Digital Services

Harry is a gentleman who lives alone in a rural area, 85 miles from his main hospital.  Harry is a Type 1 diabetic and recently had an amputation above the knee due to complications associated with his diabetes. Following the operation, Harry’s rehabilitation was supported by a multi-disciplinary team of professionals including physiotherapists, occupational therapists, the prosthetics team in the hospital, and the Hospital @ Home team who were all part of Harry’s discharge team. This team ensures Harry receives the right care in the right place at that right time; supporting him in his preferred setting and helping him to manage his Long-Term Condition. 

Harry is able to maintain contact with his friends and family throughout his hospital stay via vCreate, Facetime and WhatsApp, by using an electronic device from his bedside, keeping him connected and increasing his social interactions with family and friends. In the first week after his operation, a social worker visited his home and carried out a thorough home assessment remotely with Harry, who used his electronic device from his hospital bed and guided the social worker around his home. As a result, the social worker was able to order the required adaptations for Harry’s home including the installation of tele-care, speeding up the discharge process with the equipment being delivered and fitted within three weeks through the local authority’s ordering app. 

Harry receives rehab information electronically from his multi-disciplinary health and care team, with continued access to professionals via Near Me and he can monitor his progress through a wearable device, registering his heart rate and daily activity levels. From the support Harry received from the rehab team, self-monitoring his activity and progress and tele-care being installed in his home, his mobility improved to the point where he could be discharged home 24 days sooner than in the years prior to remote home visits being introduced; and without the disruption and upset of being physically transported to and from home post-op for his assessment.   

At discharge, the Hospital @ Home team ordered the local free ‘roamer’ community bus using an online form to take Harry home; and Harry himself was able to order his food shop online for that evening, so his return home was as smooth as possible. As part of Harry’s discharge planning, the physiotherapy team received an e-referral from the Hospital @ Home team, which is available in Harry’s Integrated Care Record, enabling his rehabilitation to continue at home.  

Harry continues to use digital options to support his health and wellbeing. He uses the My Diabetes My Way app to monitor and manage his condition with his results going directly to his local Primary Care team, his specialist diabetes nurse and his GP. He has weekly online sessions with his community physiotherapist and social worker using Near Me, as well as attending face-to-face sessions where required.   

Harry continues to monitor his progress through his wearable device and app and shares the information with his multi-disciplinary team.  In the future, Harry will be able to book and re-arrange rehab sessions online in advance, with a text reminder sent to him the day before the session through the Digital Front Door app on his mobile phone.

During Harry’s home sessions with the physiotherapist, she arranged for Harry to have a medication review with his local pharmacy and organised a Near Me call between the health and social care professionals providing his support. As a result, Harry’s medication was adjusted and the prescription sent through to the local pharmacy electronically, who organised delivery.   

As a result of Harry accessing the Hospital @ Home team, they noticed Harry’s blood pressure was high, and recruited him to the Connect Me service so he can monitor his hypertension at home and send in his readings by text – achieving greater accuracy and minimising the need to travel and helping Harry to access services directly and to be in control of his own health information.