Thousands of patients to benefit from NHS At Home roll out

Thousands of patients with cystic fibrosis and dozens recovering from coronavirus are being given devices and apps so that medics can monitor their condition remotely, as part of the NHS drive to give more people connected, supported, personalised care in their own homes.

People with cystic fibrosis (CF) are among those classed as at extreme risk from the coronavirus and have been advised by the Government to follow specific shielding advice.

From this month, NHS England will help CF patients aged six years and over to be given a spirometer to measure their lung capacity, and an app that lets them share this information with their doctor.

Home-based spirometry has been hailed as ‘the most important intervention’ for cystic fibrosis patients by the CF National Network.

NHS England has accelerated the roll out to help ensure people can stay safe at home during the pandemic, while at the same time ensuring that those whose condition worsens can get the right help fast.

NHS chief executive Sir Simon Stevens said: “For patients and their families living with cystic fibrosis this is a landmark moment, offering people vital health help at home.

“The Covid-19 outbreak has hit every household in the country but for some people with certain conditions, this virus will have been especially unsettling and dangerous, which is why the NHS is looking to make sure those at greatest risk can get safe, tailored care, despite the ongoing pandemic threat.

“As the NHS in England moves from having responded successfully to the first wave of the virus, to helping people to recover and to restoring routine services, it is common sense, convenient and innovative forms of treatment like at-home lung checks that we are making increasingly available to people across the country.”

Professor Andrew Menzies-Gow, NHS England national clinical director for respiratory services said: “The measurement of lung function, which normally occurs in hospitals, is essential to tracking disease progression and deciding changes in treatment.

“Enabling thousands of people with cystic fibrosis across England to provide this information without leaving their home is a vitally important step change in reducing the need for hospital attendances or admissions.”

Dr Janet Allen, director of strategic innovation at the Cystic Fibrosis Trust, said: “The expansion of home spirometry by NHS England and NHS Improvement to 4,000 people with cystic fibrosis across England is great news.

“We’ve been working closely with NHS England and NHS Improvement to ensure more people with CF have this equipment at home during these difficult times, so that clinical teams can continue to make important decisions about their care. It also builds on research we’re running – a study called Project Breathe – to help us understand whether measuring things like lung function, oxygen levels, activity and weight at home can reduce the number of hospital appointments for people with CF.”

At the same time, a separate trial will see some patients with COVID-19 given devices which can help spot any dip in their blood oxygen-levels while they recover at home.

The NHS is trialling the use of oximeters, combined with app-based check-ins with clinicians, which will make it easier to spot whether people need to be re-admitted to hospital.

The new oximeter service is being trialled with more than 150 patients in sites in Watford, Hertfordshire and north London, with the NHS’s digital transformation unit, NHSX, working with British digital health start-up, Huma.

Clinicians in ‘virtual wards’ are able to track patients’ vital signs – including temperature, heart rate and blood oxygen saturation – in near real-time, receiving alerts if they suggest a patient is deteriorating so that further assessments and care can be arranged.

The service has since been extended to additional sites in West London, with plans for further pilots in other areas of the country including higher-risk patients who have recently tested positive for COVID-19.

If the trials show the model to be safe and beneficial for patients, they could help to inform a national rollout ahead of the coming winter.

Tara Donnelly, chief digital officer, NHSX said: “This is a great example of how new technology is supporting healthcare professionals to provide the right care at the right time. With COVID-19, it’s vital that we make use of digital tools that can help support patients who don’t need immediate hospital care and allow close monitoring of their condition.

“The feedback we are getting from patients is that the remote monitoring with clinical oversight is really reassuring to them, and they are grateful to be at home while they recover, rather than in a hospital bed. The clinical team is finding it helps give them very rapid feedback on their patients and they are able to keep an eye on a number of people at a glance, which is working much better for them than the previous system which relied on phone calls.”

Health and social care secretary Matt Hancock said: “Technology has been an incredibly powerful tool in our response to coronavirus. We have learned so much about what can be done online, and in some cases, what is better done that way. Technology will play a growing and vital role in the future.

“While we restore face to face NHS services too, new innovations will ensure patients can benefit from the comfort of home, with the reassurance that they can be fast tracked to support from the NHS should they need. NHS at Home will help keep people safe and out of hospital while providing the best possible care.”

The digital revolution within the health service was underway long before COVID-19, with the NHS Long Term Plan setting out an ambition for greater use of connected home-based and wearable monitoring equipment, combined with apps, software and data.

Experts believe this kind of innovation has the potential to empower people to manage their conditions at home and help NHS clinicians to predict and prevent events that might otherwise lead to a spell in hospital.

Despite facing the greatest global health threat in its history, the NHS has accelerated plans to bring digital technology to patients’ homes, and leaders are keen to lock in the benefits of successful innovations for years to come. ​

Ends

For further information please contact the NHS England and NHS Improvement media team on nhsengland.media@nhs.net or 01138 250958/9

Additional information on home-based spirometry for CF patients

  • The home-based spirometry technology is currently being trialled in several sites across England, including the Royal Papworth hospital and as part of CF Trust’s Project Breathe at the Royal Papworth Hospital. To date, feedback on the technology has been positive for both patient experience and viability.
  • The scheme is aimed at supporting CF patients who are 6 years and older based on the advice of the CF Clinical Network Cell.
  • The scheme has been designed with the advice of the CF clinical community and with shielding guidance in mind. Spirometers are a long-established technology which most CF patients will be accustomed to using. This scheme will help clinicians monitor and treat their condition while avoiding unnecessary visits to hospital.
  • Following the initial roll-out, further work will be undertaken in relation to new models of care for CF patients.

Additional information on at home monitoring of COVID-19 patients

  • The software that links patients with clinicians in this trial is called Medopad, provided by Huma, and also uses pulse oximeters to measure oxygen saturation – a key detector of COVID-19 deterioration.
  • The London element of the trial is being delivered through the Academic Health Science Network in North London, Imperial College Health Partners in Hillingdon and Central ‘Hot Hubs’ in West London. It is also being run at Watford General Hospital, which is part of West Hertfordshire NHS Trust. 
  • The project started on 24 April, 2020 and suitable patients are discharged with a care plan via email or text with a unique code to download and access the Medopad mobile app.
  • More than nine out of ten (96%) of the patients in the trial are actively using the app with the oldest patient being 80 years old. At least 10 new patients are being signed up each day across all sites and remote monitoring is now the default offer for patients with a smartphone.
  • Early results are positive; patients are finding the tracking reassuring and deterioration is being spotted rapidly.  Information provided by the app and monitoring devices means clinicians are alerted to signs of patient deterioration and can provide treatment.

Plans are underway to extend the service further.