Bridging packages of care: getting Julia back on her feet

Julia was admitted to HomeLink Healthcare’s Paget at Home service for POC support, collaborating with an existing care agency in a blended approach.

Following a knee replacement, Julia faced a slow recovery and was at high risk of deconditioning. She was also becoming less and less engaged during her visits, felt unsteady when moving around and lacked confidence.

After her discharge from James Paget University Trust Hospital with the aid of a frame, Julia still required assistance with her daily activities, relying on family support for medication and meals. In addition, she was also feeling very anxious and needed a lot of support and encouragement to stay motivated.

HomeLink, working closely with the care agency, co-produced a care plan to get Julia back on her feet as quickly as possible. This included visits from our caregivers four times a day to help her with daily activities and build her confidence. This collaborative approach allowed her to be discharged home over a weekend.

While the care agency was supposed to take over Julia’s care after a few days, they weren’t able to right away. To ensure her safety and continued progress, HomeLink continued her care plan until they had the capacity to take over.

In the 16 days HomeLink cared for Julia, she progressed remarkably. Our team noticed a significant improvement in her mood and engagement, which was also reflected in her self-reported quality of life score (EQ-5D-5L). Julia had grown in confidence and was able to work with our team to make continued progress to meet her goals.

She was so happy with the care and support she received from HomeLink that she even agreed to be in one of our marketing videos. She enjoyed filming with our team and said she wished everyone could experience the Paget at Home service. Julia expressed her thanks for the encouragement the staff gave her, as she was not receiving the same now that we had finished.

Watch Julia’s video below:

Physiotherapy prevents amputation: Eileen’s journey to independence

96-year-old Eileen faced significant mobility challenges following a diagnosis of a basal cell carcinoma on her right cheek and a left lower limb arterial ulcer. With her condition being palliative and under specialised care, her mobility had declined, impacting her independence and quality of life.

Eileen was referred to HomeLink Healthcare in September 2023 by the hospital’s Early Supported Discharge (ESD) team for physiotherapy. The primary goal was to enhance her stability during step transfers to a commode or chair with the assistance of two people or using a Sara Steady, and to aid her in regaining her mobility with a walking frame. At the time, Eileen could only manage short distances with assistance.

During her initial assessment, Eileen was able to demonstrate a step transfer from her wheelchair to a recliner using her wheeled Zimmer frame with minimal assistance. This initial progress was encouraging, showing potential for further improvement. She also managed to mobilise short distances in her living room using a walking frame with one person assisting her.

Determined to regain her independence, Eileen diligently followed the exercise plan provided by the HomeLink Healthcare physiotherapists. Over the course of her visits in September and October, she showed remarkable progress. Her range of motion, particularly in her shoulders, improved significantly. Her strength increased, and most importantly, her confidence grew.

Eileen’s next of kin expressed a desire to see her mobilise to the commode independently, a goal that became increasingly achievable as she continued her exercises. By the end of her physiotherapy sessions, Eileen was not only completing her exercises daily, but also moving independently around her home.

In a heartfelt message to the HomeLink team, Eileen’s niece shared the tremendous impact of the physiotherapy support her aunt received. She added:

“I just wanted to say thank you for sending the physios back in September/October for my aunty, it’s just done her so much good. We have continued the recommended exercises, probably missed about two days in the last 6-7 months, she’s done really well!

The result of the physio is that she is now no longer needing district nurses for her ulcers and that’s because we have managed to get circulation back into her legs, one of which they wanted to amputate. Thank you to everyone that had a hand in that and please continue it. This is a very important service!”

Maximise virtual ward occupancy to protect your hospital bed capacity

Average virtual ward occupancy in the NHS is 70% (May 2024) whilst HomeLink Healthcare’s average occupancy is 97%.

Jenny Keane, Director of Intermediate Care at NHS England has outlined five barriers to virtual ward referrals:

Barriers of referring into a virtual ward

Through our strong collaboration with patients, NHS partners and social care agencies we have been able to ensure our (contracted) occupancy remains high, freeing up those much needed beds on hospital wards.

