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Cheryl has worked for the NHS for over 20 years and has a passion for improving services for the older population. In our latest COVID-19 Lessons blog, Cheryl reflects on supporting the launch of a new telemedicine service for care homes at speed to help support some of the community’s most vulnerable people – all whilst juggling home-schooling her twin daughters with her husband who launched his own start-up.

In April 2020, a new telemedicine service was launched by Hampshire Hospitals NHS Foundation Trust (HHFT), North and West Hampshire CCGs and other local organisations. The service provides instant advice for care home residents (with and without nursing care), on how to remotely connect with clinicians. This means residents, many of whom live with frailty and may need clinical help and advice, can be seen remotely, without having to visit a surgery or hospital, which also supports social distancing.

Current landscape

In the UK, 405,000 older people (aged 65+) currently live in care homes. This represents 16% of older people over the age of 85 (British Geriatrics Society 2020).

Within Wessex, there are around 23,500 care home beds. Within Hampshire there are approximately 13,900 beds across 354 care homes (Care Quality Commission 2020 and health data library).

The new telemedicine service provides faster access to care and advice and avoids unnecessary ambulance call outs, attendance to the emergency department and admissions. All of which can be stressful to the resident.

The service means care homes can virtually talk to a specialist clinical team in the event of sudden and unexpected deterioration or health event. This includes falls, trauma, new confusion, pain management, breathlessness and suspected infections. Clinicians can also prescribe medication and send prescriptions electronically to a chosen pharmacy, meaning there is no need to visit a hospital or wait for an out-of-hours GP to visit. This makes treatment or symptom control much faster.

Accelerated at speed

The telemedicine project was originally due to launch later in 2020 but was accelerated at speed; a phased, but rapidly increasing approach, has seen the service initially launch in 104 care homes in Hampshire. As the service grows, it will be accessible to care homes all day, every day, across all of Hampshire and the Isle of Wight – approximately 650 care homes.

Wessex AHSN Healthy Ageing team’s involvement

The Wessex AHSN team was asked to support in the development of communication and learning materials to aid the launch of the service. The team quickly identified an opportunity to capture local learning and best practice approaches in developing a telemedicine service, and 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 growing organically and rapidly to respond to the COVID-19 crisis.

This organic approach does not fit particularly well with traditional project plans and outlines, but we demonstrated that the programme is agile in delivering at pace with the system by working with fellow AHSN programmes; maintaining a strategic overview; making rapid connections and suggestions; and learning about the context of telemedicine and care homes at speed.

It was also vitally important to understand that care homes were working within a pressurised environment, balancing competing demands against a backdrop of variable staffing levels and emotional challenges so our approach with system leaders had to be considered and sensitive.

‘Extreme teaming’

For me, from a work perspective, the traditional organisational barriers were removed. I learnt the true meaning of ‘extreme teaming’ during the crisis. The approach advocates multiple leaders from different system partners at all levels who will engage, commit and flex across the system sharing and pooling experience, knowledge and skills as required to deliver an innovative product. It has been a game-changer for me. It has been liberating and exciting delivering a project at pace to the benefit of the care home population.

From a personal perspective, delivering a project at pace from home, whilst home-schooling my eight year-old twin daughters and a husband starting up his own business and other family pressures, had both challenging and interesting moments to say the least – but demonstrated what can be achieved when a family pulls together.

Impact

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

The agility to make rapid new connections and to galvanise existing networks to support the rollout.

West Hampshire CCG has advised that they have gained huge value in the sharing and promotion of ideas from other sources/networks we are linked into, which is now creating new opportunities for future transformation and looking at things from a different perspective.

My advice

It is important to be flexible and actively listen to collaborators, the wider healthcare and social care system and care home needs. Using this approach against a backdrop of strong quality improvement and evaluation methodologies has strengthened system wide relationships and has demonstrated the art of the possible at pace.

Find out more about the telemedicine in care homes project. Follow Cheryl on Twitter.