"Our heart failure patients really love it!" - home based heart care in Greater Manchester

Greater Manchester operates the largest virtual ward in the country, with over 600 people being cared for at home on the latest snapshot day in January 2025. Contributing to an all time record of 10,162 people cared for in this way across the NHS in England that month.

It was brilliant to visit the impressive cardiology Hospital at Home service at Salford Royal, that is part of this achievement to shift from hospital to home, analogue to digital, treament to prevention, and hear from the clinical team running it what a difference it is making to their patients. 

Dr Nehal Hussain, Consultant Cardiologist and Heart Failure Lead at Salford Royal and Penny Darby, Lead Nurse for Heart Failure for the Northern Care Alliance, hosted the visit. They started providing remote monitoring for the first Heart Failure patients in June 2020, during the first lock down of the Covid pandemic, and have provided a service ever since. Given that tech enabled virtual wards for Covid only began in April 2020, this was very innovative and must be one of the first examples across the country. Thanks to having this service in place, they were able to continue providing care to their patients throughout the pandemic, when we will all recall, the vast majority of NHS services and clinics closed. 

I’ve been fortunate enought to visit a lot of Virtual Wards and remote care models both across the UK and abroad.

The rate limiting factor for almost all of them is clinician enthusiasm for the model.

How fortunate then is NCA in having Nehal and Penny as absolute shining examples of engaged clinicians who are so passionate about the benefits of remote monitoring for their patients and indeed the team. I'm sure that this is appreciated locally, but it is worth highlighting as is such a key aspect of a succesful transformation from a traditional service to one that can do better by its patients through tech enablement, that would be the envy of many other NHS organisations seeking to accelerate the pace of change.

The Heart Failure team has a large patient caseload with around 400 new referrals a year, that they are able to manage with a pretty small team of nurses and doctors, thanks in part to smart use of remote monitoring enabling their clinical expertise to stretch to more patients. But it is the impact on patients that clearly motivates them most, with their research demonstrating that the model is making a major difference to hospitalisation rates in supported patients. 

"Having run remote monitoring for a number of years, we have seen a reduction in readmissions of 50%, so we are clear on the impact it has." Dr Nehal Hussain

We met the Heart Failure nursing team as part of the visit, which gave good insight into how this busy service works so hard to keep people well at home, with great skill and personalisation. 

"One of the benefits we have found with remote monitoring is that we have richer context on our patients so instead of getting one-off results at a clinic appointment we can make more informed decisions about their care". Penny Darby 

About the Northern Care Alliance NHS Foundation Trust 

Salford Royal is part of the very large Northern Care Alliance NHS Foundation Trust, the Trust has over 20,000 staff and serves a population of over one million people across Oldham, Salford, Rochdale and Bury as well as providing specialist services from across Greater Manchester. It includes four acute hospitals at Salford Royal, the Royal Oldham, Rochdale Infirmary and Fairfield General Hospital and runs very substantial community services too. 

Hospital at Home services across the Northern Care Alliance

1,522 patients have been supported by the service so far, with a celebration being held in August when the service reached its 1,000th patient. On a typical day, around 50 people will be being cared for at home across the Trust, so the same as two inpatient wards worth of beds every day. Since the service began there has been an impressive total of 21,700 ‘patient active days’. 

Northern Care Alliance NHS Foundation Trust has a great "Hospital at Home" website which includes a useful patient film that was made for Greater Manchester to help encourage the public to use Hospital at Home and Virtual Ward services, it is well worth a look. The website states:

“Hospital at Home is one of Greater Manchester’s top priorities, and through close collaboration with staff, patients and their families and carers, Hospital at Home will become a successful and well-established service across Greater Manchester.

Continuing "There are a number of benefits for patients who are suitable for this service. The option to stay in the comfort of their own home, whilst being closely monitored by hospital staff, can lead to faster recovery and improved mental wellbeing. It can also give patients greater independence and empower them to work alongside clinicians and carers to manage their condition”

https://www.northerncarealliance.nhs.uk/patient-information/hospital-home

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, at the link below -

Types of conditions supported 

A wide range of conditions are supported by the Hospital at Home service across the Northern Care Alliance including 

• Respiratory

• Heart failure

• Diabetes

• Blood pressure

• Urgent Care Response

• Rapid Response

• Infection

• Frailty

• Community ACPs

• SDEC (admission avoidance taking patients home from Same Day Emergency Care)

Patients rate the service very highly

Patient satisfaction with the service running across the Northern Care Alliance is exceptionally high with 97% of patients cared for on their virtual ward being highly satisfied and rating their overall experience as very good or good.

