Updated 13 April 2017
Background
Healthcare at Home is a clinical homecare provider, operating UK wide, and works with the NHS, pharmaceutical companies, private medical insurers, consultants, GPs and charities. The company was established in 1992 and since then have treated 1.4 million patients across 49 therapy areas. Clinical homecare is a term used to describe integrated care and treatment that takes place in a person’s home. This can directly minimise the likelihood of an inpatient stay or outpatient visit for the patient. Normally, the NHS provider retains responsibility for patient care.
Healthcare at Home’s services centre around a specialist nurse team providing clinical homecare to patients in areas including chronic disease, end of life, cancer care and supported discharge. Accessing services provided by Healthcare at Home, either NHS funded or privately, is dependent on a referral by a GP or hospital consultant or private health insurers. In detail the services provided are:
- Medication support
- Medication home treatment
- Supported hospital discharge
- Hospital admission prevention
- End of life care
- Cancer services
- Healthcare at Home Pharmacy
- Healthcare at Home Care Bureau (call centre)
This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides in England. The provider is registered in England to provide; Blood and Transplant services, Community Healthcare services, Domiciliary Care services and Remote Clinical Advice services.
Our key findings were:
- Staff were passionate about the care they provided. Support staff understood how their role enabled clinical staff to provide effective, safe and timely care. Patients told us that the staff were ‘brilliant’ and ‘could not do enough’ for them.
- Services were tailored to meet the needs of individual patients. Agreements with acute hospital trusts included clear guidance regarding the acuity and type of patients who could be accepted by the service. We saw how this was effective in identifying patients who needed to remain in hospital or those with needs that could not be met by the service.
- Incidents were recorded, investigated and appropriate actions were taken to enable staff to learn from incidents.
- Nursing staff were skilled, had access to training and received appropriate clinical supervision.
- Patients were protected from abuse. Staff were trained to recognise abuse. Concerns were escalated appropriately.
- Care programmes were based on and followed recognised pathways.
- Patients’ health and wellbeing was monitored. Support was available for patients who needed reassurance, advice or additional services.
- Governance systems enabled mangers to monitor performance, there were clear communications routes throughout the organisation, from informal meetings and conference calls which the service call ‘drum beat’ through formal quality assurance and board meetings.
- There was an open culture within the organisation and whilst there were clear lines of authority, this did not operate in a hierarchical manner. Staff treated each other as equals.
- Complaints were handled effectively. We saw robust systems were in place to recorded, analysed and responded to complaints.
- We found provision for patients with a learning disability and patients living with dementia was limited. Staff were trained to assess mental capacity and only provided care when patients were able to actively consent for it to take place. The service had no clear process to monitor or support patients who had, or might develop, dementia.
- Where the provider had a legal obligation to follow the Duty of Candour regulations; processes and documentation did not ensure that responses were given in the spirit of openness and transparency. Notifications were not given in person and letters were defensive; apologies related to patient satisfaction with investigations rather than apologising for the incident itself.