Hospital at Home in Manchester is epic!
Manchester University NHS Foundation Trust is the largest acute Trust in the UK, employing over 28,500 staff and running 10 hospitals across Manchester. It is the main provider of hospital care to around 750,000 people in Manchester and Trafford and the single biggest provider of specialised services in the North West of England. Its CEO is Mark Cubbon and the Executive lead for Hospital at Home is Dr Henry Morriss.
The Hospital at Home work supported by Doccla is a large-scale project covering the main acute sites of North Manchester General Hospital, Manchester Royal Infirmary, and Wythenshawe Hospital. It supports highly acute patients across a full range of specialties providing tech enabled hospital equivalent care at home to enable these patients to leave hospital much more quickly. As the Trust uses Epic as their main clinical system, the integration between Doccla and Epic has been important, as this streamlines the care of patients in a way that wasn’t possible previously.
Previously Manchester University NHS FT used Current Health but selected Doccla as its partner earlier this year, with the new service going live in March. This means that across Greater Manchester there has been consolidation of Doccla as the preferred platform with the Northern Care Alliance (covering acute and community care to a population of one million residents of Salford, Oldham, Rochdale and Bury ) Wrightington, Wigan and Leigh and the 10 hospitals under Manchester Foundation Trust. Jonathan
Manchester University NHS FT and WWL were the first trusts to go live with Doccla’s passive monitor the Corsano bracelet (link here) and all has gone well with the use of this new option for patients which is a convenient wristband that provides medical grade monitoring for a range of vital signs without the need for other medical devices. Intermittent monitoring is also available where that is more suitable for patients.
More on the passive monitor used, the Corsano bracelet -
Johnathan Elliott Head of Nursing for Urgent and Specialist Community Services and lead for Hospital at Home city wide, led our visit to Manchester Royal Infirmary on a beautifully sunny day, and explained that among the improvements they were seeing since the shift to a new provider were -
“Better flexibility, better resilience, and better rated by patients”.
Johnathan took us through a short presentation on the history of Hospital at Home across the Trust, beginning in the pandemic and taking us up to the present day. He shared a long list of conditions that they were using the tech-enabled, at-home model for but added
“In reality it is longer than this as the default question should be 'can this patient receive their care closer to home?'"
The team we met included
John Bright, Acute Medical Lead Hospital at Home Acute physician
Rebecca Edwards, MRI Acute Hospital at Home Service and Lead PA
Henry Morris, Exec Lead and Trust Director of Clinical Informatics
Prasanna Rao-Balakrishna, City-wide H@H Medical Lead
Stuart Dobbie, Clinical Nurse Specialist, Hospital at Home
Following the presentation we had a discussion with the team as well as a chance to try the kit that patients use. We then visited the Hospital at Home team and chatted to Stuart Dobbie from the nursing team.
It was abundantly clear that this is a team proud of the service it is able to offer to patients beyond the walls of their hospitals yet keen to do more to match a larger vision they have, summarised by the acute medical lead Dr John Bright as -
The care the patient wants, in the place of their choice
The Lead for the Acute Hospital at Home service is Rebecca Edwards, a Physician Associate, and in fact lead PA for the Trust. She told us -
The Hospital at Home service here at the Manchester Royal Infirmary has demonstrated flexibility and an adaptive approach within a new model of care at home. We strive to keep the patients at the centre of our processes and I am incredibly proud to lead a service that utilises the whole of the MDT to provide safe and effective care at home.
Rebecca continued -
Having seen the positive impact that digitally enabled care within the patient’s own home provides, I am excited to be supporting the onwards development of our Hospital at Home service and digital capability both locally at MRI as well as integrating into the wider Greater Manchester offer for care at home.
Jonathan added that it is important to provide a service that is genuinely open to all and he is -
“Passionate about providing a diverse, inclusive offer for our specific patient populations across Manchester”.
