Shortlisted for a Chief Allied Health Professionals Officers (CAHPO) award

South East London AHP TeamHomeLink Healthcare have been shortlisted for a Chief Allied Health Professionals Officers (CAHPO) award for their work in partnership with Lewisham Adult Therapy Team (LATT). The service saw the waiting list of 203 reduce by 85 percent to 30 in an 18 week period. Not only that, 69 percent of patients were seen within three days and improved patient outcomes were seen across the board.  

In October 2021 Allied Health Professional (AHP) Leads from the South East London joined forces with AHP Leads from HomeLink Healthcare to provide a collaborative approach to addressing the increasing demands on the community physiotherapy service for patients residing in the South East London regions of Lambeth, Southwark and Lewisham.  

The AHP Team drove innovation and change in the creation and implementation of a new pathway that addresses both the NHSE/I Long Term Plan and commitments to AHPs into Action. The results were increased physiotherapy capacity in the community; improved patient flow; and better patient outcomes and experience. 

The challenge 

The challenges identified by the AHP Team were as follows: 

  • The LATT therapy leads reported an increase in demand from referrals for patients requiring community physiotherapy.  
  • They cited workforce concerns preventing them from meeting their referral demands along with an increase in the use of agency staff thereby driving up costs and potentially reducing quality and effectiveness. 
  • LATT were experiencing an increase in staff burn out, sickness and challenges balancing annual leave and staff training. 
  • LATT reported a waiting list of 203 patients, with patients waiting more than six months for a therapy review. 
  • Concerns were raised that patients were being admitted to hospital on account of not receiving timely physiotherapy support to maintain them safely in their own homes. 
  • The patient experience was poor due to increased waiting times for therapy input. 

Aims, outcomes, and ways of working to overcome potential barriers 

Aims 

AHP-logoA set of SMART aims for the pathway were co-created to improve patient flow and physiotherapy capacity for patients living in the Lambeth, Southwark and  Lewisham localities. 

  • Provide a responsive physiotherapy service that delivers efficient and effective  patient centred physiotherapy treatments to maintain them safely at home. 
  • Reduce waiting list of community physiotherapy. Prior to the service, 203 patients were awaiting therapy. 
  • Improve patient outcomes by increasing mobility and functional independence. There were no standard clinical outcomes in circulation. 

Outcomes 

  • A shared vision of quality improvement across all pathways made it possible to mobilise the pathway in just 4 weeks.
  • 69 percent* of patients were able to be seen within three days of (non-urgent) referral (*based on patient choice). 
  • The waiting list was reduced by 85.2% to just 30 patients in just 18 weeks. 
  • Positive outcomes in mBarthel and EQ-5D-5L measures.   
    • mBarthel increased from 76.5 to 87 
    • Self-reported health state (VAS) increased from 54.4 to 67.6 
    • Self-reported EQ-5D-5L figures improved in all dimensions (note a decreasing score is an improvement) 

EQ 5D 5L

  • Quality improvement was delivered and measured with data regularly shared by the AHP Team to support wider MDT collaboration. These outcome measures are now adopted as standard within SEL.  
  • As a result of shared learnings 4x as many patients are benefitting from the new pathway in South East London. 
  • The service has spread across the System. From Lambeth and Southwark, the model has been reused in Lewisham, Bromley and Woolwich with learnings shared in other ICSs. 

How did we do this?

  • AHPs worked collaboratively. Regular review meetings were held to ensure quality and safety. 
  • An operational manual was co-produced with wider MDT to ensure effective and efficient governance. 
  • We agreed patient specific outcome measures in order demonstrate quality improvements. 
  • Wider system partners were involved in order to increase shared learning practices and collaboration to safely deliver 240 visits per week 

Transferable lessons learned:

  • Workforce retention and recruitment strategies are essential to ensure longevity to new services. This pathway enabled a 66% increase in capacity for staffing which allowed teams to take annual leave and manage COVID-19 isolations whilst providing continuation of care to patients.  
  • Involving Consultant bodies and wider system partners from the outset is essential to optimise referral and discharge processes. 
  • Being comfortable having open and honest conversations with colleagues for the benefit of the patient has enabled improved outcomes. 
  • Regular knowledge-sharing and reporting are vital for optimising patient outcomes. 
  • Ensure the whole AHP/MDT team is involved in the journey, so the service is driven by those who deliver it. Recognising the value of different knowledge and skills that staff of all levels can add. 

