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Remote monitoring for care home residents across London

What was the aim?

The COVID-19 pandemic has created major challenges for care homes as staff are forced to find new ways of supporting frail or vulnerable residents without the face-to-face support from healthcare services that they would normally receive.

As a result, 5 integrated care systems in London come together to develop and co-ordinate their digital transformation plans. This collaborative approach will help to improve the digital infrastructure of care homes and establish remote monitoring technologies to help recognise the deterioration of residents’ health and improve the care available.

Across the region, project teams are working closely with 6 leading digital technology companies. The aim is to scale up their remote monitoring services to cover more than 600 additional care homes, caring for over 22,000 residents.

What was the solution?

Across London, five integrated care systems (ICSs) have joined forces to expand the use of remote monitoring technologies in care homes.

North Central London

The roll-out of the project created an opportunity to develop a vital signs education programme for non-clinical care home staff, led by nurse educators, to complement the use of the remote monitoring technology.

The solution

Whzan Blue Box telehealth product provides portable wireless monitoring equipment to measure residents’ vital signs and calculate a National Early Warning (NEWS2) score complementing each care home’s escalation process for managing residents’ health. Total rollout to 120 care homes.

The platform is accessed by authorised carers and GPs via desktop systems, smartphone or tablet to view resident’s results to support GP caseloads, virtual ward rounds and multi-disciplinary team meetings.

Total number of residents reached across North Central London as of June 2021 was 2,900.

North East London

The project involved the creation of new ‘digital peer champions’ roles to help improve the digital capability of care homes and to help play a central role in embedding the remote monitoring technologies across the region.

The solution

Inhealthcare was rolled out to all 259 care homes across the region. Staff used portable devices to measure residents’ vital signs which were uploaded to a secure portal. Residents’ NEWS2 scores are automatically calculated and fed into a central digital dashboard monitored by GP practices, prompting alerts when signs indicate a resident’s health is deteriorating. Care home staff receive updates and guidance from the GP via the system.

Feebris is used alongside the Inhealthcare platform in 30 care homes across selected parts of the region following a successful pilot. The app guides a carer through a short check-up, including vital signs capture and uses artificial intelligence to help triage patients and support remote monitoring by GPs.

The total number of residents reached across North East London as of June 2021 was 230.

North West London

Already invested in remote monitoring services for patients with diabetes, COVID-19, heart failure and COPD, and those recently discharged from hospital. This project is now enabling them to expand use of similar technology into care homes.

The solution

Inhealthcare is the remote monitoring system selected for use in 48 care homes involved in this project.

Staff use portable devices to measure residents’ vital signs which are uploaded to the secure portal. The system automatically calculates the resident’s NEWS2 score which feeds into a central digital dashboard monitored by GP practices.

Local GPs then receive alerts prompting them to take action when there are signs that a resident’s health is deteriorating. Similarly, care home staff receive updates and guidance from the GP via the system.

The platform will help clinicians to monitor residents’ health and care via virtual ward rounds and virtual multi-disciplinary team meetings, through the data being integrated into NHS primary care clinical systems (EMIS Web and TPP SystmOne) used by GP practices.

South East London

Expanding two existing remote monitoring schemes and introducing new technology to help care home residents continue to receive high quality care from their GP during the pandemic.

The solution

Docobo is used in 20 care homes in Bexley following a successful pilot. The remote monitoring platform allows staff to take vital signs readings, with GPs alerted when they need to take action.

Arc Health uses a web-cam, a close inspection camera and other vital signs monitoring equipment to enable clinicians to perform comprehensive examinations with residents virtually. Available in 11 care homes in Lambeth and a further 35 homes in Bromley.

The total number of residents reached across 66 care homes in South East London as of June 2021 was 650.

South West London

The project involved expanding the use of Whzan Blue box to an additional 11 care homes in Wandsworth.

The solution

VCare was selected as the remote monitoring platform for this project. It can be used via mobile, app-based or desktop systems and is fully compatible with key existing GP-IT systems.

Care home staff used digital equipment to monitor residents’ early signs of ill-health and measure their vitals. Automatically generated alerts are sent to clinicians and care staff, triggering appropriate action.

