It’s changed my life! Stories on digital home care

Within a day of being on the virtual ward I just thought it was the best thing ever - Bill Archer

Bill puts it so well. He is able to monitor his heart condition at home thanks to technology sending his readings to the cardiology team at his local hospital and is one of now thousands of people benefiting from digital home care on the NHS.

This week I gave the closing keynote on the first day of HETT, the Healthcare Excellence through Technology Show in Excel, and I titled it - “It’s changed my life” stories on digital home care - because I wanted to share with the audience the consistently moving feedback we are privileged to receive from patients about the difference it is making to them. This article is a write up of what I said. I was in the Digitally Empowered Patients theatre and, in a great fit, between each speaker the HETT team ran a series of patient voice videos.

I opened with Bill, who is looked after by a digitally supported home Atrial Fibrillation service running out of Leicester hospital. They, with their tech partner Dignio, won one of our Partnership Awards last year, and have made this great film about how it works. Bill speaks about one minute in, and for HETT, given I was leading with the voice of the patient, I played this segment to open the session.

I then introduced myself and that I’ve worked in the NHS for three decades; most of that spent running hospital services in London, including as director of operations and as a chief executive. And I have great respect for them, and the people who work there. If you are acutely unwell, there is no better place to be than a hospital. But, once you are over the immediate acute phase of illness, or have a long term condition, home has enormous advantages. You can rest and sleep more easily, eat the food that appeals to you, mobilise more effectively, be with loved ones and closer to your support networks. These all speed up recovery and improve morale tremendously.

I pepper my talk with spontaneous feedback we’ve had from patients. One of my favourite quotes is from David who was able to return from hospital early and complete his recovery at home thanks to technology monitoring his health sending information to the hospital at home team at his local hospital.

The hospital is brilliant. But it’s not like being at home - David Whitlock

David and his wife Carol feature in this great BBC news item which remains one of the best clips to describe the power of hospital level care at home -

Technology at its best! - Leigh Jones

Leigh was looked after by the same home care team as David, in Norfolk and uses a very interesting word to describe it - he says he is “indebted” to the service that enabled him to recover at home, with his cats and his grandchildren by his side. He calls it “gamechanging” and “technology at its best!”.

My time spent in the NHS, has led me to believe that we need to do much more to help people stay at home longer and return there much more quickly after hospital care. Happily, developments in technology can help us do just that. Enabling people to be safely supervised with technology, wearing a wearable like David, or entering results into an app, while recovering in the comfort of their own home.

Even better we have seen the most enormous shift over the past two years and I think we are now reaching that tipping point in the NHS in England that digital home care is becoming a routine part of health care; on offer across the country to large groups of people.

Four shifts        

During the pandemic, awful though it was, there were four shifts that were positive for digital home care.

Serious downsides to attending hospital

The first was that suddenly everyone realised there were real downsides from attending hospital. Notably of course the infection risk, of catching covid in particular, but other issues too. There is strong evidence that staying too long in hospital results in serious hospital acquired deconditioning, with muscle wasting starting within 24 hours of admission. That can be hard - and in some cases, particularly in the elderly - impossible to recover from. It is also especially problematic for people living with dementia, who can become much more disoriented and distressed away from familiar surroundings, and lose cognitive abilities and independence permanently.

New digital ways to access the NHS

Secondly, overnight people interacted with the NHS in totally new ways. Both patients and staff were incredibly accommodating. Hospital appointments shifted to video, later the public learned to home test and to use the NHS App to access the covid pass; there are 27m NHS App users now, and there us work underway to be able to use this as a front door to many more NHS services such as changing your outpatient appointment to a time you can make, viewing results or recording information in your hand held record.

Urgency drove real pace

The other thing that happened as the enormity of the pandemic became clear was a tremendous sense of urgency that drove pace. For the first time in my NHS career things moved quickly enough for me. As the UK locked down in March 2020 we were approached by a doctor running one of the largest virtual wards in the country. They were just beginning to look after people with covid and he asked was there any technology that could help them. They were operating with pen and paper and phone calls and an excel spreadsheet, and four quite hectic weeks later, the digital service was live to patients, both in West Herts and in two sites in London: helping support people leave hospital with covid sooner with their condition monitored through an app on their smartphone and a pulse oximeter.

They were able to use shielding staff to help supervise patients and use their clinical skills even though they couldn’t come to the hospital. No corners were cut, all the relevant data sharing agreements were completed, but what happened was people made decisions at the speed of light. Pedro Delgado of the institute for healthcare improvement puts it well he says “In the pandemic we learnt that slow is a choice” I certainly hope that this is a lesson we take to heart across the NHS.

Steal with pride

Then the final shift has been an openness to share more and put in what works. I have to say that I’ve witnessed a refreshing change with the pandemic where I haven’t heard “not invented here” for over 3 years. Across the NHS people are hungry for good ideas that work. Some of you may have heard of the Digital Playbooks, these are a consolidation of the best examples from across the country of the where tech is helping in various specialties from mental health to dermatology - they are getting 12,000 views as week.

Digital support for Long Term conditions  
        

Around three quarters of NHS time and resources are spent on long term conditions - and much of that spend, sadly is on the complications of disease that result in hospitalisation. Most people in hospital are there because they have an exacerbation of a long term condition, and this represents 70% of bed use. Which is why it is exciting that digital tools that support people keep control of these conditions such as heart failure and chronic lung diseases are really starting to scale now.

In Airedale they are looking after people with chronic lung disease known as COPD in this way and have seen a marked reduction in emergency admissions as patients are supported to stay in control; for instance for the 256 patients provided with digital support for their COPD in June 22, their A&E admissions in the following month dropped by 41% compared to the 31 days prior, and Airedale aim to have 6,000 people living with COPD on this pathway, using Luscii. It has been great to be able to support this work and see such a marked impact.

