In this latest instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, we ask our Head of Clinical and Operational Services, April Thompson, about her role within the company, the challenges created by the COVID-19 pandemic, and the opportunities for Hospital at Home services that exist within the wider industry.
I’m the Head of Clinical and Operational Services for HomeLink, which encompasses the management and recruitment responsibility for all therapy staff within the company or for anyone who may join us, plus overseeing professional health work groups.
In addition to that, I help look after one of the services we’re delivering at Guy’s and St Thomas’ NHS Foundation Trust, providing sub-acute therapy to patients in their own home. Day-to-day I’m responsible for all the overall running of the project which includes the scheduling of the visits, and clinical support for the staff who are delivering care as part of the project.
Most recently, I’ve also assumed management responsibilities for CQC as part of HomeLink, providing support and and general oversight of all the services we provide to patients.
I think a huge positive of working at HomeLink is that you can get involved in several activity streams across the company and, in doing so, help and support others.
In the early days of COVID-19 we were probably a lot more reactive in terms of the services we were supporting NHS trusts with. But now we have an opportunity to think differently about how we can take some of the changes and adaptations that occurred during that time and apply them going forward to create both permanent and new solutions.
Clearly the pandemic compelled everyone, including HomeLink, to start using Teams and Zoom to help with internal communication, but it has greatly advanced progress when it comes to the remote monitoring of patients.
For us, that means using techniques like using remote tele-monitoring for virtual visits with patients who have the capability to support that in the home. Such methods also help to cut through some of the red tape that was present pre-COVID-19. Now there’s more emphasis on collaborative working between stakeholders to speed up the provision of patient care in the home environment.
Overall, there have been some hugely positive changes to working practices over the last 18 months when it comes to hospital at home services, and hopefully some of those will be sustained going forward. There are now undoubtedly significant backlogs in certain areas of the NHS as a result of COVID-19 delaying planned treatments. I’d like to think what we’ve learned can help clear a path back to normality and help the NHS to get back on its feet. There are certainly more challenges yet to come on that front.
I have quite broad clinical experience. I’m a physiotherapist by profession, working primarily in respiratory care before I joined HomeLink Healthcare, and that remains my main interest in terms of practical skills.
I was very much ‘on the ground’ in previous roles, before stepping into research with secondments focused on how we can improve the care given to patients in respiratory settings, such as looking at ventilator equipment and NIV (Non-Invasive Ventilation). After that, I joined another company in the hospital at home sector as an operational lead for one of its acute services, including deploying a virtual model for subacute care for people in the community.
I then returned to the NHS in a senior role as Head of Therapies in an acute hospital Trust. In that role I managed more than 120 staff. I would work alongside the bed management team to help expedite patient discharges safely, in order to free up hospital beds and help patient flow through the Trust.
That role gave me a fantastic grounding in terms of understanding operational pressures in the NHS and the impact a lack of bed space can have in the community – it really helped me grasp what’s required for both efficient bed management and patient safety.
Applying the learnings from that acute setting into my current role at HomeLink means I can work with our NHS commissioners on improving patient flow, analysing the different care pathways, and facing up to the challenges presented from an acute and community setting.
At HomeLink, we’re focused on providing community-based, domiciliary, subacute therapies. I think the impact of COVID-19 means we’re seeing patients coming home from hospital with far more complex needs.
We also have several cohorts of patient types. Many patients that were admitted to hospital during the pandemic (and in normal times) have come out weaker and more deconditioned, primarily because they haven’t had much inpatient therapy due to stretched resources.
There are also patients who have been indirectly affected by COVID-19 by having their treatment interrupted and physio delayed. Then we have patients who are still awaiting elective surgeries and who need therapeutic input before procedures are carried out to give them a better outcome afterwards.
So, all of that together means a holistic approach to hospital at home services is now very much required.
I’m directly involved in recruitment for the therapy staff and healthcare support workers when required. At the very top line, we’re creating a culture of ‘re-ablement’ and supporting patients to become more independent. The role of a health care support worker has changed recently – it’s no longer so much a case of doing things for patients, but instead engaging them to take an active part in their recovery and care plans.
