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.

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 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.

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).

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.

 

 

 

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

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