Tag: Hospital at Home

Hospital at Home: Home is where the heart is for doctor Latana Munang

A West Lothian doctor is leading the way in helping to build services across Scotland that allow people to be treated at home rather than hospital.

And with a strong sense of family firmly at the heart of Dr Latana Munang’s ethos, her role at Healthcare Improvement Scotland as National Clinical Lead for Hospital at Home, has given her a job with purpose.

Healthcare Improvement Scotland is supporting the development of Hospital at Home services which reduce hospital admissions for elderly patients by providing acute care in the comfort and familiarity of their own home. Latana brings her wealth of clinical experience to the role, supporting Hospital at Home services across the country to be established and to grow. Hospital at Home services now cover nearly every NHS board and health and social care partnership in Scotland.

Latana was born in Malaysia and came to the UK on a sixth form scholarship before gaining a place at Edinburgh University to study medicine. She spent a year in Singapore as part of her registrar training before returning to Scotland where she has remained ever since.

The mum-of-two began working at St John’s Hospital in Livingston in 2011 and has remained there since. She is currently a consultant working in general medicine and medicine of the elderly.

Latana said: “Growing up in Malaysia the family structure in Asian communities was very strong. When my granny became ill she moved in with us to be cared for and that was the norm.

“Differences in society and different pressures mean that’s not possible everywhere but I do think most people are happiest being at home with family when they are ill, if it’s an option, and I really enjoy being involved in how we can make that happen.”

Ten years ago Latana was a key figure in setting up Hospital at Home in West Lothian and she remains as committed today as then to “push the boundaries in providing the best possible care for the frail and elderly”.

Latest figures show the Hospital at Home programme has seen an increase of 68% in the number of patients. The amount of areas where Hospital at Home is an option for patients has also more than doubled.

Latana said: “Sometimes people are admitted to hospital as they feel there’s no other safe alternative, but actually for older and frail patients if it’s possible to stay in the security and familiarity of home that can be best for them.

“With Hospital at Home we have a visit at the beginning to see what needs to be organised for each patient. In many cases we are able to cut out unnecessary procedures that would have been done routinely in hospital when we consider how much more complicated it would be to do from home, as we sometimes realise they’re not needed. 

“Hospital at Home is a true generalist service where on occasion we’ve had nurses change a lightbulb to prevent someone falling or check for out of date food in patient’s homes.

“Seeing people in their own homes gives us a different perspective and empowers them to feel their wishes and choices are being fully respected.”

For Latana and her husband Phil Buchan, whom she met at university, and their two children Leo (11) and Zola (9) home is Linlithgow. Latana said: “It’s a great place to live, it’s really family friendly with a strong sense of community.

“Spending time in other countries has made me appreciate the NHS and I’m lucky to be in a role that I feel so passionate about.”

More investment in Hospital at Home

A further £3.6 million has been allocated to Hospital at Home to support more than 150 extra virtual beds.

Hospital at Home can provide a safe, patient centred alternative to an acute hospital admission. It provides a better outcome for the patient, who receives treatment in the safety and comfort of their own home, as well as reducing pressure on hospital sites.

The investment for 2023-24, which will take the total funding in the service to more than £10.7million since 2020, will increase patients managed through Hospital at Home by 50% – an additional 156 beds. 

Funding will be available to existing services, and areas yet to develop Hospital at Home, with improvement support provided by Healthcare Improvement Scotland. 

Health Secretary Michael Matheson said: “Hospital at Home has already proved to be very successful and most importantly, beneficial to patients and the wider system. That’s why we have allocated a further £3.6 million so more people can be managed at home rather than in hospital.

“Patients have spoken very positively about the service and it also reduces pressure on A&E and the Scottish Ambulance Service by avoiding admissions and accelerating discharge. Hospital beds will always be available to people who need them, but this is a better alternative for many.”

Belinda Robertson, Associate Director of Improvement, Healthcare Improvement Scotland said: “We’re delighted the Scottish Government will continue to fund the development of Hospital At Home services. An increasing number of patients are experiencing the benefits of receiving acute hospital care at home.

“More and more NHS boards and Health and Social Care Partnerships are embracing Hospital At Home by establishing and developing services. We will continue to support NHS boards and Partnerships to further develop the services they provide, and share learning across all Hospital At Home services.”

Since 2020 the Scottish Government has made available more than £8 million to support the development of Hospital at Home. 