The platform has multiple functions, including remote video GP consultations and the ability to capture and collate residents’ data into a central digital dashboard for easy viewing by healthcare specialists.

To support implementation, the project has recruited eight Digital Integration Support and Liaison Officers (DISLOs) who are working closely with care home staff to ensure they are confident using the equipment and help manage challenges. The Team also supports care homes with other digital upskilling projects.

The total number of residents reached across South West London as of June 2021 was 720 across 131 care homes.

What is the impact?

Over 4,500 care home residents have benefited from the expansion of remote monitoring technologies so far.

The projects are expected to improve technology in over 600 care homes, which represents half of all care homes across the capital.

Positive user feedback has been received, with evidence that the technology helps to empower staff, reassure residents and reduce the need for GPs to visit care homes in person.

How is the technology working in practice?

We asked a selection of residents, health and care professionals and project leaders to describe their real-world impact in using these remote monitoring technologies . Here are their personal experiences.

“We select superusers to help train up staff”

Nurse educator, Christina, describes how the training in care homes utilises superusers who guide and support staff through the process. She also reflects on how staff feel empowered by the technology.

“We can intervene early and avoid hospital admissions”

Mike Armstrong, Managing Director of Havering Care Homes, reflects on how the technology is benefiting residents, GPs and care home staff. By enabling health problems to be identified and treated much earlier, the technology has contributed to a 23 per cent fall in hospital admissions.

“It gives me reassurance in less than 5 minutes”

Ida le Roy, 75, lives at a care home in South West London which uses the Whzan Blue Box. Ida has a heart condition and other health issues and reflects on how the technology gives her reassurance when she feels unwell and helps staff to take swift action where necessary.

“It will give us more certainty over how we treat patients”

GP Annette Pautz explains how the technology is helping to improve the way GPs work with care homes, helping to identify residents who need urgent treatment and enabling them to safely monitor residents with long term conditions.

Key lessons and next steps

Looking ahead, how might this project help to shape the future direction of health services in the region? We asked members of the programme team to outline the four key lessons that are shaping their priorities for the future.

1. The power of persistence

One of the big lessons is the need for persistence, tenacity and resilience in working with the care homes to make progress at the height of a pandemic, when attention is focused on many other pressing concerns, this is no small feat.

All five projects have experienced some challenges in getting care homes to embed the technologies, and perhaps in hindsight we underestimated the amount of time and resources necessary to provide the wrap-around support needed to deliver change.

2. A whole-system approach to engagement

Fundamental advice we’re giving to ICS leads is to avoid leapfrogging straight into a discussion about the technology. What we’ve learnt is that you need to engage first to understand the need, because if you don’t build this into the specification early on you’ll end up with a solution that’s not fit for purpose.

Furthermore, if this is a system-wide change that will affect all sectors in the system then you need to invest significant time and effort to consult all parties from day one, involving them in everything from design to implementation to evaluation.

3. The importance of local autonomy

Across London, there is significant variation in the technological maturity of care homes, which requires different strategies for upscaling use of remote-monitoring technologies. As a result, project teams have been encouraged to shape their own plans in line with local needs.

By encouraging this diversity of approach, we hope to gain some rich insights into what sort of things work best in delivering lasting transformation, drawn out by the pan-London evaluation we will be completing later this year.

4. Collaboration across ICS boundaries

One of the standout features of the London programme has been the way we have collaborated as a region, drawing together project leads from all five integrated care systems to share learnings and provide peer support.

What we’ve seen as a result is the value of having a protected space for delivery

managers to share challenges and solve problems together in a non-judgemental

atmosphere. It took time to build the trusted relationships necessary to achieve this, but it’s been an extremely worthwhile investment.

Find out more

You can read the full case study on the work across the region on our Innovation Collaborative workspace at FutureNHS.

Join the National Innovation Collaborative

The Innovation Collaborative is open to all NHS, social care and local authority staff with an interest in remote monitoring, providing access to peer-to-peer support, guidance and tools designed to help you implement a remote monitoring service.

Existing members can access the Innovation Collaborative Digital Health workspace on the FutureNHS platform. Alternatively, to join or ask any questions email innovation.collaborative-manager@future.nhs.uk.