Delivering home care with digital support for staff and service users: Ireland

Overview

An award-winning homecare service has enabled a mental health service in Ireland to deliver all the same elements of its inpatient programmes to people’s homes. Delivered remotely, the service has provided the highest levels of one-to-one support.

Key benefits and outcomes

• Continued and comprehensive support for service users delivered virtually
• Robust IT support for staff and service users, addressing digital literacy
• Multi-channel communications campaign to raise awareness of the service

The challenge

St Patrick’s Mental Health Services (SPMHS) is Ireland’s largest independent, not-forprofit mental health service provider. SPMHS consists of three inpatient approved centres and accounts for approximately 8 per cent of general adult beds nationally, providing a range of inpatient programmes and therapies.

As the pandemic developed, the organisation identified that longer-term consideration was needed to pre-empt and respond to any increased demand for mental healthcare nationally – both during and in the aftermath of the pandemic. For those deemed clinically suitable, SPMHS explored options that would enable delivery of the same interventions remotely as people would receive if they were accessing onsite inpatient care and treatment.

The solution

St Patrick’s introduced a homecare service consisting of the highest levels of one-to-one support provided remotely. The package included:

• assignment to a multidisciplinary team (MDT)
• daily contact from a member of the MDT by video call or phone
• participation in an MDT meeting by video or phone at least once a week
• medication and prescribing review with the same frequency as regular inpatients
• appropriate individual therapy sessions delivered by video call
• appropriate ongoing psychotherapeutic interventions delivered remotely
• 24/7 support.

The organisation’s IT department played a key role in enabling the successful implementation of the service, with practical support for both staff and service users. To overcome challenges of digital literacy or other access issues arising for people using the service, a service user IT service (SUITS) helpdesk was established to respond to technology queries. This service continues to operate. On average, SUITS received 30 daily requests during 2020. To ensure awareness and accessible information on the new homecare service, a cross-channel communications strategy was developed to inform staff, service users, GPs and the wider public about homecare and other remote services. This included communications to all service users, regular updates to GPs nationwide, and a national press release and media campaign. A Service User and Supporters Council and a Service User Advisory Network are in place for ongoing communication and service user engagement.

Results and benefits

The introduction of homecare provided service users with the option to access a high level of care and support when attending in person was not optimal. As a result of infection control measures and the move to remote services, the rate of infection of COVID-19 was extremely low.

In total for 2020 there were 686 admissions to homecare. Demand for the service within the adolescent unit was such that two additional homecare adolescent service places were introduced at the end of 2020, effectively increasing the combined physical and homecare clinical numbers from 14 to 16.

Overcoming obstacles

Continuity of funding was a concern. St Patrick’s managed to secure agreement from all health insurers to continue the same level of cover to service users as is available for face-to-face care.

It also invested in developing eSwift, Ireland’s first fully integrated electronic health record system. It enabled St Patrick’s staff to work and provide services remotely, while having up-to-date access to a service user’s full clinical record. eSwift also allowed access to a daily report so that communication to service users was timely and accurate.

Takeaway tips

• Establishing dedicated IT support for both staff and service users was key to the success of the homecare service. 
• Creating targeted care, supported with a general wellbeing offer, ensured service users’ needs were met when unable to meet in person.
• Creating service user participation networks and forums, ensured service user participation and feedback informed the development of the homecare service.

Contact details

Professor Paul Fearon, Medical Director St Patrick’s Mental Health Services: communications@stpatsmail.com