Healthcare in Crisis - New change management initiative to reduce unnecessary hospital admissions


Leading health technologists TWME8 are offering health organisations the opportunity to collaborate on a project that will reduce unnecessary hospital re/admissions of the frail and elderly.    


TWME8 aim to reduce unnecessary hospital admissions by encouraging health organisations to work together in building a local health economy. They will then assign each local partner with Healthcare and Change Management expertise, and technology that will enable system-wide improvements.   


The key technology that will be provided is the EQuip App which enables all staff on the ground to capture concerns, resolve them and track changes and impact. It also enables the overall management and governance of the programme.  


Organisations that are involved in this project will participate in a series of workshops and interventions to align and define changes, then implement those changes through a series of tests. The tests will be designed and run by staff on the ground, each of who will be given the EQUip App to capture best practice and concerns for improvement. 


TWME8 has decided to partner with the new public sector funding website CC2i in order to help them with the collaborative approach.  


The collaborative idea of a local health economy partnership aims to help all players work together and develop more integrated working practices. As well as technology this project focuses on people, process and wider change management practices, ultimately offering the opportunity to focus on 'multi-agency working. 


The programme is ideally looking for organisations such as CCGs, GP Federations, Care Homes, Social Services and Acute Trusts' Discharge Services.  


This approach has been piloted across 25 GP Practices in Hull. During the pilot readmission levels in over 75's were reduced from 30% to 12% within 6-months for a case-load of 395 people. This resulted in estimated readmission savings of £125k over 6-months. This translates into a saving of £85k per 100k patients.  


Dr David Garwood, Medical Director at LADMS (Lincolnshire and District Medical Services) said;


"The Readmissions Pilot we ran in Hull worked across 25 GP Practices and showed that it is possible to dramatically reduce hospital readmissions by improving care integration. Early on we learnt that operational staff across different agencies working with the over 75’s all grapple with gaps in service provision and that if these are not addressed they cause avoidable, costly admissions and readmissions. 


"A lack of hospital beds, pressure on A&E services, breakdowns in communication leading to unnecessary hospital readmissions and an NHS at breaking point are all daily headlines. As many others do, we believe technology is crucial to improving the current system, but also understand that the people using the technology are just as important. This is why the joined up approach of a health economy and change management expertise are essential to this project."  


The pilot found that there were substantial and repetitive gaps in service provision when patients returned home after hospital admission. Common preventable problems included: discharges without physio support, recurrent urinary and cellulitis infections not being treated locally and no care packages in place for those that have reduced mobility due to being in hospital.  


NHS figures show that 10% of emergency readmissions are 75 years+  and we know that by 2040 more than one in four people will be over 65. Demands on Emergency Services and Acute Hospitals will be immense and technology has a critical role to play to try and alleviate the situation.  


The business case for the TWME8 pitch can be found on the CC2i website:  


Health organisations interested in being involved can express interest via CC2i. Expressing interest does not commit organisations to funding but will secure them a place at a workshop event at which the pitch will be explored in greater detail.