When health organisations in Essex sought to radically scale up their digital care home technologies in response to the pandemic, they quickly found that winning health professionals’ trust through smart and targeted engagement was essential – as Michelle Angell, Associate Director of Assurance, Mid and South Essex CCGs, explains.

As in many parts of the country, the pandemic has significantly accelerated the digital transformation programmes already underway across Essex.  For us, it has meant moving from a small-scale pilot involving just over 20 care homes in the south east of our region to a wholesale roll-out of WhZan’s Blue Box technology across the whole Mid and South Essex (MSE) area.

The Blue Box provides care homes with everything they need to monitor and report on the health of their residents in one place – all of it literally contained in a large, portable blue box. The kit measures vital signs (blood pressure, pulse and temperature, weight), records photos and performs multiple assessments such as NEWS2, MUST and the Abbey Pain Score and questionnaires, so that early signs of deteriorating can be identified before things get worse.

The equipment supports the GP practices and other clinical teams whilst conducting virtual consultations and paramedics/community teams attending the care home.  MSE are currently expanding this model to include digital stethoscopes and ECGs with links to secondary consultants to provide specialist support.  The care home can provide access to the caseload information of their GPs, NHS 111 and other clinical teams.

 

Early impact of Whzan 

The technology has really come into its own during the pandemic, where it has successfully enabled our care home nurses to monitor residents’ conditions and alert GPs and other health professionals when appropriate.

We saw early benefits in terms of earlier detection of COVID-19, pneumonia and other critical illnesses, which led to reductions in hospital attendances and admissions. Care home staff also report that it helped them look after their residents more confidently as the data helped to inform conversations they had with clinicians by phone.  Across MSE, our CCGs have seen an overall reduction of 242 A&E attendances from Care Homes and 212 admissions year to date, compared to the same time last year.

While limited in its scale, our initial pilot work was extremely helpful because it gave us a strong blueprint for effective implementation – from investing in the training and education of the care home staff who would be using the technology, to making sure all health professionals who might receive data from the Blue Box were aware of how it was captured and had faith in its accuracy.

Last year, NHSX funding meant we were able to increase the support provided by our care home training team and expand the project across the whole region, with 280 blue box kits deployed within a matter of months.   This was supported by a team of nurses undertaking face-to-face basic observations training and signing the care home staff off as competent to take these observations.  There are now more than 240 care homes participating in the programme and a number of community teams and step-down facilities, representing a ten-fold increase on the original pilot and reaching over 7,000 residents.

 

Scaling up: the engagement challenge

Yet there have been some challenges in scaling up at speed. In our case, one of the issues we uncovered was a lack of awareness among paramedics. As more and more care homes came on board, we started to receive feedback from our community teams that some observations had been discounted by paramedics. This left the care homes feeling like their observations were not being taken seriously, despite the training they had received.

Fortunately, with the support of the East of England Ambulance Trust, we were able to address this issue swiftly and effectively. A region-wide communications campaign was established, helping to explain what the technology could do and how nursing and care home staff were equipped to capture this vital data.

Since then, we’ve seen ambulance staff become some of the biggest advocates for the new technology. We’ve received feedback that they are now proactively asking for key observations from care homes as a way of saving time before their arrival and several care home managers have reported cases where paramedics have warmly praised the equipment for giving them insightful data quickly in time-critical situations.

 

Conclusion

So what did we learn from this? Looking back, the big lesson for us is that you have to match your engagement efforts so that they are proportionate to the scale of implementation, or else you risk leaving critical partners behind.

In our case, one of the biggest benefits of the technology is in reducing A&E attendances and this made ambulance services a key stakeholder that needed to be on the same page. Ultimately, trust is the currency of progress in digital transformation: you really need to invest the time, effort and thought to bring everyone on board.

We’ve learnt first-hand how important it is to put engagement at the heart of implementation – and that’s certainly what we intend to do as we shape the next key stage in our digital health plans, which will involve the roll out of additional digital stethoscope and ECG functionalities across our care homes later this year.

To find out more about the Mid and South Essex Remote Monitoring in Care Homes programme, e-mail m.angell@nhs.net