Tech enabled Frailty care at home in Kent is "wonderful!"

"Wonderful!" is how one patient cared for by the Frailty Home Treatment Team at East Kent described their experience of tech-enabled virtual ward care;?

“It was wonderful that I could stay at home and I’m monitored closely!”

and they’re not alone. So it was great to visit this impressive, and clearly well-loved service, at Herne Bay on an extremely blustery Friday recently and hear about the impact it is having.?

The busy service is led by community Geriatrician Shelagh O’Riordan and team in a beautiful part of the country, a coastal area which has traditionally attracted retirees, and has a high average age, including over six thousand care home residents locally and a higher frailty need than much of the UK.

Shelagh was a Consultant Geriatrician in East Kent Hospitals NHS University Trust for fourteen years before moving into community services. During the pandemic Shelagh developed the ‘hospital at home’ service, working with the urgent community response teams to allow real alternatives to hospital admission for people at home and in care homes.?

She is also the Professional Adviser to the Community Services team at NHS England, and in this role she is supporting work that builds on the commitments in the NHS Long Term Plan and the move towards scale Virtual Wards, to support older people to stay well and live independently as long as possible and to provide care closer to home, reducing avoidable hospital admissions.

Shelagh told me what she felt had been added to their existing at home service by having access to technology that enabled remote monitoring over the past year -

“What it has added, is that I can be more efficient as a doctor, as I can find out much more about my patient before I travel to them. As a senior consultant I can do a video assessment on a patient and provide advice and as distances are quite long in east Kent that makes a difference to how many patients I can reach in a day and increase the caseload safely.?

She described how seeing a patient's results in advance - through the remote monitoring dashboard - meant the care could be designed around their individual needs, with the best practitioner in the team undertaking visits as they were needed, and where the results indicated patients were doing well, a check in phone call may be all they need and that Advanced Care Practitioner could instead spend longer at home with someone with more acute needs. Shelagh continued -

“I am seeing that it is particularly patients with cardiac and respiratory issues who really benefit from this model of care.”?

Jonathan McGarvey, a specialist doctor in community Geriatric medicine and joint Specialty lead for the Frailty virtual ward, hosted our visit. Jonathan oversees a diverse team of healthcare professionals providing hospital level care at home, to patients living with Frailty, many of whom we met during the visit.?

The service is part of Kent Community Health NHS Foundation Trust, that provides NHS services in the community across Kent, parts of East Sussex and London, and also provides the clinical monitoring of patients on the Virtual Wards as well as clinical staff who attend in the patient’s own home.?

Building on experience gained during hospital based geriatric medicine, Jonathan has worked in the community for the last four years promoting patient involvement in the decisions around their treatment and care. His goal is to develop and promote a safe and effective alternative to hospital admission for patients living with Frailty; to promote ageing well, and preserve the quality of life that is increasingly valuable as we grow older. I asked Jonathan what made him want to deliver this type of care.?

He explained that he works as part of a team of doctors and advanced clinical practitioners with a wide range of backgrounds, who accept referrals from paramedics, GPs, care homes, acute trusts, and community hospitals and teams and said?

“Our motto is: “We find out what you would want, and we try to provide it”. That’s how I want to practice medicine and why I am in this team, so that I can give that kind of care, every day”

The Frailty Home Treatment Service?

The team is made up of consultant geriatricians, GPs and advanced clinical practitioners, working in collaboration with GPs and other parts of urgent care locally. Their remote monitoring partner is Doccla and Jonathan said they were finding the service particularly useful for Frailty patients who have heart failure, sepsis or racing heart rates (tachycardia).?

The service also uses other innovative technology alongside Doccla to support their patients at home, including mini-labs known as Point of Care testing that provide blood results in the home and also pocket ultrasounds known as POCUS which can help distinguish patients with chest infections, blood clots such as pulmonary embolisms and those with Heart Failure.?

We spent time in the remote monitoring hub where staff with a range of professional backgrounds - paramedics, nurses, doctors and therapists - were interacting and supporting patients from home, viewing their progress on a dashboard that was continually updating, so they were able to see how their patients were doing across the wide geographical patch.

Sally Sheene is a senior occupational therapist who has been working within the service for two years, who told me -?

“I love working with people in their own homes”

I asked her why that was and she said?-

“I think people have much better rehab potential when they are home, with their own things around them, they do really well”?

Mary Stracey is the operational manager for urgent care and was full of praise for the team at Doccla -?

“The team at Doccla has been supportive and easy to contact, friendly and helpful”???

Garry Champs is an assessor on the team who said of the remote monitoring platform -

“I find it easy to set up”

Facts and Figures?

The tech-enabled Frailty Home Treatment service has looked after 238 patients, with an average stay on the Virtual Ward of 5 days, so 1,353 days of patient care have been provided, and is typically between five and ten patients every day of the year. The average age of patients on the service is just over 85 years old and the oldest was over 100.?

I visited with Joe Pringle, delivery manager for Doccla for East Kent, who provided the latest statistics on patient satisfaction rates. Joe told me that 92% of these patients cared for in the virtual ward supported by Doccla, had rated their care as “very good” or “good”. The average agreement to the following statements, out of 5 are “made me feel safe” - 4.7, “prefer to hospital” - 4.8, and “felt in control of my health” 4.7.?

Comments from patients who had been able to have hospital level care at home supported by technology included -

“Compared to the hospital, it was much better for me to be at home. I could sleep much better at home. Being with Doccla was more peaceful and comfortable for me”

They rated the service the top score of “very good” and when asked could anything be better, responded

“No, not at all. It was nice to be able to pick up the phone at our age and get help in an instant with the tech.”?

Another patient recently contacted the team at Doccla saying that they?

“Wanted to say a big thank you to everyone and that the standard of care is better than what I have experienced in a hospital environment"?

The team has also produced some great videos about their service.?Here's one that is well worth a watch -

Hospital at Home service - Rachel and Alan Reed's story

After fish and chips on the sea front - of course - I returned to the train station through torrential rain which could not dampen my mood, having been well lifted by this visit to such an impressive service.?