With an NHS drive on reducing hospital waiting lists and with winter pressures forthcoming, we talk to Adrian Flowerday, Managing Director of Docobo remote monitoring about how we may be overlooking the real reason why some people are in hospital in the first place. In this blog we’ll find out more about how patients with long term conditions, particularly those with co-morbidities, could be managed differently to avoid hospital admissions and ultimately to optimise their health.
Long term conditions and the need to optimise patients' health
22 November 2023
The problem
Our whole driving force here at Docobo since 2001 has been keeping people out of hospital, and monitoring people at home, where many people prefer to be cared for. We believe the NHS workload can be dramatically reduced and patients’ health improved by using available technology.
With the percentage of people with long term conditions (LTCs) in England at over 25% of the population; and high, or very high risk patients costing the NHS more than £10k per person per year for their care : of every £10 the NHS spends, £7 is associated with long term conditions. In addition, 60% of patients admitted to hospital as an emergency have one or more long term health conditions, many with co-morbidities.
Despite the fact that there’s been lots of talk, there has been very little transformation of care in terms of people with long term conditions, while the focus onto virtual wards has become such that LTC monitoring appears to have become less of a priority than it deserves.
We think there is a lot more to do in order to prevent people being admitted to hospital in the first place. We also think that by using a more proactive focus on LTCs we could go a step further.
The technology and processes are in place in many areas of the country, and we know from several sites that the reduction in admissions when using proactive care is over 23%, recent real-world evidence demonstrates that it’s over 30%. This approach is being used in Frimley and is proven to reduce admissions to emergency services in hospital.
We need to do more of this – and at scale.
COVID stops play
During the COVID pandemic, many processes of care for people with LTCs were reduced or dropped, as NHS teams had to work out how best to deliver care under such difficult circumstances. This is where virtual care suddenly became more widely accepted and used within healthcare, and where we at Docobo were able to support new services and pathways which were enhanced with remote monitoring, for example, our COVID Oximetry@Home remote monitoring. The NHS were keen to explore the benefits of remote monitoring, and clients such as Cheshire & Merseyside, who’ve been providing remote monitoring with our technology since 2017, were able to rapidly expand their services to support significantly more individuals.
However, the pandemic has left us with a rise of people in hospital and an increase in demand which means we do need to get back into proactively looking after people with complex LTCs such as heart failure, diabetes etc.
It has been suggested that for people with LTCs such as heart failure, diabetes etc find each attack leading to an unplanned admission reduces their quality of life and health and can lead to emergency admissions in the future.
If not regularly monitored for vital signs and symptoms, individuals can deteriorate quickly and end up calling 999. They may then experience muscle loss and increased probability of acquiring additional illnesses while in hospital (such as Norovirus or MRSA). Elderly people are more likely to require longer hospital admissions, some of which experience their health to deteriorate so significantly due to the admission that they are no longer able to live independently and may require a care home, with the associated costs and concerns to the family or social care services.
However, if managed proactively, early detection of deterioration and early application of suitable inventions can significantly improve outcomes and reduce further deterioration.
New ways of working – Virtual wards and long term conditions
One of the key elements from the NHS 23/24 operational plan was ‘prevention and the effective management of long term conditions’ which the NHS see as ‘key to improving population health and curbing the ever increasing demand for healthcare services’; and with NHS England expanding its virtual ward scheme and asking Integrated care boards (ICBs) to expand their use of virtual wards to include heart failure patients, Docobo is well placed to support this expansion.
The operational plan has a significant focus on cardiac conditions – this can be partly attributed to the clinical impact of COVID, as respiratory issues are leading to heart problems and there’s been a significant increase in cardiac problems subsequent to the pandemic. We enable the NHS to safely and efficiently monitor individuals at home or keep them away from hospital, then help get them home faster if a hospital admission is required. Look at the amazing work ongoing at Liverpool University Hospital Foundation Trust and Liverpool Heart and Chest Hospital.
It’s great that the NHS is focusing on preventative measures and also the proactive management of LTCs. For over 20 years Docobo has been providing remote monitoring for people with LTCs, which enables the NHS to keep these conditions manageable within the community and – where this is not possible – reducing emergency inpatient stays.
Population health analytics –intelligently identifying cohorts
Another part of the puzzle is the need to intelligently identify people who have LTCs, so they can be offered monitoring and treatment. This is where population health analytics comes in, which enables clinicians to quickly, easily and intelligently identify cohorts of people who have co-morbidities and LTCs and then enrol them on successful programmes.
Docobo and its parent company, Graphnet, can provide end-to-end patient monitoring – from identifying cohorts via population health analytics, using that insight to apply earlier interventions for those requiring support to remain in their own home, to auto-enrolling individuals to a service – it’s the whole package!
This is where it all joins up. At Docobo we offer solutions which enable the monitoring of any condition at any stage – as well as prevention.
Effectively and proactively supporting people with LTCs in the community has been an ongoing problem within the NHS, there’s no denying it, but there is also light at the end of that tunnel. Docobo’s mature remote monitoring –enables efficient monitoring of LTCs and complex conditions and is proven in these case studies. When used with Graphnet’s shared care record and population health management– they are such powerful tools.
This recent HSJ article shows how Frimley ICB – who have the whole suite of Graphnet and Docobo products and the right teams in place – were able to identify complex patients in GP practices and provide equipment and guidance within weeks.
I want to leave a challenge to readers: which other systems do you know of that will give you those reductions in admissions? Docobo is keen to talk to any ICB or NHS organisation to share the structure and management competencies in order to make this happen.