Expansion to Hospital at Home

£3.6 million to expand services

A further £3.6 million is being made available to support the expansion of Hospital at Home services, with the aim of doubling current capacity by the end of 2022.

The purpose of the service is to reduce hospital admissions for elderly patients by providing treatments in the comfort and familiarity of their own home.

The service enables people to receive treatments that would otherwise require them to be admitted to hospital, such as an intravenous drip or oxygen supply. It also provides access to hospital tests under the care of a consultant in their own home.

Evidence shows that those benefitting from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. For older patients, it means being able to stay at home longer without losing their independence and this has contributed to overall improvements in patient satisfaction. It also helps alleviate pressure on hospital beds.

The Scottish Government’s total investment in these services is now £8.1 million since 2020.

As well as Hospital at Home, the Outpatient Parenteral Antimicrobial Treatment scheme and Respiratory Community Response Teams now offer more than 600 virtual beds to treat patients for conditions that would traditionally need hospitalisation, an increase of more than a third from 440 virtual beds at the start of January 2022.

Health Secretary Humza Yousaf announced the further funding on a visit to NHS Forth Valley’s Hospital at Home service. He said: “Hospital at Home is one of the many ways we are providing more care in the community and reducing pressure on hospitals. 

“From the success of the scheme so far, we can see that there is a real benefit to treating people at home where possible.

“We know that frail patients tend to occupy hospital beds for a longer period of time and that is why we are expanding the scheme. In reducing the number of prolonged hospital stays, we will free up more hospital beds.

“With additional funding, all health boards can apply for money to either develop or expand their services with the aim of doubling the capacity of Hospital at Home by the end of the this year.”

Dr Sarah Henderson, Consultant Geriatrician for NHS Forth Valley’s Hospital at Home Team, said: “Developing this important service has enabled us to provide the same high standard of clinical care and treatment patients would receive in hospital without the need for them to leave their own home.

“We know from feedback how much local patients have valued being able to stay in familiar, comfortable surroundings without the anxiety and disruption often associated with an admission to hospital. This is also less stressful for family and friends who know that their loved one is getting all the medical care and attention   they require at home.”

Helen Sammels from Alloa has been supported twice by the Hospital at Home team when she required treatment for a respiratory condition.

She said: “I am sure I got better, quicker by being able to stay at home. It really made a difference being in my own surroundings, but I still got the care, services and tests I required. The Hospital at Home team were great, and I feel really grateful for all the treatment and support they provided.

“I also have a little dog and I didn’t want to leave her so being able to stay at home with her was very important to me and fortunately with the support of the Hospital at Home team I was able to do this.”

Support for NHS during ‘most difficult winter’

New remote monitoring tools to support people with Covid to stay safely at home, and free up hospital beds are among a range of steps being put in place to support the health and care workforce and maximise capacity.

Measures include £500,000 to fund 25,000 remote monitoring kits, including additional pulse oximeters, and a dedicated team which will support the early identification of patients who would benefit from antivirals treatments and get these started as soon as possible. This will free up beds in acute hospitals. 

COVID admissions are rising at a rate 45% faster than they did last winter, and this combined with existing winter pressures is creating significant demand on hospitals. A large spike in staff absence relating to COVID is also significantly impacting NHS service provision.

In addition to the investment in remote monitoring, the Scottish Government will also expand existing programmes, including Hospital at Home, Outpatient Parenteral Antimicrobial Therapy (OPAT) services for managing infections and Community Respiratory pathways.  These services allow patients to be treated in their own home and to receive the relevant treatment without admission to hospital.

Health Secretary Humza Yousaf said: “The next few weeks will probably be amongst the most difficult our NHS has ever faced in its 73 year existence. We are facing pressure on a number of fronts.

“Modelling suggests that infections and associated staff absences due to the coronavirus could peak by mid-January. Treating more people who previously may have been admitted to hospital at home with anti-virals and suitable support is essential to free up capacity in our hospitals.

“We know Discharge Without Delay has made a significant impact in some parts of the country and rolling it out to all health boards will make a major difference. Local contingency plans are in place to focus on the redeployment of available clinical and support services staff to essential services. 

“All of this  builds on work already underway as part of our £300 million investment in health and care services as part of winter preparations, to help maximise capacity, support the wellbeing of our fantastic health and care staff, support flow through the system and improve outcomes.”