Our on-call service provides 24/7 clinical and administrative support and acts as a direct link for patients and carers, hospital consultants and GPs, nurses and therapists. Mobile electronic patient records allow all involved to assess care plans.

We provide complex clinical care in the home, whether it’s wound care, chronic bone infections, drain and catheter care, IV therapies or rehabilitation.

Our services look different for each hospital and care provider: they are bespoke, adding real value and real opportunities for joint working. Rather than replicate, we support and complement existing services.

Looking ahead: taking healthcare into the digital age

A number of positive changes have been made as a result of the NHS response to Covid-19. The pandemic has broken down many preconceptions about both home and virtual care. It has proved to not only be possible, but effective.

“The team have been kind, caring, understanding, sympathetic and professional at all times. Their help and support has been invaluable to me and my wife. Thank you.” Patient feedback.

The health service has been struggling with the application of technologies and digital care for decades. Since the pandemic began, there has been a significant digital shift: the uptake of tech in many hospitals, the normalisation of video-based consultations – unthinkable a year ago. Many acute hospitals have introduced temporary discharge to assess (D2A) processes to rapidly discharge all patients safe to leave and then undertake assessments and build their care plans once at home. The running of general practices has also adapted. Remote triage is now the first port of call: patients are assessed by phone or online before they can see someone in person.

Many of these changes mirror practices we have been honing for years at HomeLink Healthcare – and, we believe, make our services even more crucial. Our first assessments are at home, not at hospital. We have been at the forefront of many technological advances in healthcare: virtual assessments and digital-care are integral parts of our service.

Recently, we have begun to trial the use of telehealth devices alongside our standard monitoring: smart devices that continually measure vital signs, temperature, pulse, oxygen saturation, mobility – meaning we can observe our patients even when we’re not with them, and no longer have to rely solely on patient descriptions of symptoms. This will have far-reaching consequences for the ease and effectiveness of delivering home-based care.

Harmonious partnerships

We can help hospitals make these transitions. Agile and flexible, we’re set up to offer fast, effective solutions wherever they’re needed.

The independent sector has played an important role in supporting the NHS in its response to the pandemic. Covid-19 has underlined the need for community health care, but the infrastructure and investment are not in place to deliver it effectively. Harmonious partnerships between public, private and community are critical in improving patient experiences and the efficiency of the health service. We believe our services are not only beneficial for patients’ rehabilitation and resocialisation but are cost-efficient and cost-effective for the NHS. We deliver great value for money: honesty and transparency are at the core of what we do.

Our offerings fit with many of the NHS goals, including giving people more control over their care; encouraging more collaboration between public, private and community services; and making better use of data and digital technology. We are well positioned to add value, expertise and efficiency in all of these areas.

As the NHS continues to grapple with surges in coronavirus cases, backlogs of elective cases and the additional strains of winter, there has never been a greater need for the ‘hospital at home’. Our services are quick to deploy, scalable and ready to meet complex patient needs.

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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.

How HomeLink Healthcare can help address the mounting problem of elective backlogs in hospitals

What’s currently being done to combat elective backlogs?

Some steps are being taken to address the situation. In the recently released NHS planning guidance for the year ahead, accelerating the restoration of elective care is a core priority: in the words of the national health service, to achieve their goals, they must “do things differently”.

NHS funding has been directed into local systems to attempt to reduce surgical waiting lists, in the form of the Elective Recovery Fund. At HomeLink Healthcare, we agree that things can and should be done differently – and we believe we can utilise our experience and skill sets to deliver services that will ease the backlog challenge, make most effective use of inpatient beds, minimise inpatient stays and promote flow. Facilitating transition towards new approaches to tackle surgical backlog within the healthcare service.

As the BMJ puts it, “waiting lists” must be transformed into “preparation lists”: the time between diagnosis and surgery could be harnessed to get patients prepared for surgery, improving patient experiences and outcomes, hospital flow, and reducing the costs of healthcare. It’s exactly this that we believe should be adopted – and that we have the capacity, skills and workforce to deliver.

How HomeLink Healthcare plays their part in addressing the elective backlog:

Addressing-the-elective-backlog-challenge

Pre-surgery optimisation

“I love HomeLink, they reduced our patient length of stays which resulted in increased bed capacity for our elective surgery patients. Also helped with cancellation due to capacity.” Colleague, Imperial College Healthcare NHS Trust.

By using our services for a different part of the patient’s journey, we can help patients get fit for surgery by utilising a range of prehabilitation methods. Generally, this would mean working on enhancing patients’ mobility and general health status. For orthopaedic patients, that would mean pre-surgery physiotherapy to improve agility and mobility, working with breathing exercises to limit the risk of chest infections post-op, and working towards improvements in nutrition. We can also offer pre-op screening – where we visit the home to check the well-being and health perspective of a patient before the trip to the hospital. Monitoring vital signs, observing mobility, checking the general health condition to ensure they are well enough for surgery.

