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

Case study Hospital at Home, Partnerships 05th Apr 2024

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)

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