The health service and local government have worked together closely across the Bradford and Airedale region to provide telemedicine to care home residents and people in the community. Patients and staff can access help and support from a 24/7 digital hubbased at the NHS trust. It has reduced hospital admissions and A&E visits.
Providing support to older, frail patients to keep them out of hospital is one of the biggest challenges facing the health and care sectors. Research shows that while only 5 per cent of people aged over 65 who are admitted to hospital stay more than 21 days, that 5 per cent accounts for more than 40 per cent of all bed days. Care home residents have a particularly high risk of an emergency admission – 50 per cent higher than people of the same age living in the community, research has suggested. But keeping these people out of hospital can require a lot of support.
The solution
In the Bradford and Airedale area partners from across the NHS and local government have worked together closely to develop digital solutions to supporting older people.
The focus started six years ago with investment in telemedicine thanks to funding from the regional innovation funds via the then Yorkshire and Humber Strategic Health Authority. Staff at care homes can speak to nurses and paramedics at a digital care hub via a secure video connection using Cisco Jabber technology. The technology is on laptops and tablets so can be moved to where the residents are.
The service is run from Airedale hospital and involves care staff from local authority care homes and NHS staff working side-by-side. It operates 24/7 and consultations with doctors can also be arranged where necessary.
The hub also runs another three services – a single point of access for intermediate care services providing up to six-week support programmes to people at risk of being admitted to hospital or post-hospital discharge, the Gold Line service for end-oflife care and a telemedicine support service to prison and youth offender institutions.
The impact
Research has demonstrated significant results, showing admissions from care homes receiving the services have dropped by at least a third, while A&E attendances have fallen by almost half.
Telemedicine has proven to be incredibly successful and popular. It is now available to over 500 care homes, some of whom are outside of West Yorkshire as the video consultations allow the staff at the digital care hub to provide support further afield.
Between them they make in the region of 3,000 video calls every month.
Mrs Buchan says: “The hub is making a real difference in supporting care home staff care for their residents. Data consistently shows that at the end of the video consultation with a health professional at hub that 90 per cent remain in the home with appropriate care wrapped around them – proof that telemedicine leads to a better use of resources, better outcomes and, crucially, a better patient experience.”
One of the homes that uses the service is Herncliffe in Keighley. Deputy matron Beverley Clarkson, says staff have been very impressed with the service and they have used it to get advice for patients who have had falls, developed infections and needed palliative care.
“I think the service is a brilliant idea,” she says. “Lots of our clients get very distressed at the thought of going into hospital so anything that helps us care for them here is good.”
Lessons learned
Mrs Buchan says what has become clear over the years is the importance of having an integrated clinical IT system for patient records. Bit by bit this has been achieved in Bradford and Airedale by installing the SystmOne system across the local health and care economy. It allows social care, GPs, community services and the hospital trust to have shared access to the same information covering treatment, existing conditions, allergies and current medication.
Mrs Buchan says: “You need integrated care records otherwise you are trying to make something work with the limited information held within the summary care record or scanning care plans into our clinical system.
“We have been rolling out SystmOne across the local area’s health and social care services for a number of years. GPs were the first to use it and the digital care hub (formerly known as the telehealth hub) has been using SystmOne since its inception in 2011. It is absolutely key to get the whole view of the patient.”
How is the approach being sustained? The Airedale partners have experimented with providing telemedicine direct into people’s homes. The pilot was focused on those receiving end of life care. While it did not prove successful financially, Mrs Buchan still believes it will be something that will be used in the future.
“The problem was it proved too expensive to set up the secure connection,” she says. “In a care home you might have up to 100 residents – you get the economies of scale – but at home it is just for one person.
“We have also tried using Skype, but it is not something that works particularly well for us at the moment. Caring for patients at end of life means we need to have a solution which is cost effective but provides guaranteed quality and service availability.”