Please click on the short animation below that shows ways in which we have been able to maximise capacity on virtual wards that our clinicians support.

 

If you would like to speak to our team about our virtual ward or other hospital at home pathways, please email us at info@homelinkhealthcare.co.uk or call 020 3137 5370.

 

 

Don’t miss HomeLink Healthcare at NHS ConfedExpo 2024

We are excited to be exhibiting at this year’s NHS ConfedExpo, taking place between 12th & 13th June 2024 at Manchester Central.

NHS ConfedExpo is set to be one of the largest and most significant health and care conferences in the UK. The event will bring together health and care leaders and their teams, giving attendees the opportunity to network with leaders and managers who are driving change in health and social care, as well as attend a wide range of sessions and learning theatres.

HomeLink Healthcare has been at the forefront of shaping Hospital at Home and Virtual Ward services over the past 8 years. We are passionate about providing safe, high-quality care that allows patients to recover in the comfort of their own homes. We work in partnership with NHS providers and commissioners to improve patient flow, improve outcomes, and deliver positive patient experiences.

Come and visit us on stand D16 to learn more about our services and how we can help you to:

  • Reduce hospital admissions and readmissions
  • Improve patient flow and capacity
  • Enhance patient experience and outcomes
  • Improve productivity while delivering cost efficiencies

Join our breakfast discussion

Title: Key ingredients for successful home alternatives to ward-based care
Date and time: 8 – 9 am, 13th June 2024
Location: Charter 6
Description: Hospital at Home is cost-effective, delivers great outcomes and excellent patient experience. NHS leaders and industry experts share their experience, followed by a Q&A.

Chair:

  • Jon Green, Former NHS Chief Executive & Consultant Advisor – HomeLink Healthcare

Speakers:

  • Helen Kay, Operations Director – Sheffield Teaching Hospitals NHS Foundation Trust
  • Jill Ireland, Chief Executive & Clinical Director – HomeLink Healthcare
  • John Somers, Non-Executive Director – Pennine GP Alliance / Warrington & Halton NHS FT / Chesterfield Royal NHS FT

To explore the full conference agenda, please click here.

Book a meeting with our team

If you would like to speak to our team at the conference, please email us at info@homelinkhealthcare.co.uk or call 020 3137 5370.

We look forward to seeing you there.

Family thankful for our support with autistic daughter’s treatment

Sarah, a patient with a history of autism and disability was admitted to St Mary’s Hospital following left tibia and fibular open segmental fractures, which resulted in the removal of an intramedullary nail (IMN) and the application of a circular frame.

Sarah was to be discharged to her mother’s home and was referred to HomeLink Healthcare on Friday 19th December for weekly pin site care to ensure the skin around the metal pin areas of the frame didn’t get infected.

Sarah didn’t understand what was going on and was really anxious about going back into hospital. As she was at her mother’s home, she was not registered with a GP which made the process of arranging district nursing visits more complicated.

Sarah’s mother had attempted to register her daughter at her own GP surgery so that she could get interim nursing care, however, the process was far from smooth. She and her daughter were anxious and lacked trust in the healthcare system.

Recognising Sarah’s individual needs, HomeLink Healthcare provided support. We helped to register Sarah with a new GP, provided relevant information and arranged visits from district nursing. We worked collaboratively with the hospital teams and acted as a liaison between the Orthopaedic department, the GP surgery and the family until district nursing care was available and the mother was happy with the transfer of care.

Throughout the process, HomeLink remained supportive, with our nurses regularly contacting the patient and family to provide reassurance. To address the family’s concerns, our team contacted Sarah’s orthopaedic team, and recommendations were made to support her whilst she was under orthopaedic review. We communicated crucial information to Sarah in short, simple sentences, avoiding medical jargon but ensuring a full explanation.

