Whittington Health's director of strategy and corporate affairs discusses the response to COVID-19 among community services.
As an integrated care organisation (ICO) providing community and secondary care services to two boroughs in London, Whittington Health were in an ideal place to respond positively to the COVID-19 pandemic.
One of our early actions was to redeploy many of our community musculoskeletal (MSK) practitioners into our intensive care unit working as support workers, as we moved the ratio of patients to expert nurses from 1:1 to 1:4 and higher. We created that capacity by switching off less urgent services, but also by doing video assessments and treatments across MSK, IAPT, dietetics and podiatry, allowing patients to access services and keeping them safe. We also used the great relationships we had built up with council services and our strong rapid response team to host a single discharge hub both for ourselves and our neighbouring specialist acute trust, University College London Hospitals NHS Foundation Trust.
This resulted in the rapid discharge of many patients and we were very proud to achieve zero delayed transfers of care. This was helped by the quick rollout of ‘Medopad’ remote monitoring for our virtual ward and merging our integrated care ageing team with the rapid response team, meaning much closer working with specialists and a move to a 24/7 model. As part of this, our community frailty team have also trained all their physios and pharmacists to take bloods so patients can avoid visits by multiple professionals during comprehensive geriatric assessments.
We had previously built up good relationships with the primary care networks around locality working. One area had already set up a leadership team for the locality and this led to swiftly coordinated care with the voluntary sector for shielding and vulnerable patients. Our relationship with a local GP federation meant that during COVID-19 we were able to create joint posts where our district nurses and primary care practice nurses worked together to form a home visiting service for those that would not normally qualify for this level of care.
As we’ve seen across the NHS, technology has helped in our response to this pandemic and in keeping our staff and patients safe. Our integrated community respiratory team set up virtual pulmonary rehab clinics; our community teams used video calls to do environmental assessments to keep patients safe at home; staff used iPads for remote multidisciplinary teams in care homes, allowing clinical examinations without having to visit; dysphagia assessments were even conducted over video. These have proven so successful, allowing urgent high risk of aspiration patients to still be seen remotely, that we are also meeting our urgent waiting time targets.
Our children’s services are similarly truly integrated, not just between acute and the community, but also between the community and the council. The real integration success was moving our paediatric outpatient work off our hospital site into a community site to create a ‘green’ flow and space for surge capacity. Technology has helped here too with much of our family work becoming virtual, including teletherapy. We have created training webinars for schools and worked with Ambitious About Autism on social stories about going into hospital and seeing staff in personal protective equipment. We are also one of the first to use an online diagnostic tool for autism.
We have obviously learnt a lot over this time, the main thing being the importance of relationships across the health and care integrated care partnership at times of difficulty. The fact that we previously worked well with our counterparts in council services and primary care meant that we were about to set up services and help each other much quicker. We also knew the pressures each area was under and were willing to go the extra mile for each other, such as freeing up community clinic space for GP hot hubs and supporting the set-up of Amazon wish lists for council residents. The GP on our board helped us understand the primary care pressures and ensure continued links when things were busy.
Now as we ramp up regular activity again we are looking to lock-in the positive opportunities the pandemic has given us, such as expanding access to GP clinical notes to a wider set of our community long term conditions teams. Keeping integrated care at the forefront of decisions and guiding our direction of travel, even during acute secondary care pressures, is vital as we have found it prevents attendances, reduces admission rates, supports primary care and maintains that vital link with social care and the voluntary sector to tackle the wider determinants of health. Being an integrated care organisation is essential to this as by nature we have one foot firmly in secondary care and the other in the community.
Jonathan Gardner is director of strategy and corporate affairs at Whittington Health. Follow him and the trust on Twitter @jpgardner24 @whithealth
Focusing on the 'neighbourhood level', the Neighbourhood Integration Project draws together case studies on how more joined-up care has been delivered in four localities.