Developing a Telemedicine service across Hampshire to support the older population

 

“The AHSN team have demonstrated a can-do attitude, pushing the boundaries in providing not only resources that will be utilised within the Wessex geography, but nationally.”

– (Project Director, Hampshire Hospitals Foundation NHS Trust)

 

Challenge / Problem Identified

Care home residents account for 185,000 emergency admissions each year and 1.46 million emergency bed days, with 35-40% of emergency admissions potentially avoidable[i]. These admissions can cause unnecessary stress, confusion and impact on long-term recovery for the older population.

Hampshire Hospitals NHS Foundation Trust (HHFT), West Hampshire CCG and Mid Hampshire CCG had plans to implement a 24/7 Telemedicine service starting in summer 2020 to approximately 78 care and nursing homes in Mid and North Hampshire over a two-year period. The evidence coming from the pilot would then be used to develop a business case to roll out to all homes in Hampshire and the Isle of Wight (HIOW).

The aim of the HHFT telemedicine service is to triage patients using tools such as ReSPECT and RESTORE2TM to reduce the number of emergency department attendances and subsequent hospital admissions.

COVID-19 sped up the launch of the planned service, with the HIOW STP Digital Care Home Working Group agreeing to expedite the timeline for delivery, launching the service in April 2020.

The telemedicine service went live on 15 April 2020 8am to 8pm, to 78 care homes and included the Holiday Inn step down facility. The service as of the 12 August 2020 is provided to 166 care homes.

Actions Taken

Wessex AHSN training materials to support the launch of the new service and to train care home staff in the initial cohort of 78 homes, as required. A comprehensive training pack and associated communication materials were developed at pace with the project team producing the training and communication materials rapidly within a two-week timeframe, ensuring materials were of a high quality and peer reviewed. The team worked in partnership with the Hampshire Hospitals NHS Foundation Trust project team, CCG partners, nurse facilitators, care homes and system leaders demonstrating the art of extreme teaming.

To capture local learning and best practice approaches in developing a telemedicine service, a telemedicine for care homes strategic scoping and implementation strategic guide was developed for ICS / STP and CCG leads for use across Hampshire, Isle of Wight and Dorset. The guides will also support other comparative telemedicine services being developed nationally and can be used alongside other implementation strategies.

In collaboration with the Health Innovation Network, Wessex AHSN’s Healthy Ageing programme team co-hosted a national AHSN Healthy Ageing Network webinar showcasing best practice telemedicine approaches #telemed4CareHomes. The event took place on 16 July 2020. 350 colleagues from across the NHS, social care and voluntary sector registered to attend, with 170 attendees at the peak of the session (retaining 140 of the audience to the end of the webinar [82% audience retention]). The event was chaired by Dr Emily Gibbs, Southwark GP Practice. The event focused on the ingredients for success in implementing telemedicine for care home approaches and included the Hampshire Hospitals Foundation NHS Trust and West Hampshire CCG model. The Wessex AHSN also promoted the launch of the strategic scoping and implementation guides.

Materials are easily accessible on the Wessex AHSN telemedicine for care home website and will be made nationally available on the NHS England Ageing Well Futures Platform, enabling the learning to be shared across the wider NHS, social care and care home forums.

Impacts / Outcomes

By July 2020 the service:

  • Rolled out to 166 care homes (including South East Hampshire), with all of these homes benefiting from the materials developed. A further 60 care homes in Southampton will be able to access the service from September 2020 onwards and will utilise the materials.
  • Received 184 calls
  • Prevented 72 emergency attendances
  • Prevented 38 hospital admission
  • Streamlined 21 hospital admissions.

 The telemedicine for care home webinar was attended by 170 colleagues, with all 359 registered attendees receiving copies of the recorded webinar, slide deck and links to resources on the website.

Lessons Learned

As an AHSN it was important to be flexible and listen and respond to the COVID-19 brief. It has strengthened system wide relationships and has demonstrated the art of the possible.

The project was set up at speed -growing organically and rapidly to respond to the COVID-19 crisis.

We demonstrated that the programme  can deliver at pace in an every changing environment; we demonstrated the ability to work and connect with local and other AHSN programmes, consistently maintaining a strategic overview, making rapid connections and suggestions and rapidly learning about the context of telemedicine and care homes.

It is important to understand that care homes working within a pressurised environment, balancing competing demands against a backdrop of variable staffing levels and emotional challenges.

There is a need moving forward to review the number of homes who are utilising the service and those who are not, to understand the issues and barriers to uptake as well as promoting the service and increasing the uptake of digital solutions.

Future Plans / Next Steps

The scoping and implementation guides will be reviewed on an annual basis by the Hampshire and Isle Of Wight STP Digital Care Home Working Group.

The developed materials are freely available on the Wessex AHSN telemedicine for care homes website, the West Hampshire CCG website, and the NHSE Ageing Well Futures Platform.

The materials can be downloaded and adapted for local use as appropriate.

Potential review of guides to provide a GP/PCN telemedicine approach, subject to need.

 

[i] https://www.longtermplan.nhs.uk/online-version/chapter-1-a-new-service-model-for-the-21st-century/1-we-will-boost-out-of-hospital-care-and-finally-dissolve-the-historic-divide-between-primary-and-community-health-services/