HomeLink discharged Sarah when the district nurse service commenced, ensuring open and clear communication throughout.

Understanding Sarah’s sensitivity, we also requested that she be allowed to wait in a quieter room whenever possible when coming for her orthopaedic review at St Mary’s Hospital. Additionally, we advocated for the same staff members to support her consistently, aiming to ensure continuity of care and enhance engagement.

Without HomeLink Healthcare, Sarah would have needed an ambulance to take her for weekly visits to the hospital to be reviewed by the orthopaedic team, which would have been very distressing, as well as using much needed ambulance resources.

The family expressed gratitude for the service and were appreciative of the ongoing support and positive aspects of Sarah’s orthopaedic progress. Sarah’s mother thanked us for the quality of care and emotional support we provided both to herself and her daughter through this difficult time.

She added, “Thank you very much for all your care and attention given to my daughter. You all did a marvellous job. It’s really appreciated.

Shirley achieves her reablement goals in less than half the expected time

Shirley was admitted to St Mary’s Hospital at the beginning of January following a fall. When she was referred to HomeLink Healthcare for physiotherapy on 31st January, she was felt to be at a high risk of further falls.

The goals were for Shirley to become independently mobile with a Zimmer frame and to be able to visit the toilet by herself within four weeks, as well as being able to manage stairs and meals independently in five weeks.

In the first week of Shirley’s care, HomeLink carried out daily double-handed physiotherapy treatment and also made one nursing visit to monitor her two wounds that were identified whilst she was in hospital, before handing this part of her care to the district nursing team.

Shirley’s progress was remarkable. By the end of the second week, with physiotherapy sessions reduced to single-handed support, she had achieved most of her goals with supervision and demonstrated excellent mobility.

This improvement was reflected in her self-reported quality of life score (EQ-5D-5L), which had increased from 40 to 75 in the two weeks between 2nd and 16th February. Similarly, her mBarthel scores showed an improvement from severe dependence (a score of 45 on admission to our service) to moderate dependence (a score of 62 after two weeks).

Despite plans for her transition after the second week, delays in the community physiotherapist’s availability necessitated an additional week of support from HomeLink Healthcare. To ensure Shirley kept up the momentum and didn’t deteriorate, HomeLink provided two additional physiotherapy visits in week three.

Following her discharge, Shirley’s daughter reached out to our office to express her gratitude for the fantastic progress Shirley achieved during her time with us. She specifically highlighted the exceptional teamwork demonstrated by the HomeLink team and said she is extremely happy with the results and the support her mother received.

Paul gets his reason to smile back

One of our recent patients, Paul, was living with Parkinson’s disease and depression when aspiration pneumonia and cognitive decline led to his hospitalisation on 11th February.

Needing significant support, Paul was referred to HomeLink Healthcare on 22nd February for physiotherapy. When we first met him, Paul required two therapists to assist him with any movement and used a Sara Stedy for stability.

Through intensive physiotherapy sessions, Paul began a journey to regain his strength and mobility. Over the course of the next two weeks, our focus was on helping him move safely and independently. During this time, Paul saw significant progress. His mobility score (mBarthel) jumped from 28 to 53, indicating a marked improvement in his daily activities. His self-reported quality of life score (EQ-5D-5L) also rose from 50 to 65, showing a positive shift in his overall well-being.

Originally scheduled for discharge on 9th March, with the expectation of community team involvement, the handover process took a bit longer than initially anticipated. To ensure continuity of care, we extended our visits until the transition could be completed.

Throughout his time with us, Paul’s physical progress was remarkable. His wheelchair mobilisation progressed from 0 to 8, and he successfully transitioned from using the Sara Stedy to a four-wheel Zimmer frame within two weeks. Initially requiring double-handed physiotherapy, Paul transitioned to single-handed visits by the end of our care.

Beyond his physical progress, we also witnessed a remarkable transformation in Paul’s emotional well-being. Initially grappling with severe depression and feelings of burden, with increased mobility and independence, his outlook shifted dramatically during his time with us.