Feedback from patients includes - 

“Overall experience? Very good - easy to use. Felt reassured that I was still having some followup and my observations were being checked by a clinician after still feeling poorly on discharge from hospital. Also reassured that I could speak to a clinician if I felt the need to. What could be better? Everything was great, I cannot think of any improvements that could be done.” 

Another patient said -

“The Doccla service was outstanding. I felt safe knowing I was being monitored by professional nurses. Truly amazing, thank you for your support.” 

Sometimes we can think that those less confident with technology might not get on with the service, but this is not supported by the feedback which is consistently that it is easy to use, as one patient put it -

“Very good - I’m not brilliant with computers but found it very easy.”

And simply

”Fantastic service!” 

Lead Nurse, Penny Darby confirmed:

"Our heart failure patients really love it!" 

What do NHS staff involved think?

A recent survey of Service Leads at NCA, undertaken last autumn, showed that they felt the biggest areas where the system had demonstrated most value were - 

• enhanced patient satisfaction 

• reduced admissions 

• improved patient outcomes 

• increased clinical efficiency 

Celebrating innovation in Greater Manchester 

It was great to catch up with Mark Britnell, Chair of Health Innovation Manchester , as part of the visit.

Mark described why he believes digital home care is important: 

“Across Greater Manchester we are running the largest virtual ward in the country, looking after over 600 people every day, providing tech enabled hospital equivalent care. HIM has played a key role in supporting local clinical teams set up this new care model, and the feedback from patients is that they far prefer home-based care. I am fully supportive of the move out of hospital and into the home, and tech can help us do that. But over the past 20 years, despite the rhetoric, the proportion of NHS spend in hospital based care has gone the wrong way and increased, from 47% to 58%. In my view we now need to make a shift, with greater investment in keeping people out of hospital; using tech to help us anticipate need and acting early."

Heart Failure at Home at Salford Royal

Dr Nehal Hussain, Consultant Cardiologist and Heart Failure Lead at Salford Royal explained how the Heart Failure at home service works.

“Patients don’t want to have to go into hospital and we want to try to care for them in their home and in the community."

“One of the key things we look for is the patient’s weight – if it increases more than two kilos over seven days there is the potential for a fluid build-up and we would need to have a telephone consultation to discuss this. We can actually use the system to have a video consultation. Rather than having to wait several weeks to find this out, we can potentially pick this up sooner and give the right advice. The aim is to avoid hospital admissions for our patients.

“We often tell people to weigh themselves, so this isn’t new, but if there is a way to get this fed back to us and to show them visually, I’m hoping it will encourage and help us engage more with our patients. There are a large number of patients who do not do this, so this service helps them engage with us more.”

If a patient with heart failure becomes unwell, it can potentially lead to a hospital admission with a patient staying in hospital for up to 11 days. This costs over £4,000 for each stay as well as being very disruptive for the patient.  

Mythbusting 

Nehal continued -

“A common misconception is that older people with heart failure are less keen on this model than younger patients, however our research on this has demonstrated this not to be the case at all.”

At the visit the team provided feedback on the product and support they received saying it was great and made the care process more streamlined than products they used before. 

Partnering across Greater Manchester 

The Northern Care Alliance NHS Foundation Trust uses Doccla across its acute and community Hospital at Home service. Recently other large Trusts in the Greater Manchester area - Manchester University NHS Foundation Trust and Wrightington, Wigan and Leigh NHS Trust have also awarded contracts to Doccla and are currently transferring their services across to go live over the next month. 

Manchester University NHS Foundation Trust is one of the largest acute Trusts in the UK, employing over 28,000 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. It’s CEO is Mark Cubbon who it was great to see during the visit. 

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 will support high-acuity 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 these streamlines the care of patients in a way that wasn’t possible previously. 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. 

