Protecting hearts in Herts
At NHS Providers last week, I shared the stage with Sarah Brierley as we told the story of impressive work in Hertfordshire to look after people living with Heart Failure in a very different way. That tech-enabled home care had reduced A&E attendances by one-third in the supported cohort, reduced readmissions - there were none at all in the group with remote monitoring - improved symptoms and increased confidence. Such that the service had won an award for the team, working across East and North Hertfordshire NHS Trust and Hertfordshire Community NHS Trust
One of the hard hitting points in the Secretary of State for Health and Care speech's at the same event was that -??
The NHS has not met its promises to patients since 2015?
It is clear to me, that we need to think more radically about how we deliver services so that the NHS can return to meeting its promises. A priority area should be a totally different way of managing long term conditions, which represent the largest aspect - around 70% - of NHS time, resources and money, and targeting those at most risk of hospital admission with extra support - those at the "apex of need".
Focusing on people at the Apex of Need
In my talk I highlighted that in our current model -
5% of patients use more NHS resource than the remaining 95%
Source: A descriptive analysis of health care use by high-cost, high-need patients in England https://www.health.org.uk/sites/default/files/upload/publications/2019/Health-care-use-by-high-cost-high-need-patients-WP07.pdf October 2019, Kathryn Dreyer and colleagues, The Health Foundation
If we focus on people within the 5% - our VIPs if you like - and wrap digital home care around them - it will have disproportionate benefit?on the rest of the system.
It is then critical that ICBs target their 5% and provide them with a completely different model of support for their progressive long term conditions, in order to return to meeting promises to patients. I'd love to see this outlined in future health policy including the 10 year plan. The work undertaken in Herts and by the fellow 10 sites who have adopted the model, is entirely replicable and should, in my view, become the model for Heart Failure care across the NHS in England.
About East and North Hertfordshire?
In Hertfordshire there is a very large, mature and multi professional remote management hub that has been delivering virtual wards and many other aspects of home care, for several years. When the national Managing Heart Failure @ Home programme was announced, the clinical team there, led by Dr Elizabeth Kendrick, were keen to bid in collaboration with their Acute Trust, as a natural progression of their innovative service to move into proactive care and support for major long term conditions.?
This service involved a link up between the Cardiology team at East and North Herts led by Dr Mosaad Elbanna and Sharon Jones, Deputy Director of Nursing and Quality for Cardiology, the Hertfordshire Community Trust hub and their partner Doccla - and the partners successfully bid to become one of ten national accelerators.
Heart Failure: A health needs analysis of East and North Hertfordshire
My last blog shared that there are 730,000 Britons living with a progressive health condition known as Heart Failure - for the definition of Heart Failure and other useful context see that one (link at the end of this article).?Sarah provided the local context in Hertfordshire, they had
4,176 registered heart failure patients
which seemed low given their populations estimates - and we know that 80% of Heart Failure is only diagnosed in the A&E department, and that these patients were experiencing a high rate of admissions at -
1,698 emergency admissions/year
How it worked?
Sarah explained that they had run data to work out who best to invite to join the programme, by looking at who had a Heart Failure diagnosis and was most "at risk" of admission.
Then these patients with Heart Failure were recruited to the service and a “Doccla Box” was delivered to their home. This included a SIM enabled tablet plus linked medical devices for recording vital signs at home, such as blood pressure and heart rate.
The Doccla customer support team on boarded the patients, and as part of this took a set of test readings to ensure participants were happy and confident at using the devices. From there on in the HCT team took over, observing the results and liaising with patients.
Where there were concerning readings there was a clear escalation pathway with ready access to Heart Nurse Specialists, Consultants and other clinical staff from the Cardiology team at East and North Herts.?
"I just recover better with a cup of tea and being in my own home" Edna
Impact?
I then took over and shared some reflections that we often don't get it right for those most in need and hospital becomes the answer, with lots of crises and periods spent in poor health.
This approach of proactively seeking out those at highest risk of admission and providing extra support did appear to be game changing, and I commended it to other health leaders in the room to look to scale this locally.
I then went through the results that showed marked reductions in A&E attendance and readmissions in the cohort supported. They also experienced measurable improvements in quality of life and improvement in anxiety and depression, and I went through each in turn.
Reduction in A&E Attendance
32% decrease in A&E visits for heart failure-related issues after joining the remote monitoring programme.
Reduction in Readmissions
100% reduction in 30-day readmissions for heart failure
The project saw the 30-day readmissions related to heart failure reduce; from three to zero - saving ￡6,822 across 52 patients. Extrapolated across the Trust’s 4,176 registered heart failure patients, this is estimated to result in savings of over two million pounds a year.
Improvements in Quality of Life - EQ-5D-5L Index Score
There was a statistically significant improvement, with an average increase of 7.6% for each variable.?
Patient Empowerment and Satisfaction - Higher Self-Rated Health
Significant improvement from 65 to 72 out of 100.
Cost Savings and System Efficiency
Estimated Savings
Achieved ￡6,822 in avoided costs across 51 patients over three months due to reduced readmissions.
Projected Long-Term Savings
Potential savings of ￡2,191,436 a year if applied to all heart failure patients in ENHT.
Patient Empowerment and Satisfaction - Positive Patient Feedback
86% of patients rated the service as good or very good.
High satisfaction with support quality (4.6/5) and equipment reliability (4.5/5), indicating that patients felt well-supported and confident in the technology, which contributed to their successful engagement with remote monitoring.
Next Steps
The service and East and North Hertfordshire Trust have been awarded additional funding to expand on the pilot and aim to develop a permanent Integrated Heart Failure Service providing this at home support.?It also was recognised through winning a Health Tech News Award earlier this year.
Encouragingly, the model is also scaling into other parts of the country from Somerset to Derbyshire - North Sedgemoor PCN Somerset and Chesterfield Royal Hospital NHS have partnered with Doccla to implement this model of MHF@Home service, as well as a number of other sites, such as Cambridgeshire Community Services NHS Trust and Leicestershire, Leicester and Rutland ICB creating multi-condition tech-enabled LTC hubs for those at highest risk of hospital admission.
Conclusion
It does feels as though we could be at the beginning of a change that redefines long term condition care across the NHS. We know, that this model applies equally well to other major progressive long term conditions such as COPD and if we took the most at risk of hospital admission, in every ICS, and gave them this support, our NHS would look completely different.??
I'd love to see this become a key plank of the 10 year plan for the NHS, so we can help many more people living with Heart Failure spend more time - like Edna - in the comfort of home.
Co-Founder and CEO at THIS Labs Ltd
4 天前I attended this session - very inspiring
Head of Digital Consulting
4 天前Love this Tara! what fantastic solution for the future if this can be adopted more widely