His daughter expressed her gratitude for the positive impact our team had on Paul’s life, adding:

“They are fantastic! They’ve made a massive difference in my dad’s life. They put a smile back on his face and supported him both physically and mentally.”

Partnership with HomeLink saves 20,000 bed days at James Paget Hospital

Thanks to a partnership with HomeLink Healthcare, The James Paget University Hospital NHS Foundation Trust has freed up nearly 20,000 bed days since they started working together four years ago. The service, known as Paget at Home, creates an additional ward of capacity every day, by providing treatment and care at home to patients who would otherwise have remained in hospital. The operational headroom created contributes to productivity benefits while the bed days are costing less than half the equivalent in-hospital care.

"Pro-active lead, excellent engagement with Trust colleagues and escalating concerns"
- James Paget Client Survey

The situation

Like almost all acute hospitals The James Paget was experiencing extreme capacity issues when they first commissioned our services back in March 2020. Fast forward to the end of 2023 and hospital bed capacity was 88%. This compared favourably to an average across all NHS hospitals of 90%, thanks in part to Paget at Home.

The solution

Paget at Home started as an Early Supported Discharge service which included clinical care at home and Bridging Packages of Care. It has developed over four years to cover a range of pathways including supporting the Virtual Ward, IV Therapy, Discharge to Assess and Reablement.

How does it work?

An on-site team pro-actively identify patients who are medically optimised or no longer meet the criteria to reside and enable same-day transfer / discharge home. Home based wrap-around care is provided by a HomeLink Healthcare multi-disciplinary team. The on-site team do the heavy lifting managing the on-going care, co-ordinating with consultants, referrers and community providers, minimising the impact on hospital staff.  The service is supported by a 24/7 on-call service.

As a clinician-led organisation, a commitment to quality care is at the heart of everything we do. For each new pathway HomeLink Healthcare carry out a feasibility assessment using hospital data. Clinical governance is co-produced, and pathways are rapidly prototyped, evaluated and rolled out, using technology as an enabler where appropriate. A comprehensive suite of KPIs is implemented, and real-time data allows the team to identify best practice quickly and apply corrective actions as necessary.

Services are commissioned using the NHS SBS Patient Discharge and Mental Health Step Down Beds Services Framework Agreement. Using the Framework means that the time to contract is shortened significantly compared to a full tender. This saves significant time and money and enables us to fully mobilise new services through a ‘test and learn’ phase to full ramp in 4-12 weeks.

"Excellent team and service, so happy I can be treated in my own home"
- Patient

The results

Increased capacity and improved patient flow: Over the last four years Paget at Home has supported over 1,000 patients and released over 20,000 bed days, saving an average of 20 bed days every day. This is the equivalent of almost a whole hospital ward. With a capacity of around 500 in-patient beds, these 20 ‘at home beds’ effectively increase hospital capacity by four percent.

Better patient outcomes: Patients reported, on average, a 21 percent improvement in clinical outcomes (EQ-5D-5L) by the end of their treatment. 99 percent also said they would recommend HomeLink/Paget at Home to Friends and Family. By supporting patients across a largely rural area our service also address inequalities in access to care.

Better patient outcomes

Cost effective: In 2022, James Paget calculated the average cost per hospital bed to be £450. The cost of our Hospital at Home services are currently under £200 per bed day. Even without factoring a cost increase, this is a 55 percent cost saving.

Implications for the future

Patients: Paget at Home and other HomeLink Healthcare Hospital at Home models ensure that patients spend much less time in hospital which reduces the risk of infections, deconditioning and depression. By being discharged as soon as they are medically optimised or medically fit, and starting rehabilitation immediately, they also have much better outcomes. Patients much prefer being treated in the comfort of their own homes and, as a result of all these factors, they are much more likely to return to their pre-hospital level of independence. Patients are less likely to be re-admitted into hospital and will need reduced ongoing care.