Pre-pandemic, this was usually done in the hospital or within community provisions, but both have been stretched to their limits. In some parts of the country, no community prehabilitation is currently available at all. Regardless, prehabilitation was something primarily for those undertaking radical surgery, and there is a body of evidence that demonstrates it is highly beneficial for all pre-op patients.

Prehabilitation has been shown to reduce postoperative complications by 30-80%, and reduce hospital stays by one or two days. Other studies illustrate reductions in postoperation mortality. If all patients had access to a degree of presurgery optimisation, people would recover better and leave hospital earlier – alleviating both hospital capacities and surgical waiting lists.

Virtual ward and early supported discharge

Virtual ward and early supported discharge are services we have been honing and delivering for many years at HomeLink Healthcare. We have multiple successful, harmonious partnerships with NHS Trusts in the UK where we create added capacity by freeing up space in the hospital. In terms of the elective backlog challenge, this equates to more space in hospitals for other patients to get in and have their operations.

Once patients have had surgery, we support them to come home sooner than they normally would and continue to deliver safe care in their homes. How do we do this? Under our Discharge to Assess service, we identify patients that are medically fit to leave hospital, speed up their transition home and undertake their assessments and package of care there. With our Virtual Wards, patients remain under the care of both the hospital consultant and members of our team, while receiving a wraparound of home-based care from our experts.

HomeLink

This method is not only possible but effective – and is one we are already delivering across the country. In one of our co-created programmes,

There is a wealth of evidence that demonstrates a patient can safely return home three days or even 24 hours after an operation. The only issue is that the community capacity is not in place to facilitate it.

Looking forward: change is both possible and beneficial

The problems are well-documented. There are solutions and the evidence to support them. Covid-19 illustrated how rapidly practices and behaviours can change on a wide-scale. Now that the virus is slowly being wrangled back under control, healthcare should not retreat to past practices, but embrace the new ways of working and the light that has been shone on what needs to be done differently.

How can my Trust or health system find out how much could be gained by the adoption of these pre and post-surgery practices? HomeLink Healthcare will provide a free assessment of your organisation’s ability to improve patient flow through prehabilitation and Virtual Ward/Early Supported Discharge, based on real world experience in the NHS. To find out how to get started please click here to get in touch with us today.

CEO presents lessons learnt from setting up and managing virtual wards

HomeLink Healthcare’s Chief Executive and Clinical Director Jill Ireland has been in demand recently and has presented at several events in the past month:

  • HSJ: Integrated care summit: Taking a system level view to address the elective backlog
  • Convenzis: NHS Virtual Wards: Managing demand and empowering patients
  • GovConnect: Defining Virtual Wards: How Virtual Wards can ease NHS backlog pressures and improve patient flow
  • NHS England: Virtual Wards Clinical Summit: Working across the system: Building partnerships and supporting collaboration in virtual ward services

Winter planning puts new focus on virtual wards

Virtual WardOur Chief Executive and Clinical Director, Jill Ireland, welcomes NHS England’s early guidance on creating additional capacity and resilience this winter. She argues commissioners should be looking to work with an expert partner to deliver them safely and effectively.

NHS England has just issued a ‘dear colleagues’ letter to advise managers on the steps they should be taking to increase the ‘capacity and operational resilience’ of services this winter.

The advice is not the winter plan with additional funding that everybody hopes will follow this autumn. Instead, it gives an early sight of some of the themes and actions that will be in the plan. The need for early action is a recognition of two, uncomfortable truths. The first is that pressure on the NHS has hardly let up since last winter.

As the letter acknowledges, health and care services have had to contend with further waves of COVID-19, an unprecedented heatwave, and record numbers of A&E attendances and urgent ambulance call outs this summer. The second is that pressure on the NHS this winter will continue to be ‘substantial’ as elective services try to recover after the COVID-19 pandemic in the face of a continuing surge in unmet demand.

Extra capacity means new commitment to virtual wards  

From a provider perspective, it is really helpful to have this early sight of NHS England’s thinking. HomeLink Healthcare was set up to provide hospital at home services. Our services build long term capacity and deliver new models of care. As an agile organisation we are well placed to work with the NHS to respond to demand for at home services when health and care is under pressure.

However, commissioners tend to come to us and ask if we can provide additional capacity in weeks, rather than months. With more time, we can work with them to co-create new pathways that embed innovation, permanently increase capacity, and deliver a better service for patients.

