Homeward bound

Clinicians across the county have joined forces to help people in Kent get the urgent treatment they need at home and relieve pressure on emergency teams.

In a small and non-descript office behind Westwood Cross shopping centre in Thanet, something extraordinary is taking place.

A ‘hub’ of highly-trained doctors, community nurses, paramedics and emergency care practitioners, are keeping a watchful eye on a giant blue screen on the wall. It’s showing a live list of 999 ambulance calls in the area, which is being carefully reviewed by the team. Each entry shows details of the patient and the injury, condition or reason they are calling for help.

Anyone who is not in immediate danger – not in category one – is picked out by the team and will have their problem virtually assessed, to see if there is a more appropriate way of treating them, which could mean they stay out of hospital. Dr Emma Hill from Kent Community Health NHS Foundation Trust’s (KCHFT) Frailty Home Treatment Service, is on the rota in the clinical hub today.

Emma said: “Relatives or carers need help and their first call can often be 999. In the past, paramedics might have taken the patient straight to hospital, but thanks to our new way of working, we’re often able to keep people at home and get urgent care to them.”

Brian*, 83, has had a fall in his back garden and his wife, Iris, called for an ambulance. Brian’s details pop up on the screen and the hub team swings into action. Emma phones the ambulance crew on the scene who advise her Brian is confused, shaken up and has cuts and grazes. The crew take Brian’s blood pressure and pulse and send photos of injuries back to the hub. All of the information appears on the blue screen for the team to discuss.

Emma said: “We can provide really good treatment at home, so we monitor the ambulance queue to see if we can stop someone from being admitted in the first place.

“Eight out of 10 of the people we support at home are frail and elderly who really don’t want to go to hospital. They might have had a fall, or an infection for example, which is causing them to be confused, distressed or unsteady on their feet.

“If someone is in immediate danger, has suffered a suspected heart attack, a stroke, or an injury that needs an x-ray like a broken hip, we will let the ambulance crew get on with taking people safely to hospital.

“Otherwise, we see if they can be seen at home, or by a more appropriate service, such as same day emergency care (SDEC), an urgent treatment centre (UTC) or a frailty team.”

Emma arranges for a community healthcare assistant and an occupational therapist from the KCHFT Urgent Care Service to visit Brian and Iris later that day at home – and another hospital admission is avoided.

One of the next patients is Susan, 75, who has fallen and appears disorientated and confused. A neighbour has called 999 and the call is picked out of the list by Emma and South East Coast Ambulance Paramedic, Joshua Byrne-Smith. They decide to contact the paramedics on site and speak to them about the case.

Joshua said: “The crew has told us the lady is living alone in a cluttered home and she’s not coping well. She’s ok, but we have made a referral to social services and they will go in and assess her. She doesn’t need to go to hospital.”

Next, a dementia care home manager has called 999 following a violent outburst from a resident.

Emma explained: “Sometimes people living with dementia experience a crisis and care home staff will call an ambulance as they are unsure what to do. We can make a direct referral to the Dementia Crisis Team in the mental health trust which can make a home visit. The last place someone with dementia needs to be is in hospital – if we can hospital avoid it. It could make the situation for them so much worse.”

Emma gives advice and reassurance to the care home manager who is able to keep the patient safe until extra help arrives later that day.

First set up as a trial in November 2023, there are three more hubs in Kent, Ashford, Paddock Wood and Strood, meaning teams can provide local care quickly, when needed, to support our main acute hospitals. The Thanet and Ashford hubs will combine into one site, serving east Kent.

The east Kent hub, run by South East Coast Ambulance Service NHS Foundation Trust (SECAmb), East Kent Hospitals University NHS Foundation Trust (EKHUFT) and KCHFT is proving so successful it has been shortlisted for a national award.

Wendy's wellbeing

How our clinical hub helped a family from New Romney to stay together.

When Mandy Remy’s 89-year-old mother, Wendy, started experiencing a decline in her health, her family was faced with a challenge.

Wendy, a fiercely independent woman who had until recently been running a farm single-handedly in the Welsh mountains, had broken her shoulder a year earlier, and the trauma had taken its toll on her physical and mental health.

Mandy, from Littlestone on the New Romney coast, said: “We decided to move mum closer to us, but still living independently in a flat just behind our house.”

But Wendy was struggling with a hidden condition which meant she had low sodium levels, leading to nausea and confusion.

Mandy said: “She had already experienced a short stay in the William Harvey Hospital after one episode, when I called 999. The hub actually stepped in at that time and the home treatment team came to the house.

They said, ‘right, we have a mobile hospital. Let’s get set up in your kitchen’ and that’s what they did.”

Dr Yohan Perera, a speciality doctor from the Home Treatment Service, said: “Wendy was identified by the hub team in the ambulance queue as someone who, although unwell, could be a candidate for home treatment.

Our team went to the house and carried out an assessment, where a point-of-care blood test revealed she had hyponatremia, a condition which can cause sodium levels to drop.”

The team tried to stabilise Wendy’s condition at home, but her sodium levels continued to fall and they had no choice at the time but to send her
to hospital. Mandy said: “They did everything they could to advocate for the care that mum received in hospital, we got a bed, and she went in for two weeks.”

However, the hospital stay did little to improve Wendy’s condition and when she was discharged she moved in with Mandy and her husband, Peter.

A few weeks later, after finding her mum in distress, Mandy called 999 again and the hub team intervened.

This time, they sent a clinician to Mandy’s home every day for a week to monitor Wendy’s condition, carry out blood tests to assess her sodium levels and, with support for Mandy and Peter, it meant Wendy could stay at home.

The approach proved transformative for the family. Mandy was able to keep her mum in familiar surroundings with her beloved dogs by her side. The daily visits and constant communication from the clinical team provided the reassurance and support the family needed.

“They calmed her down. They calmed us down,” Mandy said. “If anything wasn’t right, or we were worried about something, we had support straightaway.”

Wendy’s condition sadly continued to decline and she eventually had to be moved to a nursing home. But Mandy is grateful for the time they were able to keep her mum at home.

“It just took so much pressure off of us,” Mandy said. “We knew somebody was keeping an eye on her and it wasn’t just down to us to manage. We definitely felt we were lucky.”