The visit team alongside me consisted of -
Matthew Gardner, Deputy Chief Digital Information Officer, MFT
Jacqui Cooper, HInM Chief Nursing Information Officer and exMFT CNIO
Saif Ahmed, Associate Medical Director Digital, Tameside and Glossop ICFT, Urgent Care and Long term conditions CCPL lead GM ICB Tameside locality, Clinical Digital Lead for Transformation, HInM & Frailty Advisor, GM Strategic Clinical Network.
Chloe Smithers, Senior Partnerships Manager, Doccla
James Wolfenden, Strategic Partnerships Manager, North of England, Doccla
Very good to catch up with Matt Gardner having worked together at NHSX and NHS England previously as he joined as part of his induction to the Trust, in his new role working as David Walliker's deputy.
Patient views
Since go live 175 people have used the new Hospital at Home service supported by Doccla, with typically around 20 of people a week receiving hospital level care at home via the service.
Jonathan told us that the digital questionnaires were proving invaluable covering symptoms, pain, wounds, and that the instant messaging feature also really helps patients feel supported and that it is very easy to contact a clinician.
Patient satisfaction with the service is running high at Manchester with all patients who have responded to the survey so far rating their experience as very good or good.
Overall experience % good or very good - 100%
Patient feedback via the survey included -
“I felt well looked after in the comfort of my home”
Knowing that I was being monitored when I was ill at home.
The equipment was excellent
Very good - clear instructions, easy to use
To tell Doccla, the service is good!
My health was monitored at home after my discharge from hospital. I feel not abandoned
Very good - the equipment was excellent
The team added that patients who have had it before are asking for Hospital at Home if they are being considered for admission to hospital again.
Health Innovation Manchester
About HInM -
Home - Health Innovation Manchester
Health Innovation Manchester’s vision is to be world leading in improving the lives of local people, transforming care and boosting the economy through innovation.
The team from HInM were interested in how they could help the future expansion of the service, with innovative ideas about new workforce models that they will follow-up with.
The opportunities to use technology to improve prevention, support self-care and symptom management as well as provide care and treatment in the home are significant. We have to deliver care differently and there is "no place like home". Paula Bennett Chief Nurse & Clinical Director (interim) Health Innovation Manchester
Hospital at Home in Greater Manchester
This video “the care of hospital, the comfort of home” explains more -
There is also a very good website on Hospital at Home across Greater Manchester with testimonies from patients (and staff) on the difference this model is making
Future
The plan is to reach 100 beds within six months rising to 170 once fully recruited and to expand into admission avoidance with community teams, support to Care Homes as well as into surgical pathways, such as pre-operative care for patients being treated for pancreatic surgery including support to optimise as far as possible ahead of the major operation and then rehabilitation afterwards.
Additionally, the Trust is keen to start to reach people living with a serious long term condition, at greatest risk of emergency hospital admission, as early as possible with remote monitoring. They want to look at using this tech in a proactive way to support people to spend as much time as possible well and at home and catch any deterioration early so they can help manage it and keep people from needing hospital in an emergency.
We know that the NHS is facing sustained pressure across urgent and emergency care due to a rising burden of long-term conditions, and that in fact 5% of patients consume more healthcare resources than the remaining 95% combined, with 70–90% of these patients living with long-term conditions. With chronic disease incidence expected to rise 37% by 2040, nine times faster than the working-age population, a transformational shift in care is needed.
In Manchester, modelling indicates that there will be a significant increase in emergency bed days use of 20% by 2040. Accounting for the aging population, annual NEL bed days would therefore rise to 2.05 million by 2040. The compounding effect of an aging population means that a radical transformation in capacity planning is essential to meet future demand.
There is good evidence that providing remote monitoring support to those with severe long term conditions such as those living with advanced Heart Failure or COPD has a major impact on their health and ability to do well at home rather than in hospital.
Creating a Healthier Nation
On this theme of preventative and personalised care, we then joined a session hosted at CityLabs on Creating a Healthier Nation: the case for a national obesity and CVD transformation. It proved a fascinating event with recommendations on how the government should take action to better support people and reduce the obesogenic environment and stand up to Big Food.
