Innovative ‘Hospital at Home’ initiative helps to save NHS more than 2,000 hospital bed days in south west London

The Wandsworth and Merton Hospital at Home team, part of Central London Community Healthcare NHS Trust, provides intensive hospital-level, holistic support for serious conditions, in a patient’s home.

Since the initiative launched a year ago in December 2021, more than 310 patients have been directly accepted by the team from both the hospital and the community, with an estimated 2,134 hospital bed days saved.

Originally set up with a focus on supporting early discharge from hospital, Hospital at Home was the first community trust-led virtual ward in the country. The initiative involves a team of healthcare professionals, made up of doctors, nurses and pharmacists, working together to make sure patients are managed by the right person, in the right place at the right time.

Since then, the team has quickly developed skills to support more digitally enabled care, such as virtual assessments, heart rhythm testing and remote monitoring. The team has also expanded to include a wider range of professionals, such as a physiotherapist and occupational therapist, so that more patients can benefit from support at home.

Two-thirds (66%) of the patients that have been seen are classified as severely frail, with 88% of patients having four or more chronic conditions, including heart failure, COPD, asthma, and pneumonia.

Remaining in a hospital bed for prolonged periods of time can cause frail patients to lose muscle tone and fitness because they are no longer doing routine activities such as bathing, getting dressed, and making meals. It can also lead to an increased risk of falling, sleep deprivation, catching infections and sometimes mental deconditioning.

Getting care at home can be better for frail patients, as it allows them to get the hospital-level care they need at home safely and conveniently, and closer to family support networks.

Dr John Rochford, Divisional Medical Director at Central London Community Healthcare NHS Trust, explains how the service is helping to improve the lives of patients with serious conditions in south west London:

““This innovative way of working means that we are able to support more patients to get better in their own homes, optimising their wellbeing and helping them to avoid unnecessary and lengthy admissions to hospital, which can have a detrimental impact on their health.

“Patients fare better in familiar surroundings, when they can sleep in their own bed, eat the food they like and have friends, family and pets around them whenever they wish. The service is already showing a significant impact, with many patients and their families embracing this new way of receiving care.”

There has been excellent feedback from patients and carers and staff are positively embracing the opportunity for this new way of working.

Agatha Anyiwo lives in Wandsworth and recently received care from the Hospital at Home team. She said:

“Hospital at Home was a life saver for me at a time where I was severely in pain and experiencing mental challenges. The help in providing me with the right medication and home equipment relieved my distress and pain. This equipment included a beautiful riser recliner chair, Zimmer frame and commode. All members of the team I met were professional, kind and helpful.”

The team works closely with other community specialist services including consultants and primary care professionals to deliver a truly integrated multidisciplinary approach for patients.

Mark Creelman, Locality Executive Director - Merton and Wandsworth at NHS South West London said:

“People have been shown to get better faster when in the place they call home, rather than if they’d stayed in hospital – sleeping in their own bed with their families and friends around them. 

“It also helps support our local hospitals as people are supported to go home earlier or avoid going in altogether. This is a great example of partnership working between the Hospital at Home team, St George’s NHS Trust, GPs and specialists in the community for the benefit of our patients.”

Going into what is expected to be a challenging winter, it is estimated that this initiative will save just under 200 hospital days each month and improve patient experience of care.

Dr Joanna Preston, Consultant Geriatrician at St George’s Trust said:

“The Hospital at Home team have provided a viable and safe alternative to admission by expanding their skillset to provide what would traditionally only have been available in hospital. This has led to more people being able to access high-quality healthcare where it will benefit them most. The team has received really positive feedback and delivered high-quality care with good outcomes.”

Sayanthan Ganesaratnam, GP in Merton said:

“As a GP, I work collaboratively with the Hospital at Home team to support patients who are at risk of being admitted to hospital and need step-up care. This is beneficial to patients as, rather than going into hospital for potentially lengthy stays, they can stay at home, receive excellent care, and be monitored closely in familiar surroundings. And should a patient start to feel unwell, there are systems in place to quickly alert a clinician, reducing the possibility of an emergency re-admission.”