A good example is setting up virtual wards. NHS England’s letter sets out eight areas for action, one of which is to ‘reduce hospital occupancy through increasing capacity by the equivalent of at least 7,000 general and acute beds.’ Some of these will be physical beds, but many more will be on virtual wards, because NHS England has already committed to a significant expansion in this way of working.

In April, it issued guidance to integrated care systems on the ‘enablers of success’ to support its ambition to deliver 40 to 50 virtual ward beds per 100,000 people in the population – or 24,000 virtual ward beds across the country by December 2023.

The guidance was useful because it clarified the virtual wards concept. It said virtual wards should be developed across systems, that they should be tech-enabled, so patients can be safely monitored via a digital platform by their clinical teams, and that they should include private partners where they can add value.

It also outlined that there is funding available to develop virtual wards over the next two years. So, if their roll-out can be facilitated and accelerated, it should help with pressure on the inpatient beds that are available this winter.

New pathways must be delivered safely and effectively 

However, as the April guidance underlined, that roll-out must be safe and effective, which is why we need time to plan carefully and mobilise effectively. The idea of virtual wards gained new impetus during the COVID-19 pandemic and now is the time to build on that work to create more sustainable, holistic models of care.

Collectively, we need to give the same care and attention to commissioning and delivering a virtual ward that we would give to commissioning and delivering any other service. That means governance is paramount.

There needs to be clear lines of clinical responsibility and accountability for patients. Patients need to be informed about the parameters. Monitoring needs linking to clear escalation points; and everybody involved needs to know what to do when they are reached.

HomeLink Healthcare is expert in this area because we have worked with the NHS to develop virtual wards since 2019. We worked with Norfolk and Norwich University Hospital NHS Foundation Trust (NNUHT) to create a new pathway for patients who needed IV therapy that could be safely delivered at home.

During the pandemic, the concept was expanded and developed to the point where the trust could take over the service. HomeLink Healthcare has been retained to provide hands-on, clinical care at home for the NNUHT Virtual Ward, while moving on to create virtual wards with other trusts in the region.

Time to plan means time to succeed  

In our model, the virtual ward is an extension of the hospital and its governance structures. Its consultants retain responsibility for their patients. They determine the need for continuous or intermittent monitoring, and our expert, acute-trained clinical staff with community experience support that by delivering interventions at home, organising tests, and providing hands-on care.

Commissioners that are looking to roll-out virtual wards this winter should consider NHS England’s advice to work with an expert partner. One that can provide sound advice, as well as the additional staff that the NHS can struggle to recruit and retain without the flexible working patterns and extended patient contact that the private sector can offer.

However, commissioners approach the challenge, they need to think through their need, work out where virtual ward can add most value, sort out the governance, mobilise carefully, and then prepare to build out to new areas.

That’s why I welcome NHS England’s ‘dear colleagues’ letter. It outlines the additional capacity that it thinks will be required this winter. It indicates where that capacity is going to come from. It renews the focus on virtual wards. And it gives commissioners and providers time to deliver those virtual wards in a way that is safe, effective, embeds innovation and, most importantly, delivers that better service for patients.

Supporting the flow of patient care from hospital to home

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

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

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

The situation

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

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

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

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

Finding the solution

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

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

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

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

NNUH at Home service initially focused on two patient pathways:

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

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

Developing NNUH at Home together

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

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

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

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

A service designed with patients in mind

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

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

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

NNUH at Home pathway

Easing pressure at NNUHT

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

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

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

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

Proving the success

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

 

 

Work with us

Find out more about the process of commissioning HomeLink Healthcare to set up a Hospital at Home service.

Get in touch

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

 

Almost 60,000 NHS beds blocked by delayed transfers of care every month

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.

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. Despite these efforts the latest figures from NHS England & Improvement show almost no improvement in the national figures.

In London and the South (East and West), for example, the number of patients waiting for Non-acute NHS care rose by approximately 25% between December 2018 and June 2019. Every day some 330 patients remained in a hospital bed instead of being discharged to receive treatment in another setting. The knock-on effect is a lack of available beds, exacerbating delays in A&E and leading to planned procedures being postponed.

What options are open to NHS Trusts as another busy winter period approaches?

Early Supported Discharge services and Virtual Wards offer a way to provide patients with the care they need at home, instead of in hospital. These services fill in the gap until established community services are available or provide types of home-based care not locally available. 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.

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.

One of our patients recently summed it up ‘This is a really good service which should be expanded. It enabled me to come home 2 weeks earlier which was better for my well being & saved the cost of my being in hospital. The nurses were very friendly & considerate’

To find out how early supported discharge services and virtual wards could reduce delayed transfers of care at your hospital this winter please contact us.

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

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