Because there’s been such an increase in demand for social care, and different packages of care, it has become more important to try and give patients that bit of independence to help themselves. Not just for their own quality-of-life, but also to ensure that resource is available to help others who truly do need extra levels of at home care.
We’re very much looking to recruit qualified staff with a broad range of skills and experiences. Having acute hospital experience is probably a key requirement – that helps staff identify patients at home who may be deteriorating, who may not be doing quite so well, or who need an advocate. Picking up on those signs as early as we can is essential to prevent re-admissions. Ultimately, the main thing we want our staff to do is to put patients first.
We’re on the lookout for people with specific skillsets, who may have worked in a hospital previously but are also comfortable working remotely with people in their own homes, without all the backup you would find on a ward, like a crash trolley and senior doctors or consultants. It’s a different requirement and a different mentality – being able to function in tricky situations without being phased or panicked is crucial.
That said, as a values-based organisation, if we find the right person without the necessary ‘in the home’ experience, we can help them adjust to that new environment and then teach them new skills through mentoring and training.
In fact, training and mentoring are extremely important when it comes to our clinical staff. HomeLink Healthcare offers quite a range of services in what we call a ‘package of care’ that can vary greatly by individual patient. They might require physiotherapy. They might need help getting back to their baselines, which is really important for people who have spent a prolonged period in a hospital bed as people lose muscle mass and a lot of the time personal grooming goes out of the window. Those are things we can help put right once the patient is home.
When you look at the NHS in terms of its priorities for the next year or two, I think it’s overwhelmingly about getting things back up and running. For example, delayed cancer treatments and all the pathways that have been put on hold because of the pandemic, plus the return of elective surgery. All those elements need to be restarted and I don’t necessarily think the way in which it was running before is how it’s going to look going forward.
So again, we need to think in terms of what we can do pre-admission to help patients to achieve the best outcomes. For example, where patients would normally come into hospital to have all their pre-appointments and assessments completed before surgery, can those be delivered at home using technology and out of hospital services?
We’ve worked on pilot projects before using technology to remotely monitor patient vital signs in the home setting. That includes a live dashboard, looking at patient respiration rates, saturation levels, blood pressure, temperature and more. It was a challenge to implement but showed a clear way forward in terms of what’s possible.
Ultimately, I think adopting a blended approach of remote monitoring where appropriate, plus having community nurses visiting patients at home to review in person and quantify data, will really help build confidence in the use of technology.
We’re continually assessing how we can use technology to better provision the care that we provide and the efficiencies that are then created. The goal is always to make sure care is delivered on time, at the right time, in the right place and with the right staff.
I think we’ll probably still be talking about hospital pressures and bed flow, plus reflecting on COVID-19 and its impact. Hopefully in five years’ time technology will mean we’re able to offer new models and services that right now we just can’t envisage – things can change so quickly given the pace that digital advancements take place.
Professor Chris Whitty, the Chief Medical Officer (CMO) for England. He’s obviously working clinically, but he’s also working in government and supporting our pathway through COVID-19. I think it would just be nice to chat to him about how he’s managing those pressures, on both a professional and personal level.
Just how quickly we can develop a new service, ramp recruitment and become operational. On one service HomeLink was able to mobilise and deliver care to patients within just four weeks. And I think that ability boils down to brilliant people and being able to cut out red tape. And during the pandemic it’s been a real eye-opener to see how quickly we can implement change and put a new service into place.
Undoubtedly working with the people who use our services. No day is ever the same, we’re constantly faced with new challenges and opportunities, and compelled to discover ways we can further improve the care we offer to patients. There’s always room for improvement.
The need to be reactive, because things can change very quickly in healthcare, as we’ve seen over the last 18 months.
Be honest. Be honest with your colleagues. Be honest with your patients. Be honest with yourself if things are getting too much, too hard, or if you need that extra bit of support.
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