Non-clinical roles in Hospital at Home

Hospital at Home (H@H) isn’t just clinical roles – non-clinical roles are just as vital for the effective running of a service. Gail Black, senior co-ordinator in NHS Western Isles shares her thoughts on her role within the team.

The winding road to H@H

My journey to joining H@H was not straightforward or immediate. I graduated with a degree in equine science, and spent the first seven years of my career working on a sporting estate. I spent the following seven years in Langabhat medical practice, starting off in reception, then working in the dispensary, before moving into booking clinics for the practice staff. Soon after this I moved to another role in Western Isles hospital as interim surgical secretary. When the coronavirus pandemic hit a lot of staff, including me, were redeployed, which is how I found myself providing admin support for the developing Hospital at Home service.

Developing in my H@H role

I believe that my previous experience in a medical practice and the background knowledge it has given me has really helped me develop this role. My understanding of how systems and processes worked made speaking to consultants and building relationships much easier. When I’m talking to junior doctors they often think I’m a nurse!

My role has definitely developed significantly from when I first joined the team. When I started, my time was spent on service coordination and managing the day-to-day logistics: things like coordinating with the nurses in the service, understanding the capacity, initial screening to determine how to manage new patients and chasing bloods, were just some examples of my responsibilities. Now I hold the post of senior coordinator. This allows me to spend my time focusing on service development - like spreading the service to the southern isles, looking at additional pathways, and increasing the number of patients we can take on.

The 'average' day in H@H

There is really no such thing as a typical day, but the one constant are the meetings. We have an 8.45am huddle where we create checklist and make a plan for the day. At 11.45am there is a daily meeting with all of the SCNs within the hospital, where we review every inpatient and discuss their present needs and any possible barriers to discharge, which is a great opportunity for identifying patients suitable for hospital at home. We’ve recently implemented a third meeting at 3.45pm, which allows us to go through our checklist from the morning, making sure that nothing has been missed, and discussing what needs to be carried forward to the next day. This makes a big difference when it comes to keeping everything on track for the 4pm handover.

What's next?

There are definitely exciting times ahead for H@H in Western Isles. We have recently appointed two Health Care support workers, which will allow me to hand over some of the admin elements of my role, allowing me to focus on spreading the service into Uist and Barra, and understanding what the model there could look like. I have so many ideas! I have recently been awarded a PhD Scholarship which will focus on development and implementation of a virtual ward to support remote and rural community hospitals.

We have also recently developed a cellulitis pathway – changing patients who are on antibiotics four times a day, to once a day, allowing them to return home under H@H or Outpatient Parenteral Antimicrobial Therapy (OPAT), and receive appropriate treatment whilst not developing all the health problems that come with being admitted. We also want to look at other pathways and direct GP referrals to maximise the number of patients we are able to treat at home, providing support and continuation of care, and most importantly having the patient at the centre of everything we do.

We’re also recruiting for a GP with special interest to be part of our team, and this medical input will continue to raise engagement and confidence in our service.

If you're looking to join H@H...

Being in an admin role in H@H is so interesting. There is a huge element of patient involvement - you’re not just looking at names and figures on a spreadsheet, you get to see the patient journey through to the point where they’re at home and doing well. Knowing that I’ve got a part to play in this brings a huge amount of satisfaction. The thought of going to a job without any patient involvement just doesn’t appeal to me!

To work in this role, I would say you need confidence and good negotiation skills! In the early days of delivering the service, we faced quite a bit of understandable resistance. It was really important that consultants were able to put their trust in us to treat their patients. We’re moving away from a ward-based culture of thinking we need to ‘fix’ patients completely before they can go home, to understanding what it is that the patient really needs, and asking the question of ‘can they manage at home’? Having confidence and good negotiation skills are key to having these conversations - it’s vital to create trust in these relationships, because when it’s gone, you can’t get it back.

To anyone thinking of taking a role in H@H, I would say go for it! You get to see the other side of the patient journey, and help people