Adeola Telesford, Highly Specialist Rehabilitation Occupational Therapist from Enabling Services, Lewisham and Greenwich NHS Trust commented:

“I am truly pleased with the professional relationship/rapport we have built because it has enhanced our regular verbal and written feedback on cases.

I am particularly pleased by the fact your service has been able to visit patients in a timely manner (within 24-48hours of receiving the referral) and to carry out pre-planned joint visits with me. Timely intervention, which I have found with a number of cases, made a significant positive impact on the SMART goals that were set for each patient.

It was refreshing if not amazing to see how the combined intervention of PT and OT input complimented each other. Your service input proves the validity in having PT and OT working alongside each other in a service of this nature when working towards a time frame of maximum 6 week interventions. I look forward to continued working with 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 muchneeded bed for weeks. 

The wider benefits for Admission Avoidance patients 

By treating patients like Ron and Brian at home we are able to prevent recurrent hospital admissions, improve patient experience and help improve patient flow. 

Bed days saved: On average HomeLink Healthcare Virtual Wards save 9 hospital bed days per patient. In Ron’s case this service saved the hospital 14 bed days and in Brian’s it was 12 days.   

Better patient experience and outcomes: Research by the British Geriatrics Society shows that there are similar outcomes for those allocated to hospital at home versus hospital admission for the main outcome of living at home. The research found a reduction in admission to new long-term residential care and high levels of patient satisfaction for hospital at home.  

HomeLink Healthcare’s own clients report a self-reported average 9.3% improvement in all health outcomes. 98% of HomeLink Healthcare’s patients would highly recommend our services to their friends and family. 

Work with us 

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

Get in touch 

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

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

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

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

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

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

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

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

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

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

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

Patient stories 

Sam:

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

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

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

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

Glen:

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

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

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

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

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

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

About HomeLink Healthcare 

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

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

Work with us 

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

Get in touch 

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

Physiotherapy at Home reduces care costs by over 65%

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

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

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

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

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

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

Shirley says:  

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

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

Shirley reports that during this third referral:  

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

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

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

Shirley says: 

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

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

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

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

Small steps and big changes

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

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

Samantha Rusike, a HomeLink Healthcare Physiotherapist, says:

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

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

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

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

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

Pat says:

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

Pat’s daughter adds:

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

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

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

Samantha concludes:

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


Case study: Partnership with Buckinghamshire Healthcare NHS Trust

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

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

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

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

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

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

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

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

An average of nine hospital bed days saved per patient

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

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

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

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

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

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

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

 

 

 

Work with us

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

Get in touch

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

Capacity challenges overcome with rapid response at Norfolk and Norwich University Hospitals during Covid

Covid-19 home testing service improves capacity, accessibility and patient flow.

From October 2020, HomeLink Healthcare have provided additional capacity to Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHT), preventing cancellations of elective surgery by offering Covid-19 screening at home. HomeLink Healthcare has delivered a new pre-elective Covid screening pathway for housebound patients, helping NHS hospitals and Trusts avoid financial penalties from surgeries being cancelled and further reducing inequalities in access to care. This case study shows how capacity challenges were overcome, whilst accessibility and patient flow were improved, with rapid responsiveness and time-critical precision.

Their advanced scheduling tools ensured that the clinical staff were deployed efficiently. As a result, patients were ready and available for their scheduled surgery.