If you’d like to hear a patient talk about getting back in control of their life and staying well clear of hospital thanks to great community respiratory nurses and a digital tool they use listen to Barry James on episode 2 of the Innovation Collaborative podcast series cared for by the community heart failure service in Leicestershire.

My home is my care home         

When we talk about home, we very much include those 400,000 people in England for whom home is a care home. In fact some of the most marked early impact has come from the care homes we’ve worked with to introduce digital vital sign monitoring. Sometimes called a Doc in a Box these kits enable care home staff to do a quick check of any resident they are worried about. They are then either reassured or have information that confirms deterioration that they can escalate to clinical teams.

We have been able to support 136,000 care home residents with these tools, that is almost a third of the care home population, and the evaluations across the country are indicating some very consistent findings, deterioration is being picked up more rapidly, and across the board there is a reduction in ambulance call-outs, unnecessary A&E attendances and hospital admissions among those with access to this remote monitoring as the tech is able to reassure care teams that the resident doesn’t need to go to hospital.

It makes me feel safe - Paul McCook

This one minute clip tells you how it works; it is Paul's story -

Feedback from NHS staff         

And to return where I began to the power of bringing the hospital into people’s homes. NHS staff too are enjoying this new way of working, and they tell us that they find it tremendously satisfying to help keep people at home where they want to be, providing really individual one to one care. In fact Sam, the CEO, Norfolk & Norwich University Hospital says

“We have yet, in nine months of operation, to have a single day of staff sickness on the virtual ward” - Sam Higginson

When we met his nursing team we asked what it was that they found so compelling. They told us it was really satisfying to see people flourish at home where they wanted to be, but also enjoyed the fact that they could really focus on the individual and given them "proper old fashioned nursing care" without the interruptions of a busy inpatient ward, ironically enabled by very modern technology.

Supervision can be done from home, giving new flexibility to clinical roles and could help with retention by attracting clinical staff who might have been thinking of retiring to stay in the NHS for longer and use their skills in new ways.

This model of care helped enormously during the Covid pandemic with covid@home services established across the country. It also gives people the information they need to manage their health to best effect, by sharing results with people it helps them better stay in control and spot the things that may be triggering them. It is empowering and a helpful shift away from the old patriarchal approach.

My team is supporting work happening across the country to increase the coverage of patient portals that enable people to access their results, feed in home monitoring information and interact with their hospital more easily. This will be linked into the NHS App providing a simple single front door and enabling people with long term conditions to report in on symptoms enabling much greater personalisation of care. If all is going well and their indicators are good, they may not need an appointment at that time, if things are looking problematic it might be they are asked in sooner. Southampton has been a real pioneer in this and Debra who receives her care there says -

Through the app on my phone my medical record is beside me all the time and I felt like I had this envelope of care around me. I would recommend it to anyone - Debra

The NHS Planning Guidance which is essentially the instructions to the NHS each year published in December – in fact at 5pm on Christmas Eve – to me it was a fantastic Christmas present - outlined a major ambition to make virtual wards available to many more people across the NHS in England, committing significant funds just under half a billion pounds over two years including ￡200m in this current year,

My team is involved in supporting Trusts to establish and expand these services and we have built a great peer network, sharing resources to help accelerate this work and essentially aim, in Eric Topol’s words to

Share more and get smarter faster - Dr Eric Topol

There is a lively community, where essential info, docs, slides, business cases, operating policies are shared widely, we hold events and seminars, share films and podcasts and everyone is welcome to join this Innovation Collaborative for Digital Health. There is a super animation on the Collaborative at the link below and we'd love you to join - details at the end of the article.

There are record numbers of people waiting for outpatient appointments and operations, ambulance and emergency services are under huge pressure and the NHS is likely to experience extra demand linked to Covid for years to come. Through supporting much more digital home care, to help keep those with long term conditions well, enable admission avoidance where possible and help those who do need admission to leave sooner and recover at home under supervision, we will expand the availability of inpatient hospital beds to those that need them most and ensure that this is without delay.

We now have over a hundred tech enabled virtual ward services live across the country, and have reached 400,000 people benefiting from digital home care over the past two years. It is an exciting time and there’s much more ahead. We see this as part of a real social movement in how care should be delivered. With the patient very much at the centre, and supported to stay, as far as possible, in the place of their choice thanks to new pathways of care enabled by digital technology.

So please join and help power this social movement and spread the word that there really is, no place like home.

With thanks to HETT for having us, and to everyone who is already part of this movement, the amazing frontline teams implementing new models of care, the teams supporting them at Trust, ICS and Regional level, it’s been great working with you all on this.

#DigitalHomeCare #VirtualWards #NHSInnovCollab

NHS Transformation Directorate Janet King Eddie Olla Luke Readman Stephen Firman Steve Trowell Fiona Sanders Barry Frostick Paul Rice Shani Gray Marie Buchan Breid O'Brien Tim Cullinan Rhod Joyce Donna Clements Zharain Bawa Ph.D. Dan Wootton Karen Doyle Lauren Harkins Dr Ewa Truchanowicz FRSA HETT Show

Resources         

If you have an interest in digital home care please join the Innovation Collaborative starting with our workspace on NHS Futures. Designed to help accelerate this work by creating a network across the NHS, the workspace holds a host of resources such as videos, documents, slide packs and many sections are open to digital health innovators with relevant products - to become a member please email: [email protected]

If you are specifically interested in virtual wards there are lots of dedicated resources and this webpage is a great place to start -