The future of care is at home – why integrated care is incomplete without home care

Malte Gerhold, Chief Integrated Care Officer at DigitalHealth.London Accelerator alumnus Birdie, describes how digital technology can enable new ways of integrating health and social care, and support people to stay at home for longer.

Our ambition at Birdie is to work with older adults, care professionals and new technology to radically improve the lives of a million older adults. We want everyone to live independently at home as long as possible, healthier and happier.

At our core is a care management solution for home care agencies, helping them to improve their efficiency and quality of care. Yet this is only the first step to achieving our ambition. During our time as a member of the DigitalHealth.London Accelerator, we have started to explore how our digital solution can also help home care to integrate better with other health and social care services and pathways.

Home care – a vital missing piece in the integrated care puzzle

We know that there are such huge opportunities to be harnessed in home care. Care workers supporting people in their own homes or in supported living settings (whether that’s older adults or younger people with a variety of needs) visit their clients daily, and in many cases multiple times a day. This means that they have a much better relationship with their clients, and understanding of their well-being, than any other care professional. A physiotherapist, for example, may visit a client once a week, a GP generally only sees them a few times a year.

We currently don’t make use of this powerful relationship and understanding from home care services to improve care. From the many conversations I have had with home care agencies, GPs and other NHS services, genuine partnerships like this are incredibly rare. In most cases, on discharge or reablement pathways as well as in long-term home care support, collaboration primarily extends to emergencies (where it usually comes down to picking up the phone). This is exacerbated by little tradition of collaborative working between home care workers and health professionals, and the widely spread (and definitely unhelpful) perception of care workers as “less skilled”.

How Birdie is helping to shift the dynamic for home care

Working with our home care agency partners, we at Birdie have set out to address this imbalance. Using digital tools, home care workers can be empowered to make observations with and about their clients that help to identify health risks more quickly, and share these with NHS professionals, for an earlier clinical response where appropriate. This helps improve outcomes and well-being for care recipients, while delaying or avoiding the need for residential care or urgent care interventions, such as hospital stays. It also supports better collaborative working between care and health professionals, and provides greater continuity of care for care recipients. And this can further underpin professional development and job opportunities for care workers.

In March, we launched our first partnership to demonstrate the benefits of such collaboration between home and health care. Working with Fosse Healthcare, Nottinghamshire County Council and Nottingham and Nottinghamshire CCG, home care workers have been trained to notice early warning signs of health risks for their care recipients, such as infections. Where a concern has been identified, senior care workers follow up with measuring vital signs (such as blood pressure or temperature), which helps identify the severity of the issue. This information, with a structured description of the context, is then shared electronically with the GP for a clinical response. Birdie’s home care app enables the recording, sharing and analysing of this information. You can read more about our partnership here.

Early feedback from care recipients has been positive, saying that they feel better supported. Members of the local Primary Care Network have welcomed the work and supported its development. We have already learned a lot about improving the design of the work and information flows, how to manage clinical responsibilities across health and social care, and building good local working relationships. It’s still early days, and the East Midlands AHSN is helping the project to secure an external evaluation of the work. Emerging case studies so far give examples of infection or falls risks being noticed and addressed earlier than would have been the case otherwise.

The future of care is at home

For us, and our partners involved, this is only the first step of our journey to better integrate home care into the wider health and social care support people receive. New technologies will make it easier for home care workers to identify other risks to physical and mental well-being. The national priorities of the NHS England Ageing Well and Community Care programmes to establish local community urgent and rehabilitation response teams opens up new opportunities for sharing information with those best placed to respond. Many primary care networks are also considering how to enable coordinated triage and response across several GP practices, which will help overcome the fragmentation of care across multiple care agencies and GP practices in an area. And the technology is already there to be able to share home care agency information from Birdie into local care records.

There are still barriers to be overcome. The existing ‘by the hour’ payment approach for home care means that unless additional revenue streams are unlocked – particularly from the NHS, where most of the cost benefits are ultimately generated – it will not be viable for home care agencies to add new approaches into their model, even if it takes no longer than five or ten minutes during a visit. This is not a plea for more money or bigger profits – unless we change the commercial incentives, private home care providers with thin margins will not be able to make it add up, no matter how willing the heart. The new Integrated Care System’s responsibility for funding and commissioning is a huge opportunity here to look across health and care budgets.

We are excited to be on this journey with our partner agencies. The time has come to drop the old distinctions between social and health care, for the good of those we support, together. The future of care is at home.

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Birdie is an alumni of the DigitalHealth.London Accelerator programme.

The DigitalHealth.London Accelerator is a collaborative programme funded by London’s three Academic Health Science Networks – UCL Partners, Imperial College Health Partners,and the Health Innovation Network, MedCity, CW+ and receives match funding from the European Regional Development Fund.