Patient flow: Patients needing complex treatments or multi-disciplinary care often remain in hospital for far longer than they need to. A recent study found that the average length of stay in hospital was 34.8% longer in 2022/23 compared to 2019/20*. HomeLink Healthcare’s feasibility assessments often reveal around a ward worth of patients across the hospital that could complete their recovery at home, with the right Hospital at Home provision in place.

If every hospital in the country could create an additional 4% capacity, as The James Paget has done, this could be used to reduce the occupancy levels from 90% to 86% (85% is widely considered the risk threshold).

Sustainable additional capacity: If hospitals are to tackle increasing demand on Urgent and Emergency Departments, growing elective waiting lists and pressure on GPs they either need to increase hospital capacity (requiring more staff and additional wards) or treat more people at home.

As HomeLink Healthcare bring our own multi-disciplinary staff team, this avoids the recruitment challenges associated with resourcing additional capacity. This additional capacity, along with lower occupancy rates enables existing healthcare staff to focus on core delivery and allows time to plan for new patients and longer-term care.

Cost-savings: When occupancy levels are optimised** the cost of hospital at home services are significantly lower than the equivalent in-patient care. Improved patient outcomes mean smaller ongoing care packages, which are easier to source and lower in cost. The costs of building new hospital wards are also avoided.

Key stats (March 2020 – Feb 2024)

  • Over 1,000 patients have been treated at home
  • Patients spend on average 20 days fewer in hospital.
  • Patients reported an average 21% improvement in clinical outcomes
  • The service costs 45% compared to in-patient care
  • 99% of patients would highly recommend the service
  • 100% of client contacts said they would recommend us
  • SBS Framework allows new pathways to be mobilised in as little as 4 weeks

About HomeLink Healthcare

HomeLink Healthcare have been delivering Hospital at Home services since 2016 and provide a solution for the future. We deliver system benefits for ICBs, Trusts and the Community. Our services improve patient outcomes, improve patient flow, reduce waiting lists and save costs. In our recent survey 100% of client contacts said they would recommend us.

HomeLink Healthcare is a named supplier on the NHS SBS Patient Discharge and Mental Health Step Down Beds Services Framework Agreement. By using the framework, you can contract with us directly and we can get a new service up and running in around 12 weeks.

To discuss how HomeLink Healthcare could help your organisation, or to request a free Feasibility Assessment please get in touch.

Call 020 3137 5310 or email info@homelinkhealthcare.co.uk

 

* Newton / CCH report Finding a way home, November 2023

** HomeLink Healthcare virtual wards have a 97% occupancy rate compared to 70% across the NHS (Jan 2024)

HomeLink Healthcare achieves BSI ISO 14001 certification for environmental management

We are proud to announce that HomeLink Healthcare has been awarded the BSI ISO 14001 certification for environmental management systems (EMS). This certification reflects our commitment to reducing our environmental impact and continuously improving our sustainability practices. It ensures that we are effectively managing our environmental responsibilities.

BSI ISO 14001 certificate 2024

Our commitment to Net ZeroNet Zero

As part of our commitment to the environment, HomeLink Healthcare aims to be Net Zero carbon emissions by 2035 and for our supply chain by 2045, aligning with the Independent Healthcare Providers Network (IHPN) climate pledge.

Looking Forward

We are excited about this significant milestone and remain dedicated to our environmental responsibilities. HomeLink Healthcare will continue to seek innovative ways to enhance our sustainability initiatives and contribute to a healthier planet in line with our Carbon Reduction Plan.

Shortlisted for a Chief Allied Health Professions Officer (CAHPO) award

South East London AHP TeamHomeLink Healthcare have been shortlisted for a Chief Allied Health Professions Officer (CAHPO) award for their work in partnership with Lewisham Adult Therapy Team (LATT). The service saw the waiting list of 203 reduce by 85 per cent to 30 in an 18-week period. Not only that, 69 per cent 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”.

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

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