Artificial intelligence to identify vulnerable people that need preventative care this winter

Artificial intelligence (AI) will be used to identify patients at risk of needing to go to hospital so community NHS teams can get to them first and reduce pressures on A&Es, as part of a range of tech and data solutions being rolled out across the NHS ahead of winter.

Four GP practices in Somerset are trialling an AI system which can highlight registered patients with complex health needs, at risk of hospital admission or who rarely contact their GP and reach out to them for conversations about their health.

People most at risk will then be contacted by health coaches, nurses, or GPs, who can provide a range of preventive care such as offering vulnerable patients food parcels, escalating care to specialist doctors, putting in support to avoid falls, or link them up with a local voluntary group to help avoid loneliness.

In Buckinghamshire, the NHS is using AI linked to electronic sensors on kettles and fridges that spot changes in patients’ eating and drinking habits. These are then flagged with a non-clinical Onward Care team who speak to patients, solving 95 percent of their issues or escalating anything clinical.

Patients can choose whether they want to benefit from these local, practical measures which are helping frail patients avoid hospital readmission by offering monitoring, as well as a range of other help such as cleaning, shopping, and food parcels.

NHS teams in some areas of Birmingham are piloting an approach which uses an algorithm to predict the top 5 percent at risk of potential hospital attendances or admissions. Staff check in to offer social care assessments, medication reviews or other social prescribing measures to avoid A&E admissions. Over the next two years, the scheme is aiming to prevent 4,500 unnecessary A&E attendances, 17,000 overnight hospital stays, and free up 23,000 GP appointments.

The new innovations come as latest data shows the significant pressure the NHS is already facing as it heads into winter, with most recent data showing it was the busiest October on record for A&E departments while ambulance services experienced their busiest month so far this year.

Winter preparations have been well underway since the urgent and emergency care recovery plan was published earlier this year, with measures to help boost capacity and resilience across the NHS, including care ‘traffic control’ centres to speed up discharge, additional ambulance hours and extra beds.

The NHS has continued to expand its world-leading virtual ward programme, delivering on its ambition to roll out 10,000 virtual ward beds by the end of September, so patients can receive hospital-level care from the comfort of their own home closer to family, friends, and carers.

Sam Burrows, Chief Transformation and Digital Officer at NHS Frimley said: “For years we have talked about new technologies being able to work alongside our clinical teams in order to help patients stay healthier, happier and safer in managing their conditions. This vision is now being realised across the country, including in the Frimley Health and Care partnership, where we have been working with local people and those who care for them to ensure their needs are met.”

Across Frimley, state of the art technology and algorithms have predicted the 6,000 people most at risk of admission – those with conditions like diabetes, heart failure and COPD, and is helping them stay well at home through an app, where patients submit their health readings and get quick clinical responses and support. So far A&E attendances among those eligible have dropped by almost a third, with GP contacts down a fifth and medication prescriptions down 11 percent.

Chris Holt, Chief Transformation Officer at Birmingham Community Healthcare NHS FT, said: “Using data more smartly and harnessing the power of AI is now crucial in supporting the highest risk patients who, with the right support, can stay well at home. By identifying those complex patients – most likely to attend or be admitted to hospital over winter – means we can step in much sooner and give them support that’s personalised for them.”

Hundreds of thousands of NHS patients who have been waiting the longest for treatment will be offered the opportunity to travel to a different hospital if it means they could be seen sooner and access assistive technologies or mobility equipment via the NHS.