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust is a major acute trust serving the people of Wigan and Leigh. Innovative and forward thinking, the trust is dedicated to providing the best possible healthcare for the local population in the Wigan Borough and surrounding areas. It runs the Royal Albert Edward Infirmary in Wigan, Wrightington Hospital and Leigh Infirmary. It has had long standing virtual ward provision, which I visited some years ago when working as Chief Digital Officer and was impressed by the virtual ward team and the strong support for the model from the Board leadership team. 

Like Manchester University Hospitals they are transferring from another provider so have in place a strong hub based model where they have a full Virtual Ward team based at Buckingham Row. The service will cover both the acute and community teams and provide care for high acuity patients at home. These will mainly be stepped down from Urgent Care, with some surgery pathways and a number of step up patients. They have a number of specialty focused pathways in Heart Failure, Respiratory and  Frailty, but they are also going to be bringing in new surgical pathways, and this service will provide 100 beds.

Health Innovation Manchester

We also met a number of the team from Health Innovation Manchester for whom home first and digital innovation are central; Laura Rooney, Director of Strategy, Paula Bennett, Chief Nurse & Interim Lead Clinician, Gareth Thomas, Digital Innovation Director and Ben Bridgewater, the CEO. It was so interesting to hear more about the great work in life sciences, technology and preventative care underway across GM that HIM is supporting. As well as the clear health benefits, this is also helping the economy; creating jobs locally as well helping people back to work so that they can contribute to local and national prosperity.

Paula told us -

"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 & Interim Lead Clinician, HIM

Living Well in Manchester

It was really good to hear Andy Burnham, the Mayor of Greater Manchester, talk about the work they are involved in as they seek to help people “Live Well” in Manchester, at the excellent Cambridge Health Network that evening.

Live Well is Greater Manchester’s movement for community-led health and wellbeing.

”What is Live Well?

Being able to Live Well can mean different things to different people:

• Enjoying life;

• having purpose;

• a good job;

• being in a warm and safe house;

• people to spend time with and care about;

• being represented;

• having a voice and a say in decisions about my life.

The neighbourhoods we live in and the communities we are a part of, help us live a healthy, happy life. They help us feel supported, connected and resilient through a variety of information, activities, and networks.”

Caroline Simpson, the Group CEO of the Greater Manchester Combined Authority, spoke impressively about creating a more proactive service that brings together health and other aspects of public services to wrap around people who need them most, with the aim of keeping them well, in or returning to work and out of hospital. It is a really exciting vision and the level of partnership was both impressive and tangible during our visit. 

For more on Live Well see here -  

Services in the Community 

It was so interesting to return to the Greater Manchester area to visit an acute virtual ward this time as almost exactly a year ago I had visited the community Hospital at Home team based out of the Royal Oldham Hospital. This service is led by Professor Emma Vardy consultant geriatrician and clinical lead for hospital at home and frailty at NCA, and the blog is here -

Reflections

It really was great to spend a few days in Greater Manchester and learn about the impressive work being undertaken, in their virtual wards, in moving to proactive virtual care and in creating a more joined up, holistic approach for people in greatest need as part of the "Live Well" programme. 

It feels as though this is a great example for the rest of the country to follow - providing extra support within neighbourhoods for those who need it most and generating the advantages of tech enablement to do so at scale. As well as new models of care for those with progressive, long term conditions such as Heart Failure, helping support people to spend more time well at home and far less time in hospital.

Many thanks to the teams who hosted us, especially Nehal, Penny, Laura, Paula and Gareth, and all at the Cambridge Health Network for an inspiring trip north!

Health Innovation Manchester Ben BridgewaterCambridge Health NetworkNorthern Care Alliance NHS Foundation TrustDr Owen Williams OBERafik BedairLorna AllanAmanda VaughanSarah GunshonManchester University NHS Foundation TrustMark CubbonHenry MorrissSohail MunshiDavid WallikerKarl GuttormsenJohnathan ElliottCharlotte Wilkinson Kaye HadfieldWrightington, Wigan and Leigh NHS Foundation TrustMary FlemingSarah BrennanDavid MeekinSanjay AryaAlison ChadwickAlex MeacePam GarsidePenny DashTom BreezeJames WolfendenMiles ReedKatherine BoylanWarren Heppolette Richard Stubbs Cara W Afzal Sameer Kothari Taz AldawoudJonathan BloorBenedikt von ThüngenProfessor Mark Britnell Rachel Anne J. Heather Caudle