Connecting the Dots: Enabling Proactive Risk Assessment across Kent and Medway

Connecting the Dots: Enabling Proactive Risk Assessment across Kent and Medway

Connecting the Dots: Enabling Proactive Risk Assessment across Kent and Medway

“The connecting of home-based and wearable monitoring equipment will increasingly enable the NHS [and social care] to predict and prevent events that would otherwise have led to a hospital admission.”

NHS Long Term Plan, 2019 

According to figures from the Office for National Statistics (ONS), around 440,000 people currently live in care homes across the UK (ONS, 2023). In England and Wales, over 80% of these residents are aged 65+, with more than half aged 85 and over. Around 185,000 emergency admissions per year are attributed to this demographic, amounting to 1.5 million emergency bed days (NHS Long Term Plan,2019). Evidence shows that 35-40% of these emergency admissions can potentially be averted with the right care in place (NHS England internal analysis, NHS Long Term Plan, 2019). It is well known that up to 55% of older patients experience a decline in the ability to perform routine activities during hospitalisation, and up to 65% a decline in ambulatory function.

Within the last five years, we have seen an increasing focus on digitally-enabled initiatives aiming to empower carers with the tools needed to spot early deterioration, ultimately preventing hospitalisations and improving quality of life for residents. An independent health economic evaluation of a project running in North-East London found our virtual care platform enabled a 38% reduction in visits to A&E, 25% reduction in hospital admissions, and £500,000 saved every year for every 1,000 patients (York Health Economics Consortium, 2023).

An interim impact report of a similar project currently ongoing across Kent and Medway, completed in December 2023, echoed similar findings.

“As a care home, we are not fully digital until next year, so this helps us to prepare and do things in a different way than before.” 

“The system has been very beneficial (…) we were able to pick up low blood pressure for a patient and the GP arranged medication and support, reducing the number of falls (...). It massively increased our confidence [to use health technology]. It’s so easy to use and provides very good support for GP surgeries as they can access information much quicker.”

“Staff don’t have to go back and forth seeing separate folders as all the information is right there in one place.”

Care Home Managers, Kent and Medway

Kent County Council (KCC) partnered with Feebris in June 2023 to launch a programme to enable proactive risk assessment and early detection of deterioration of older adults residing in care homes. As one of the largest local authorities in the UK, KCC supports a population of just over 1.5 million, with 16,000 people in social care. The region has an ageing population, with forecasts indicating the number of people aged 65+ will increase by 40.7% between 2022 and 2040, yet the number of people aged under 65 only forecast to increase by 12%.

“We’re always looking for innovations to help us achieve better outcomes for people living in the community and in care homes, but also to help us achieve more sustainable social care,” said Georgina Walton, Senior Project Manager, Innovation Delivery Team, Adult Social Care & Health, at KCC.

“As part of that, we were exploring opportunities last year, particularly around falls prevention and the use of technology. We were really keen to look at solutions that will allow us to help the care homes that have the highest rate of ambulance callouts and see if a digital solution could help reduce that and therefore have that wider system impact,” Gina added.

Figures from the Office for Health Improvement and Disparities (OHID) show that around a third of people aged 65 and over, and around half of people aged 80 and over, will experience a fall at least once a year. From 2017 to 2018, over 220,000 emergency admissions to hospital were related to falls in patients aged 65 and over, with over 66% aged over 80 (OHID, 2021).

Working together, the Council identified care homes in the region within the top 20% of ambulance callouts, and looked at where admissions were linked to a potential fall to then introduce mobility monitoring.

“We’ve now got the data to show there is a significant reduction in health events requiring 999 calls and then following ambulance visits and conveyances to hospital.”

Georgina Walton, Kent County Council

“There were a number of elements that we were trying to achieve when we started. One is around how we can use digital and be more innovative, with a real focus on falls prevention, looking at how we can potentially use digital to reduce falls and hospital readmissions. This is to help us manage the hospital discharge process while also achieving better outcomes for residents living in care homes, making them feel more comfortable and more confident. Supporting the care workforce was another big piece for us,” Gina added.

“Since launching, we’ve got some really powerful data coming out from the care homes using Feebris, supporting large numbers of residents across 30 care homes, and some really rich feedback. We’ve been able to collect data and evidence to demonstrate the impact the programme has been having on both the workforce and the residents the homes support.

“What we are finding so far is that carers have reported increased confidence in using health technology more broadly, it's reducing duplication of effort, and they’ve also observed a real positive impact on the relationship with the residents. And it’s allowing better communication with primary care as staff have access to the data they need. The total number of health assessments per resident also really increased over the last six months, and we’ve now got the data to show there is a significant reduction in health events requiring 999 calls, and following ambulance visits and conveyances to hospital.”

Gina continued: “By having the system in place, the feedback we’re getting from carers is that it really complements the work that the care come currently does, but it also enhances it and ensures that staff feel confident they’re getting good data, and residents feel confident as well,” Gina added.

The Feebris platform uses advanced algorithms to ensure the precision and accuracy of insights, enabling better prioritisation and reducing waste in the system.

Within the next six months, the programme is expected to grow as mobility monitoring is introduced to support residents at risk of falls, supporting assessments of frailty and associated risk.

“It’s been brilliant working with the Kent County Council team for the past year to support carers and residents across the region. The impact that we’ve seen in the first six months of the programme highlights once again the importance of investing in initiatives prioritising early detection of deterioration. With the added mobility monitoring functionality that we started to deploy in January, we are excited to see the impact and continue to work with the Council team to support people across Kent and Medway to live longer, healthier lives,” said Dr Elina Naydenova, CEO and Cofounder of Feebris.

The Feebris virtual care platform is currently deployed across over 100 sites in the UK, spanning care homes, primary care facilities, community and district nursing and virtual wards. This includes the biggest integrated virtual ward programme in the country, covering four different trusts in the Norfolk and Waveney region. The solution is designed to enable the continuum of care, supporting patients through periods of stable monitoring and episodes of higher acuity.

If you would like to learn more about this project, please contact the Feebris team at

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About Feebris

Feebris helps carers to identify health risks and deterioration within elderly communities. The Feebris app guides a carer through a 10min check-up, including capture of vital signs from connected medical-grade sensors (digital stethoscope, pulse oximeter etc.).

Powerful AI augments clinical guidelines and personalised monitoring to help decisions on triaging health issues. In care homes, Feebris can help carers triage the day-to-day health needs of their residents during the COVID-19 pandemic, and also enhance the capabilities of remote clinicians



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