Supporting the management of heart failure at home

The challenge

To enable remote care during Covid 19, the NHS accelerated the shift towards forms of care that allow people with heart failure to stay at home while continuing to be supported safely.

The NHS @home team in NHS England asked us to articulate the approach for managing heart failure at home, and help build consensus among stakeholders on the most appropriate way forward.

They also wanted us to establish a learning network for sites and a way to share implementation lessons to support the spread of this approach across the NHS.

Our approach

We approached this work in four phases:

• understanding the evidence base and the case for change
• developing and testing the approach and pathway development
• developing tools and resources for implementation
• agreeing final approach and pathway with national steering group and launch.

We drew on insights from learnings from the Covid 19 pandemic, those taking similar approaches across the NHS, as well as the emerging evidence base from published literature. We led work to synthesise the evidence and develop the Managing Heart Failure @home approach and pathway.

We explored where the greatest need and impact could be for patients, workforce and systems in the heart failure pathway through expert interviews and literature review of evidence.

The learnings informed an initial pathway that was refined through co-design workshops that engaged more than 470 stakeholders from across the heart failure care community.

Overall, we defined the approach and benefits in reports, an expression of interest document, co-authored thought leader blogs, and case studies from initial sites.

Building on our work, we were then commissioned to support scoping for the wider implementation of MHF @home with the aim of moving beyond intensive support for demonstrator sites, and towards wider spread implementation, recognising the progress that is underway locally.

We designed a learning network to support implementation and sharing among 10 MHF @home early adopter and accelerator sites.

Through stakeholder interviews and a co-design workshop, we collaboratively designed the network then facilitated learning network events and captured insights over the year.

Lessons and insights from the sites in the learning network were written up into a comprehensive report and service blueprint to share implementation tips and tools, and support further spread of the MHF @home approach.

Results

In collaboration with NHS England, we led work to co-create the MHF @home approach and supported partnerships among 10 early adopter and accelerator sites.

We also built on early learnings to develop a service blueprint to support further spread of the approach.

Through an iterative, collaborative methodology aligning insights from published evidence, experts and on-the-ground experience, we built a validated case for change and an evidence based pathway for MHF @home.

Our co-created pathway and service blueprint are now empowering teams nationwide to enhance and personalise patient care through deployment of MHF @home.

The work has significantly improved patient quality of life, outcomes, resource allocation and service delivery. Its success has led to wider NHS adoption, with a blueprint supporting implementation in other healthcare settings, establishing it as a transformative model for long-term condition management.

It was really important that we developed the Managing Heart Failure @home approach in collaboration with the many stakeholders involved in this important work, especially patient groups, front line teams and systems. Kaleidoscope’s expertise in research and engagement made sure we developed an approach for MHF @home that was grounded in evidence and co-produced with all of our key stakeholders. Now we have a strong case for change and a defined approach and pathway to test further with early adopters to better support people to manage their heart failure at home.

Lizzie Cardis, Senior Delivery Manager, NHS @home (long term conditions), NHS England,