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“The whole point of doing this is to do it big” Rachel Binks of Airedale NHS, on remote monitoring at scale

Last week at HTN Now, we held a series of webinars focusing on different health tech topics. In one of our sessions, we were joined by Rachel Binks, nurse consultant and clinical lead for digital and acute care at NHS Airedale Hub, for a presentation on digital innovations and remote monitoring at scale.

The session shared the work Airedale NHS Foundation Trust has undertaken in order to deliver digital and acute care, touching on their progress and the positive outcomes they have made so far in their journey.

Airedale’s digital journey

Rachel began her session by sharing a timeline of the digital process made by the trust.

“In 2006, we started digitising patient services and started to deliver outpatient consultations to prisoners who either didn’t want to come out of the prison for health assessments, or where it was preferable to assess them remotely due to their high security risk,” Rachel said.

Over the next years, they worked on a range of small-scale pilots. “Some of them were evaluated extremely well, but getting the funding to continue them and to commission those services across the board – or even just across our patch – was really quite difficult,” she noted. “In 2010, with the support of higher management, we opened our Digital Care Hub. I was nurse consultant for critical care and carried this role on alongside my work with the hub for many years.”

In 2014, Rachel said, the trust started their 24/7 Goldmine service which provides support for people in their last year of life. “It began as primarily a telephone service but we can also use video. The point of this service is that we can safely support people who want to be at home. We arrange for care to come to them and their families, rather than them having to travel to the hospital or a GP practice.”

As part of this, the trust supports the patient and their family to ensure that the individual can die in their preferred location. “When we look at our Goldline data, we can see that by successfully monitoring patients in their last year of life at home, 93 percent of people remain at home. These are people who don’t want to go to hospital – through out services and digital tools, we do everything we can to keep them out and where they want to be.” Rachel shared a video on Goldline which can be viewed here.

“The service is still going ten years on and is really well evaluated by patients, who love the fact that they can stay at home,” Rachel shared. “Their families and carers often tell us that we gave them the confidence to be able to support their loved one at home, and that has been invaluable for them. It makes the experience more bearable for somebody who is caring for someone in their last year of life.”

As the service continued, the trust had the idea of expanding the service beyond people in the last year of life, so that it could support people who are in their own homes with long-term conditions too.

“And so, MyCare 24 was born,” Rachel concluded. “In 2023, went into a joint venture with a tech company, who supported us and helped us to spread the services much further and we became adept at marketing and selling our services across the country.”

MyCare24 and the Digital Care Hub 

Rachel described how the trust continued with MyCare24 through the pandemic, as it evolved into virtual wards and a service called CO@H. “It’s getting to a point where we’re now looking in on 6,000 people with COPD, frailty, diabetes and so on in their own homes,” Rachel said, “and we’re also looking at a tech-enabled virtual respiratory ward.

“We care for people using video and telephone services to support carers who may not be registered nurses to keep people at home – whether that’s a care home, their own home, or somewhere else. We use electronic patient records and we have registered practitioners to deliver clinical assessments, as well as band three healthcare support workers to handle calls.”

There is the capacity to participate in remote monitoring via an app along with a paper alternative as needed, though Rachel noted that most people tend to use the digital option. “Users can input all sorts of information and access services from COPD, Parkinson’s, heart disease – there are lots of different modes and modules within this app that we can use. They put their observations in and it alerts to us on a dashboard in the hub – we can then process that alert and make a plan of what we’re going to do. That’s all documented in SystmOne, so everybody can see that this person has alerted and what we’ve done about it. Sometimes we call them, sometimes we video call them – in other situations, we just message them to say ‘how are you doing?’, depending on what the alert is. We are able to identify very early if they’re beginning to deteriorate or veer from their normal state, meaning we can intervene very quickly.”

Essentially, Rachel said, “We offer 24/7 access to a qualified health care professional for patients living in their own homes with a long-term condition… We want to improve patient experience and flow, keeping them out of hospitals if we possibly can and thereby reducing costs.”

Touching again on offender health, she described how the service covers around 44 prisons and young offender institutes, offering a mix of consultant, therapy and specialist nursing services. Rachel shared some data on appointments and waiting times, commenting: “Waiting times are quite low which is great in terms of accessibility for these vulnerable people. It is truly amazing how many different services and patient consultations you can deliver remotely.”

