The ambition for NW London is that by 2026, our health and care system will enable 50,000 residents to spend 180,000 more days at home with the right support for them and their families. Residents will only spend days in a hospital, community, or mental health care bed when it is the best place to meet their health and care needs. Staff in all settings will feel they have the right resources to provide the best possible care.
To meet this ambition we are working collaboratively across NW London on three specific innovation opportunities, with the potential to provide transformative care for patients and to better support our health and social care workforce.
Using a Population Health Management (PHM) approach to identify specific patient cohorts who can benefit from preventative management and intervention.
Using data science and AI to predict people most likely to be at risk of long LoS (and readmission to hospital) to implement proactive and intervening support.
Implementation of technology solutions to optimise discharge coordination by, (i) supporting the collaboration of teams across multiple settings, and (ii) providing an improved pathway which connects patient need with the most suitable care provider.
Want to learn more about how you can become part of our innovation networks? Email firstname.lastname@example.org.
Thursday 28 March, 12.00pm – 5.00pm
Royal College of Nursing, 20 Cavendish Square, London
Do you have an innovation that could support enabling patients to spend more time at home?
ICHP– in partnership with North West London ICS – is hosting an innovation network event, bringing together NHS, Local Authority and Social Care colleagues with Patients and Carers, Innovators, and Third Sector Organisations, to explore possible solutions and inspire a ‘networked innovation’ approach to this mission.
We’ve spoken to NHS staff, patients and carers to better understand why enabling more days at home, and alleviating the pressures on our acute care system in NW London is so vital…
I had to stay longer in the hospital because the system couldn’t find the proper way of finding the services.
For my care package if they had all the information about me, [the] support system would have been much quicker.
We need to improve when we’re identifying patients and the ability to work on [discharge] plans a lot earlier. We work in a really reactive environment and that’s a cultural change that’s going to be a huge challenge to overcome.
I spend 90% of my time negotiating discharges for my patients. Sometimes I feel like I am the only one who can fight their corner and question the decline (for acceptance to a community bed). You need to be persistent to get anywhere as there is so much back and forth. Most of the time, all it needs is a phone call.
There’s no communication or communication channels between acute and community. And that causes frustration for patients. Now, for example, a patient will be discharged with a catheter. But there’s no communication to say the community nurses can insert a catheter on that patient or not. Without that, we can’t really change the catheter. So whenever there’s a problem, the patient has to go back to the hospital, which is frustrating because we could do that in the community in five or 10 minutes.