Urgent Community Response and Whittington Hospital at Home, previously Rapid Response & Virtual Ward provides a joined up integrated service at home for acute unwell patients, to avoid unnecessary admissions.

Patients will have access to:

• a multi-professional team consisting of nurses, therapists and health support workers, providing support from 8am until 10pm, seven days a week
• clinical and social input
• nursing staff within the service have advanced physical assessment and prescribing skills and will lead on the patients' clinical management.

The Urgent Community Response (UCR)

The service offers:

• a face-to-face initial assessment within two hours, four hours or 24 hours, depending on need identified at triage and agreed with you
• an initial assessment by a nurse and/or therapist dependent on clinical needs identified with you at triage.
• intervention will be for up to seven days or as needed, with patients being directly referred onto appropriate health and care services if required
• matron led clinical input and coordinate of the patient's health and care needs until patients are discharged from the Urgent community Response service. GPs will maintain overall clinical responsibility for the patient. The matron will update you of any concerns and contact you once your patient's intervention has been finalised.

Admission advoidance for such conditions including decline in mobility, including falls (without head injury/acute injury requiring imaging), acute MSK related pain, urinary tract infection, upper or lower respiratory tract infection, acute exacerbation of heart failure, acute exacerbation of chronic, respiratory issues, unstable diabetes, cellulitis and social needs for those needing an urgent new package of care up to three times a day or increasing care packages up to three times a day, in addition to their health or therapy need, limited to care delivered by a single person (single-handed packages of care).

Hospital at Home (step-up)

There are two step-up hospital at home pathways services available to adult Haringey and Islington residents:

• Whittington Hospital at Home (H@H) including remote monitoring pathways, for adults in Haringey and in Islington
• Islington Complex Hospital at Home, offering intensive home-based care for adult patients in Islington with complex health needs.

The services support patients of a higher acuity or clinical complexity than those supported by UCR as the patient is under the clinical oversight of a Whittington Acute Consultant, rather than their own GP. Both services are available via UCR.

The Whittington Hospital at Home, including remote monitoring pathways, supports Whittington patients including people living in Islington and Haringey, who are acutely unwell but stable enough to receive care at home instead of being admitted to hospital, or to help safely reduce time spent in the hospital. The services enable eligible residents to receive nursing, therapy, pharmacy and medical support for up to 14 days.

Patients can receive:

• daily nursing and therapy support
• medical input where required
• medication reviews and management
• remote monitoring or in-person visits based on need.

Patients who meet the criteria of hospital at home and who are stable but need close monitoring can be supported through remote monitoring using medical technology. These patients will receive:

• at least one in-person home visit
• clear instructions and support for device use
• daily monitoring and virtual reviews
• monitoring equipment (e.g. BP cuff, thermometer, pulse oximeter)
• regular phone check-ins and coordinated care with hospital teams.

This approach enables early identification of deterioration, helping patients stay safe at home while under professional supervision.

The Islington Complex Hospital at Home team is a specialist multidisciplinary team offering intensive home-based and remote (telephone or virtual) care for patients in Islington with complex health needs. The team includes:

• geriatrician
• nurses
• occupational therapists
• physiotherapists
• healthcare assistants
• therapy assistants.

The team works closely with hospitals, GPs, and other community services to provide joined-up, person-centred care.

Medicines Management

Note that all medicines governance and oversight sit with the hospital at home team while the patient is under their care. This is to reduce the risk of duplication or other incidents. If you have any questions or concerns about an individual patient, contact the service directly. Medicines supply arrangements may vary across teams.

For further details on hospital at home, visit the West and North London website.

Eligibility Criteria

Inclusions

Urgent Community Response

• aged 18+
• resident of Haringey and Islington

The service will travel up to one mile from Haringey and Islington borough borders, for patients registered with NCL (Haringey and Islington) GPs, if this supports continuity of care and is requested by the GP.

Hospital at Home (step-up)

• aged 18+
• resident of Haringey and Islington (Islington only for H@H)
• assessed face-to-face by a GP and would otherwise require hospital admission or a stay of more than 24 hours
• patients who are stable enough to be safely supported at home.

Exclusions

• patients already discharged or those whose needs are better met by traditional hospital care
• patients requiring new initiation of oxygen therapy
• those with mental health conditions as the primary diagnosis
• unsafe home environment (known drugs/alcohol/violence).

How to Refer