A large-scale project led by senior nurses to improve the health of care home residents in Calderdale, Yorkshire has reduced emergency admissions by 33 per cent with the help of technology-enabled care. Analysis1 has indicated this type of care model could release £1 billion NHS capacity if deployed on a national scale.
NHS Calderdale Clinical Commissioning Group (CCG) has pioneered its clinically-led approach in partnership with Calderdale Council and Calderdale and Huddersfield NHS Foundation Trust. In the first two years alone, the telecare supported programme made savings equating to approximately 7,000 hospital bed days and technology continues to be used for monitoring and risk reduction.
The Quest for Quality in Care Homes initiative has involved 1300 care home residents over the past five years, with a multidisciplinary team and care home staff working to improve care and prevent avoidable emergency attendances and admissions – typically for urinary tract and respiratory infections, falls and fractures. Since 2013, care home teams have used. Tunstall technology to support individual care plans for residents, enabling the prevention of incidents.
Results of the project show reduction in emergency hospital admissions2. In the launch phase (2014-2016) NHS Calderdale CCG:
- Cut emergency admissions from care home residents by 33%
- Made savings equating to approximately 7000 bed days
- Reduced GP care home visits by 45% following the introduction of the Quest multidisciplinary team
Telecare continues to help the CCG support care home residents and prevent falls. In the last year (2016/17 to 2017/18) emergency admissions relating to falls have decreased by 7.7% which has resulted in an annual saving through the Quest programme of more than £200,000.
Katie Berry, a Quest Nurse from Calderdale said:
“This type of technology is massively important. It has without a doubt enhanced safety for our vulnerable care home residents. For example, I worked with a lady who, before she became unwell, had been extremely active and enjoyed long walks. She had suffered many hospital admissions for injuries from falls. We advised giving her a falls detector, so that rather than restrict her in doing something she enjoyed, she still had the freedom to walk about the care home and grounds. Staff and relatives had the reassurance that if she did fall, they would be immediately alerted.
“The technology is particularly essential in our intermediate care wards, where acutely unwell patients go to recover before being discharged. The technology has meant we are able to help more people return home rather than being readmitted to an acute ward because of a fall injury.”
Liz Morley, Associate Director of Nursing, community services said:
“I would absolutely recommend this type of technology to every care home, it enables a safer environment for residents, while enhancing the care we provide.”
Dr Steven Cleasby, Chair of NHS Calderdale CCG said:
“The telecare service has been a really important part of what we have achieved through the Quest for Quality in Care Homes project. Our care homes have engaged with telecare and welcome the support Tunstall provide through equipment provision for residents and carers, with regular on-the-ground support. These have led to efficiencies in staff workload, reductions in falls and general improvement in the quality of care provided.”
Calderdale is one of the care home initiatives demonstrating what impact clinically-led technology-enabled models could have on a national scale.
Independent analysis1 commissioned by Tunstall revealed that the NHS could release nearly £1bn capacity annually using this type of approach – avoiding 226,000 emergency admissions and 2.5 million bed days. The study combined national government data and data from other regional initiatives that use telecare and telehealth enabled models, such as video based remote consultation technology in care homes by Airedale, Wharfedale and Craven (AWC) CCG.
Dr Belinda Coker, Clinical Director of Tunstall and a sessional NHS GP at the Hurley Clinic in South East London said:
“Around 383,500 older people with multiple and complex long- term conditions reside in care homes. Although they represent just 0.7% of the population, due to their healthcare needs, they use a disproportionately large share of the NHS’s resources. That is why reducing avoidable admissions and prolonged hospital stays has become a priority for healthcare commissioners and STPs. We believe NHS Calderdale CCG has led the way in showing that proactive management by highly-skilled multidisciplinary teams using technology in care homes could deliver significant efficiencies and release major capacity while at the same time providing a high-quality service.”
National analysis indicates that care home residents may represent 13.5 per cent of all acute bed days, 9.1% of emergency admissions and 10.7% of ambulance responses3.
Tunstall has created a reference model that allows the potential opportunities to be analysed at NHS England and regional (STP or CCG) levels.
1 Improving services for care-home residents using clinically-led and telehealth enabled models of care have delivered impressive results for existing Tunstall clients at scale, but at a regional level. To assess the opportunity for NHS England (and other regions) Tunstall commissioned independent analysis and modelling from Ignetica Ltd.
The project involved secondary analysis of a small group of mainly large scale (>1000 patients) and multi-year programmes for which performance/operating data was already available along with control group data and/or pre-post intervention data to assess the impacts. Each of the cases were analysed to establish the differential change parameters relative to the baseline, the prevailing demographics and wider NHS resource demand. Drawing on the best practise approaches from each, a reference model was developed to indicate the potential opportunity relative to the overall population, care-home populations and current NHS demand from the same. This incorporated the key learnings from the case studies including clinically-led and telehealth/care enabled approaches, out-of-hours remote medical support and remote monitoring for specific (eg Dietetics) programmes. Alongside this, national level data (Hospital Episodes Statistics (HES), Office for National Statistics (ONS), National Audit Office (NAO), STP plans and others) was accessed and used to model the opportunity if the reference model approach was scaled at NHS England level (and at STP/CCG level).
2 Research undertaken by Ignetica Ltd for Tunstall
3 Research undertaken by Ignetica Ltd for Tunstall