NHS capacity, accessibility and patient flow challenges overcome

As part of the third phase of the NHS response to Covid-19, there is a requirement to restore and recover NHS services, whilst overcoming increased demands and capacity constraints. The need for patients to be screened for Covid and then self-isolate 72 hours prior to elective hospital admission is critical to ensuring that elective surgery can go ahead as planned.

Challenges with accessibility to Covid testing risks cancelled electives.

NHS Trusts need to accelerate the return of non-Covid health services, which will help address the growing waiting lists for elective procedures. Therefore, it is imperative to overcome any challenges with capacity, accessibility and flow. Housebound patients are unable to get to Covid testing sites which is where HomeLink Healthcare can help.

Additional capacity provided by a trusted partner to prevent cancellations.

Norfolk and Norwich Hospitals NHS Foundation Trust (NNUHT) asked HomeLink Healthcare to provide urgent additional capacity for Covid home testing, to prevent cancellations in elective surgery. Rapid mobilisation enabled quick, accurate and responsive results. HomeLink Healthcare set up a fully functioning home testing service within 6 days, including training the clinical team to Trust standards.

Recognised as ‘the most esteemed accolade of healthcare service excellence in the UK’, HomeLink Healthcare were finalists for an HSJ Award for their partnership work with the NNUHT making them trusted partners with a proven track record.

Benefits of Covid testing pathway to combat NHS winter pressures:

Cursty Pepper, Emergency and Urgent Care Performance and Recovery Operations Director, reported: Having HomeLink to support us is fantastic as it means we have a trusted and experienced team supporting our elective patient pathway – this provides real peace of mind and their willingness to diversify and respond so quickly really has saved us from having to cancel operations so thank you HomeLink for stepping in and stepping up.

Helps prevent cancellation of elective surgeries

Reduces inequalities in access to care

Maximises community capacity available and improves patient flow

Smart logistics and scheduling tools provide real time data and deployment

Fully integrated with existing systems and services

Reduces risk of financial penalties

Enhanced management as patients have confirmation of a 1 hour time slot

Clinical team trained to Trust standards

Overcoming issues of patient flow for the maximum elective activity possible. HomeLink Healthcare added an additional pathway to the core service delivering Covid testing in the community for housebound patients prior to pre-elective surgery.

To manage logistics and increase availability, HomeLink Healthcare called patients in advance and agreed a one-hour window for testing. This resolved the challenges reported by community teams of the patient not being at home on the agreed day.

To maximise responsiveness, HomeLink Healthcare used real-time data and analytics to provide same day reporting back to the Hospital Trust.

Whole system benefits of HomeLink Healthcare Partnership

Smart logistics and specialist support provided the time-critical level of precision and quality required. The availability of tests across the whole CCG area helped reduce inequalities in access to care. By providing Covid testing at home, HomeLink Healthcare prevented surgeries being cancelled at the last minute. This has a financial impact on the Trust avoiding penalties for not meeting targets in elective cases.

This also increased capacity for the NNUHT team to focus on other important work, in the confidence that this service is being efficiently managed.

Due to the disruption caused by the pandemic, some patients may have been waiting longer than usual to access elective services. Being able to plan and maintain scheduled appointments is imperative to patient’s physical and mental health and wellbeing.

Jonny Lim, HomeLink Healthcare Project Manager, concluded: “We want to support the NHS Trusts, hospitals, and patients during this challenging time. This was a great example of how additional capacity, accessibility and patient flow can be deployed quickly, safely and reliably by our clinical team. It was excellent knowing that life-changing procedures could go ahead as planned and seeing the positive benefit this had on the patient’s lives, as well as the teams involved.

HomeLink Healthcare delivers hospital-based patient services at home, making healthcare systems more flexible, efficient and cost-effective. We provide expert face to face nursing and therapeutic care combined with new technologies to improve patient flow.

HomeLink Healthcare has clinical teams available immediately to assist NHS, CCGs, Community teams and private hospitals.

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.

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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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