Improving outcomes and value for patients in Manchester

Virtual wards really came into focus during the Covid-19 pandemic and this experience was used to inform the mandate that all local systems had to establish condition specific virtual ward pathways for respiratory, frailty, and heart failure.

System partners in Manchester and Trafford took this mandate and set themselves an ambition to go further; they wanted to make virtual ward care a core part of their urgent care offer. We supported system leaders to identify an opportunity to transfer patient care out of acute hospitals and into people’s own homes which equated to 6 inpatient wards from across Manchester Foundation Trust (MFT).

Creating confidence in seizing these opportunities

Realising the huge potential of Hospital at Home required clinicians to feel confident that the service was safe and appropriate for the patients in their care. Building this confidence was complex and required strong leadership at every level of the health and care system.

The most senior leadership came from MFT’s executive directors and the MFT Medical Director Group. Consistent commitment from this level set the tone for the whole organisation, and the Medical Directors championed the clinical benefits of the model of care. This really empowered the Hospital at Home teams in each hospital and community to make the model work.

The second level of leadership came from clinical champions on the ground. Frontline professionals who really believed in the model, took responsibility for setting up teams. We worked alongside clinical leads in each of Manchester’s three hospitals and in the three community health localities around the hospitals.

We provided on the ground support for Hospital at Home teams, working with them to overcome the practical challenges of mobilising new services as well as becoming trusted advisers, providing the encouragement to teams so they stuck at their task. We also provided a programme management structure so that teams were connected into the right support from the wider system.

Our support combined with consistent executive leadership helped to engender confidence that the massive opportunity for Hospital at Home could be realised over time.

Impact

In January and February 2024, we supported the Local Care Organisation to review what impact Hospital at Home had made to help build a case for MFT to further invest in the service in 2024/25. For a case to stack up we had to prove that Hospital at Home improved outcomes and experience for patients, and at the same time was more cost effective than inpatient hospital care.

The review was conducted by doing a deep dive into the impact of the service during the period 01 September 2023 to 31 December 2023, and we compared groups of patients who had been through the Hospital at Home service with patients who had been to hospital but had not been through Hospital at Home, and we made sure that this second group had the same characteristics and clinical indicators as the Hospital at Home patients.

The key impact stats which we identified were:

• There was 14 day in-hospital length of stay reduction for patients with frailty referred into Hospital at Home.
• A 35% reduction in readmission rates for patients referred into Hospital at Home.
• 92% of patients on the service who were surveyed were extremely likely to recommend Hospital at Home to a relative or friend.
• 11% reduction in the rate of mortality for patients with advanced frailty.
• A £1.1 million financial benefit from supporting these patients at home when compared to inpatient care.

This impact evidence was presented to MFT’s Executive Director team in March 2024, and the evidence was strong enough that the executives asked for a business case to be prepared so that the trust could continue to invest in Hospital at Home.

Creating a more resilient client orangisation

Making Hospital at Home work is really important for MFT and for the whole NHS, because demand for health services is only going to increase as the population both grows and gets older. It is impossible to meet this growing demand by building more hospitals, and even if we could, we know that there are serious downsides to keeping people in hospital for too long, like infections and muscle deterioration. This is why it is mutually beneficial for both patients and healthcare systems if we can support people to recover back to health and independence in their own homes.

To make Hospital at Home successful we need to start by recognising that providing care on a virtual pathway is a significant change for clinical teams. Clinicians are above all concerned with the safety of their patients, and Hospital at Home goes against a lot of the traditional ideas of safety; we are keeping patients at home whilst they are acutely unwell, away from all the support available within the walls of a hospital. As the evidence continues to grow to show that Hospital at Home is safe it is important the clinicians are empowered to lead this development, to give each other confidence in the safety of the model, and the benefits it can bring to their own patients.

For the health service to become more resilient, to meet rising demand and do so safely, an empowered clinical workforce will be critical for delivering innovations like Hospital at Home which will determine the future shape of the NHS.