Enabling More Days at Home

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.

Innovation Opportunities

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.

Proactive Urgent & Emergency Care (UEC) demand prevention

Using a Population Health Management (PHM) approach to identify specific patient cohorts who can benefit from preventative management and intervention.

Predictive long Length of Stay (LoS)

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.

Discharge coordination optimisation

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 adam.ashworth@imperialcollegehealthpartners.com.

Interested in finding out more about our Enabling more days at home mission?

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Why is this important?

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…

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.

Community Nurse, NW London

I had to stay longer in the hospital because the system couldn’t find the proper way of finding the services.

Resident, NW London

For my care package if they had all the information about me, [the] support system would have been much quicker.

Resident, NW London

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.

Discharge Hub Staff, NW London

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.

Discharge Coordinator

Mission Resources

Case study: Innovation Networks in practice – selecting NW London’s first Implementation Sites  

Partner: NW London ICB In December ‘23 ICHP launched a Call in partnership with NW...
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Case study: Managing deterioration in care homes

Partners: Kensington & Chelsea and Westminster Bi-Borough Local Authority, NW London ICB, NW London Patient...
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First North West London Implementation Sites testing innovation to enable more days at home for residents

Five health and social care providers in North West London have been selected to receive...
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Unique research collaboration highlights innovative approaches for post-pandemic healthcare

A new report outlines the findings of 14 projects which identified and tested promising innovations...
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Urgent care in London engagement programme

Published findings from the ICHP and Ipsos dialogue and deliberation engagement process to better understand...
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