In this latest instalment in a series of articles giving insight into how HomeLink Healthcare works behind the scenes, we ask our Chief Clinical Officer Jane Tobin about her role within the company, the challenges created by the COVID-19 pandemic and the opportunities that exist within the wider industry.
My official title is Chief Clinical Officer and I’ve been with HomeLink since 2016, having worked with our CEO Jill Ireland previously in another healthcare company. My role is strategic and focused on establishing the clinical roadmaps for our services once they’re up and running: making sure our teams run effectively; that we have the right skills; planning recruitment; and onboarding new starters. There’s naturally an element of training and development too – we encourage our staff to grow and learn new skills along with the company itself.
My background is very much entrenched in community-based healthcare. I started my career as a District Nurse working mostly in and around London, which is where a lot of our teams are based now. In fact, when I was a District Nurse, the role was very much about combining health and social care. While those elements have since been separated within the NHS, it is essentially how we work here at HomeLink today, which I enjoy very much.
The impact of the pandemic has been multifaceted at HomeLink, like at most organisations, encompassing both emotional and practical considerations. Operationally, we were quite a dispersed group of people pre-COVID, working in different parts of the country. But, like everyone else, we learned quite quickly that you can meet and collaborate extremely effectively using tools such as Microsoft Teams. That virtual interaction during lockdown has given us back so much more time to focus on the development of services, opposed to travelling up and down motorways to meet with each other physically.
In terms of how the pandemic affected the work we do with our NHS commissioners and patients, our first task very early on was to help set up a COVID testing facility at James Paget University Hospitals NHS Foundation Trust in Great Yarmouth. However, quite quickly after that we needed to prepare for the longer-term implications of COVID on patients, including rehabilitation in the home – one of the priorities for the NHS during this time has been to free up hospital beds as fast as possible, which we can absolutely support.
In Southeast London, where we’re working with hospitals right now, we spend a lot of time supporting NHS staff who have worked all the way through the pandemic – particularly district nursing staff who are, quite frankly, exhausted.
This also brings us to the other main impact of COVID within the NHS – the growing list of people who weren’t able to visit hospital during the lockdowns and who are now quite sick or in pain as a result. So many routine procedures were put on hold and now the waiting lists for elective surgeries are much longer than before. At HomeLink we want to help our NHS commissioners manage that backlog by helping them move people out of hospital and back home as quickly as medically possible. Even now some people are scared of going into hospital, so we could be living with the impact of delayed treatments for a long time to come. Luckily there are solutions at hand.
It sounds counter intuitive, but the pandemic has actually been a catalyst for a lot of positive change in terms of patient care because the rule books had to be changed. The challenge now is to not immediately fall back into old, bad habits post-COVID.
I think how we are working to care for patients during the pandemic is closer to how we used to work years ago when I was a District Nurse – the health and social care elements very much intertwined. In many ways it’s a natural and obvious thing. This coming together of disciplines also ties into the complementary skill sets within HomeLink’s management structure; Jill’s background is one of oncology and acute care, whereas mine is primary care in the community.
I think the greatest challenge the NHS faces now is the growing backlog of patients needing elective surgery and that’s really a big problem for the NHS to be facing alongside ongoing concerns about possible new COVID variants and how they might impact patient care needs.
In addition, we’re very aware that many patients have experienced deterioration in health due to the length of time they’ve needed to wait for surgery during the pandemic, to the point where they’re no longer fit for the procedure. So, we’re doing some work looking at pre-habilitation and pre-surgical optimisation, which involves putting interventions in place for patients, particularly around therapies, so that an individuals physical condition is maintained or improved before they get into hospital.
And then, once the surgery is complete, we can move to support those patients in their recovery at home, rather than in hospital. That’s where our services can really step in and help maximise flow through those hospital inpatient beds.
As a District Nurse, I was always used to receiving somebody back home and dealing with a lot of unknowns; the way a patient presents in hospital can be very different to how they present in their own home. So, I don’t think anything particularly shocked me in that sense during the pandemic – it was more about how quickly the move towards hospital at home happened.
Also, as a community nurse your skillsets are usually a little broader than hospital-based nurses. You need to be more flexible and work within the parameters of how people live in their homes and accept their treatment. Plus, soft skills are hugely important when it comes to liaising with family members or friends who also may be present in the home environment. There can been unique dynamics and different requirements at play compared to the relatively controlled environment of a ward.
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 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.
As we look into 2022 and beyond, I think we’re going to see the NHS require increased levels of district nursing care from the private sector. The impact of COVID and the backlogs on acute and elective surgeries mean hospitals will soon be bulging at the seams if they’re not already.
