As the NHS moves towards shared primary care services, Helen Dempster, chief visionary officer at Karantis360, outlines the value of 24/7 remote monitoring in enabling elderly individuals to stay at home for longer – with better outcomes – whilst reducing the burden on GPs, social services and carers.
The financial pressures on the NHS are severe, and show little sign of easing, especially as hospital attendances and admissions continue to rise. Clinicians don’t have time to care when they are understaffed and under financed. With one in five of the population now over 65, every part of the health service is being compromised by models that simply do not support the needs of today’s population.
The best place for the majority of the elderly is at home. The outcomes are better; the costs are lower. But with the ever rising pressures on primary care services, how can the elderly stay safely at home without putting an untenable drain on GP, social service and caring resources? How can clinicians avoid the critical events that lead to A&E visits and hospital admissions? How can integrated home care services deliver the preventative care that improves outcomes and maximises clinician time and expertise?
From GP surgeries to A&E, mental health services to ‘bed blocking’, the rapidly rising elderly population is compromising effective service delivery across the NHS. It is drastically reducing clinicians’ time to care – yet often also failing those patients at the same time.
With 11.6 million people aged 65 or over in the UK, GPs are overwhelmed not only by the complex physical health needs of the elderly but also their mental health concerns, including loneliness. Social care providers and GPs endure a huge administrative burden in creating and justifying care packages – and delay in achieving these packages, or frankly, patients falling through the cracks in paperwork, results in emergency hospital admissions, extended stays and often a very rapid patient decline.
Individuals want to stay in their own home. But how can this be safely achieved without over burdening primary care services? How can families feel confident that individuals are safe to live alone and avoid the risk of rapid decline leading to A&E and hospital admission? How, then, can the NHS get the patient into rehab and back into their home safely?
Safe Care at Home
The NHS is increasingly moving towards shared primary care services. The creation of hub locations that offer GP services, social care, adult social services, paramedics and 24/7 care are an essential step in creating a joined-up primary and social care service model that is increasingly required by a population with a complex set of physical and mental health issues.
The question is, how can these services be delivered in an efficient and effective manner that both safeguards the well-being of the elderly population and, critically, releases highly skilled clinicians from the burden of patients demanding house calls because they are lonely, worried or struggling to feed the cat?
Research shows that common ‘older age’ incidents that are an inevitable part of ageing are significantly lower when care is provided at home compared to an institutional care setting. But to safeguard the elderly population at home, clinicians, families and caregivers need better insight into their daily activities. Adding 24/7 monitoring sensors to the home can help to safeguard those who are living with long-term conditions by helping to create a fuller picture of their daily pathway. Changes in behaviour and/or physical health – such as failing to make a cup of tea in the morning or spending longer than usual in bed – may reveal signs of deterioration. Any out of the ordinary behaviour can raise an alert, for carers, families and GPs, enabling early intervention that can significantly reduce hospital admission and extend each individual’s ability to stay at home.
Data Supported Care
For GPs managing so many elderly patients, it can be incredibly hard to identify an underlying issue, especially when patients rarely see the same individual in today’s consolidated primary care model. Rather than painstakingly raking through six months’ data, including multiple surgery visits, an intuitive dashboard that presents essential clinical information in a simple chart or graph enables a GP to immediately see the full patient picture. At the touch of a button, the GP has the information to determine and create the required care package.
Combining that information with biometrics and sensor devices in the home, as part of the care package, enables individuals to stay at home. In the case of those who have been in hospital, they can receive rehab and rapidly return home, freeing up much needed bed space. With on-going continuous monitoring, family, care providers and GPs can be confident that, should the individual be in the process of developing a condition or illness that requires further examination, the sensor data will rapidly highlight the problem.
GPs have the data to hand and can immediately determine whether a home visit is required, if a phone call will suffice or whether another member of the shared services team needs to become involved. With this approach, common problems such as urinary tract infections (UTIs) can be spotted and treated – minimising the risk of individuals reaching a critical stage that requires a disruptive trip to A&E and possible hospital admission. Data enabled decision making reduces the burden on carers and clinicians while delivering a far better patient experience.
For primary care providers, the combination of this patient data with a comprehensive data analytics dashboard also provides the ability to understand trends in patient demand and demonstrate cost savings that can be achieved by preventative action. In one CCG area, an annual net saving of over £350,000 was achieved as a result of cutting hospital admissions – through early identification and treatment of UTIs, for example; reductions in A&E visits and avoidance of over 2,000 unnecessary GP call outs.
Proving the Case
The shift towards joined-up primary care service delivery is a welcome, if somewhat overdue, step in the right direction – but this push to reduce A&E visits and cut hospital admissions is putting an ever greater burden on primary care clinicians. The good news is that everyone involved in this process – from the elderly to family, carers and GPs – has the same objective: to enable an individual to stay safely at home for as long as possible. But this must be achieved without adding risk to the individual or additional pressures on clinical resources.
Twenty-four-seven monitoring provides elderly individuals with a preventative solution, avoiding the risk of falling through the cracks in joined up health provision. For practitioners and carers, technology in the home can provide the full picture of an individual’s health, enabling informed decision making that can reduce unnecessary activity – from home visits to ambulance call outs that place a strain on clinical time to care.