Looking care care homes, Rachel shared how the hub uses ‘wall boards’ which “act as a live core management system. It shows us how many calls are coming in, how long people are waiting and if they are abandoning the calls if the wait is too long. Our KPI is for 80 percent of calls to be answered within five minutes.”

Data from the service also enables the team to analyse calls by hour and track which times of day they are most busy, enabling them to alternate staff accordingly.

The impact of digital on care homes

The trust is particularly proud of the hub’s work to support care homes, Rachel said; she shared some stats showing how it has supported 90 percent of patients to remain in their place of residence, with 4000 calls per month handled in 2020/21. 50 percent of those required no onward referral.

At 9:28, she showed a graph demonstrating the number of calls received from care homes and the percentage of residents who were conveyed to hospital as a result, peaking at around 30 percent in 2018.

“We do not convey people to hospital if we can help it, if we can keep that person safe in their own home or care home. The last thing we want is for people to be carried into hospitals on trolleys, sitting there for hours and hours,” she said. “Importantly, the kind of monitoring that we would do in terms of their neurological observations, such as blurred vision, feeling drowsy or confused, can all be done in the care home. Staff can reach us within a few minutes, we can go through how to monitor the patient to make sure that they are not deteriorating, and then we call back after a couple of hours and after six hours to check in.”

The team can also support care homes with things like falls and medication, which could include advising GPs on whether a resident is due a medication review. “We have consultant pharmacists working in the hub now, which has been a brilliant addition in the last year.”

The service has helped the trust get conveyance rates down to 10-15 percent, she said, and 50 percent requiring no onward referral “is fantastic.”

As well as keeping patients safe at home, Rachel added, it’s about changing the flow of patients into hospital, and the associated benefits that come with that.

“We can now electronically prescribe which is brilliant for people in their own homes as well as in care homes,” Rachel continued. “We are spreading this from our local area towards Dorset, Devon and Liverpool. Electronic prescribing is great in terms of governance as we can keep an eye on things, what staff members are prescribing, and look at their scope of practice.”

72-hour service 

Moving onto the 72-hour service offered by the hub, Rachel said: “This is a service that we started off right at the very beginning, for people who are coming into A&E who have been confirmed as low risk by us or by the hospital. They can either go home or they will potentially be kept in for a day for observation. We then come in and tell the hospital to get them stable and send them home, and we will keep an eye on them for the next three days.”

This entails making calls a few times a day, making sure that the patient still stable and that they are feeling well enough to remain at home. Rachel noted that “nearly all of them want to be, and if there are any questions that they have or any worries, we can support them by telephone or video to manage those issues at home.” As the hub is based in an acute trust, Rachel continued, they can also get their specialists and nurses to make a telephone or video call if required.

“People don’t have to go to A&E to be referred – our urgent care response team can also visit people at home to assess whether they need our help.” The stats show that 86 percent of these cases have no onward referral.

Ambitions and future goals 

“In our Digital Care Hub, we have put all these services together as a means to empower patients and carers to manager their conditions at home with support from us. We’re trying to build system resilience because as  a system, we cannot sustainably cope with all the work the way things are going at the minute,” Rachel said.

“Our other key goal is to protect our environment, which is crucially important. If we can decrease the amount of people having to travel to hospital, not only does it protect us in terms of our physical and mental state, but it also protects our environment and our patients as well.”

Over the next three to five years, she said, she would “love to see everybody with a long-term condition being able to be managed or supported like this in their own homes. We do it in our places, there’s no reason that we can’t spread across other systems so other places can do it too. The whole point is to support people to help themselves, to proactively manage their condition keeping them happy and healthy at home.”

A few years ago, Rachel acknowledged, she would have thought that they would “never be able to get people to use apps to support them, but actually having introduced it, it works really well. I think one of the few things we can say about COVID is that it did make people realise that you didn’t necessarily have to be face-to-face to deliver a really good service.”

The other ongoing objective of MyCare24 is to “reduce dependence on stretched healthcare services. I think sometimes in the community, people go to see their patient at home just in case, because they’re a bit worried. We can do that assessment remotely now and reassure those healthcare professionals that their patient is absolutely fine and does not need a member of the community service team or the virtual ward team to go and see them in person. We are realising the patient and system benefits of this and we want to do this at scale – the whole point of doing this is to do it big.”