That means patients shouldn’t be spending any more time in hospital than they must – we should have the resources in place to get them home as soon as possible. That’s particularly true with elective procedures – the hips, knees and things like that. I’m a great believer in admission avoidance, particularly with elderly people, who we should be trying to help and support in the home as much as possible when it comes to physio and other rehab.
At HomeLink our clinical staff work from iPads when on the move or in a patient’s home, which is all the time. We are already a paperless company. A key tool for us is the Mobizio digital care management system, which allows us to electronically record all patient interactions, encompassing digital care plans and forms, eMAR, family & funder access, automated alerts and visit logs.
The platform gives us access to invaluable real time patient data and, from there, you can layer up digital workflows, such as video calls with doctors while we’re with a patient or submitting images of wounds or injuries for assessment. That’s a huge opportunity to speed up patient care and something that’s obviously in a GP’s or consultant’s interest too. Plus, NHS staff are able to look at our records to gain more insight into an individual patient’s condition. A likely evolution of this we be companies like HomeLink being granted reciprocal access to NHS patient records.
Wearables are going to be key to the evolution of the hospital at home model, whether that’s data gleaned from a patient’s Fitbit device or a patch on their arm that monitors sats, blood pressure, temperature, etc. The first generation of wearables were quite bulky – a bit like wearing a phone and a charger on your arm. But the latest solutions, which we’ve been helping to trial, collect vital signs data via a small pad attached to the arm, with a team monitoring it remotely 24 hours a day in real time, alerting clinical staff as required.
These kinds of technologies give people, who would otherwise spend all their lives in hospital, an opportunity to be at home. Sometimes it isn’t that long before they have to go back in again, but wearables will give the NHS and our own staff the chance to monitor patients closely without them physically being in a hospital bed. And there are huge patient wellbeing and mental health benefits with that approach.
I’d like to think that by 2025 we’ll see a significant move towards more community-based hospitals, separate from the big sites that offer care for acute illness, and which are very much geared towards deeper integration between health and social care. That might be wishful thinking, because we don’t know what the government’s plans are in that respect, but I think such an approach could help the NHS solve many of the long-term issues it has been trying to deal with, both pre- and post-COVID.
Companies like HomeLink would be able to manage and support that combined health and social care model. We’ve already seen so much progress in the last 20 years – when I was working in rapid response in the 2000s, patients would come into hospital with big swollen knees and stay there for weeks. Now they’re in for treatment and out within days. It’s mind-blowing what is already possible, so with hospital at home treatments that process will get even quicker.
Fundamentally, I think we’ll just be able to have sicker people at home, which means hospital stays and hospital infections will be minimised because, generally, you don’t get so much cross-infection in the home.
Undoubtedly it would be Jos de Blok, Founder and CEO of Buurtzorg, a Dutch organisation that specialises in neighbourhood nursing. De Blok is a nurse by education and is considered a ‘change agent’ in the Netherlands when it comes to community-based home care, having been motivated back in 2006 to find solutions to many of the same healthcare problems we have in the UK today.
Buurtzorg has succeeded in reducing administrative burden for nurses, improving quality of care and raising work satisfaction for its employees (the company has three times been awarded employer of the year in the Netherlands).
The Buurtzorg model employs very light-touch management, with coaching staff the only layer between De Blok and his nurses. While that approach perhaps will never translate fully to the UK, which has a publicly-funded health system unlike the private structure in the Netherlands, De Blok is something of a guru and many of his ideas can certainly be applied here.
The most exciting are the opportunities we’ve been talking about, because I think we are finally on the cusp of moving from the traditional IV model for healthcare. As a company, we want to help the NHS make positive changes at a strategic level, as many of the senior staff here at HomeLink have worked within that tremendous organisation and care greatly about its future.
Finding new and better ways of doing things, or helping people see solutions from a different angle is hugely rewarding, especially when that translates into positive feedback at the patient level. There have been occasions when the people we care for have initially been sceptical of a private company helping them, but they end up being hugely reluctant to see us leave. That kind of reaction inspires us perhaps more than anything else.
In the not-too-distant past, I was in a corporate environment where what I felt were good ideas from myself and others were continually being shot down. I shared my frustration with a colleague who simply said: “Don’t let them stop you from growing into the tallest poppy”. I had to look it up, but so-called Tall Poppy Syndrome refers to a culture of criticising, resenting, and undermining the ideas, success or ambition of other people. Some organisations are really infected with poppy cutters. It can be toxic. That piece of advice helped me realise that if something doesn’t work initially, then sometimes it’s just a case of bad timing. But keep persevering and be that force for change.
“I am so grateful to have been referred to HomeLink Healthcare, they have really helped me get back on my feet. If I had stayed in the hospital I would not have achieved everything I have done”
“The visiting therapist took her time with me, was always providing encouragement and without that I wouldn’t be at the point I am today.”
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