Chaired by Professor Mark Britnell the excellent speakers included James Bethell Angela McFarlane Rt Hon Andy Burnham and Laura Rooney. The audience included senior leaders from a wide range of influential backgrounds - the NHS (including NHS England Chair Penny Dash), the Mayor's office and local authorities, private sector companies and innovators.
For further details see the event summary below -
"Creating a Healthier Nation: The Case for a National Obesity and CVD Transformation
We are delighted to share our recommendations that would realise impact within the next 5 years on both the obesity crisis and the sustainability of the NHS. The recommendations encapsulate the ambition that obesity must be urgently recognised by UK Government and the Royal Colleges and wider NHS as a chronic long-term condition, for which the UK has a once in a generation opportunity to change the CVD metabolic, mental health and economic productivity of UK citizens through a commitment to scale adoption of pharmacological and digital innovation.
Hosted by Health Innovation Manchester, this launch event will not only create a forum for discussion on the report recommendations but crucially demonstrate the truly pioneering work that Health Innovation Manchester is mobilising to change the obesity trajectory and related CVRM conditions to realise the health, productivity of its citizens and guarantee a sustainable NHS fit for the future."
The session covered the fact that 1.6 million people in the UK are now taking this new type of drug to reduce obesity, mainly with no involvement at all of the NHS. It talked about the role of digital companion tools, that had shown their efficacy in digital diabetes prevention programmes and have enormous potential here to support people at a scale the NHS is not ready for.
Professor Mark Britnell outlined how Greater Manchester was eager to build on its recent successes with Live Well and major pharmaceutical research and real world evidence studies based in GM to establish a Prevention Demonstrator.
There was a strong close from Rt Hon Andy Burnham with the importance of making progress on the wider determinants of health including supply of decent housing as a priority as“health is made from the bottom up”.
The report is here -
Conclusion
A great end to a day of learning about innovation in practice, the importance of place and how technology can help us deliver care differently, in a way that the public want.
Brilliant to see a very large, leading Trust investing in expanding its Hospital at Home service and looking to a future where this support can be provided to people proactively to improve care with less dependence on hospitals in future.
Many thanks to Jonathan, Henry, Rebecca, John and all the team who spent time with us showing their impressive tech enabled home care service.
David Walliker Maxine Power Ben Bridgewater Manchester University NHS Foundation Trust Doccla #HospitalAtHome #VirtualWards #ProactiveVirtualCare
#TheresNoPlaceLikeHome
Some good posts capturing what was covered at the Creating a Healthier Nation Event are here -
Cara W Afzal - Health Innovation Manchester
Head Of Clinical Operations at Mastercall healthcare, Clinical Safety Officer for Mastercall Healthcare and Health Innovation Manchester, UEC Programme Lead for GMUPCA, Advanced Nurse Practitioner
2moGreat article and services like these support the new 10yr plan of community-centric patient care.
Queens Nurse * CNO/CMidO BME SAG Northwest Regional Lead * Alumni The Kingsfund * Alumni NHS Leadership Academy
3moJohnny, our family are extremely grateful to have crossed pathways with this and several other services, before my father Mr Lee passed last year. Please convey our gratitude and thanks to the team, from our family lived experience, which was extremely positive. Also glad that you are in the citywide role, your understanding of moving beyond the boundaries of traditional care to the person .... great stuff !
City-Wide Head of Nursing Urgent Care Community services Community and secondary care interface Clinical Academic Honorary Lecturer Prev Consultant Nurse Acute/ Urgent Care RGN MSc x 2 Doctoral Student
3moMark Edwards Sohail Munshi munshi Kimberley Salmon-Jamieson
City-Wide Head of Nursing Urgent Care Community services Community and secondary care interface Clinical Academic Honorary Lecturer Prev Consultant Nurse Acute/ Urgent Care RGN MSc x 2 Doctoral Student
3moIt was great to meet you and the wider GM team So much opportunity as we move to a new Community based Urgent Care model. Digital solutions are key to its success
Chief Digital Information Officer - NHS
3moFabulous to catch up with you Tara during your visit to Manchester and thanks for extending the invite and sharing your reflections. Look forward to catching up again soon!