Virtual care reducing hospital admissions
These are difficult times for the health and care system. In most trusts and places it is a matter of trying to survive through winter, to minimise patient harm and not slip too much further on national targets. But even in these challenging circumstances, leaders have their eye on ways to innovate to make services more effective and lay the foundations for more resilient ways of working. Matthew Taylor writes about his visit to Northampton General Hospital's virtual ward team.
Increasingly, particularly as we battle high demand, models of virtual care are being seen as both a short and long-term shift in models of care to meet increasing backlogs and deliver high quality care. Virtual care approaches range from virtual wards to remote monitoring and have been transformative for patients, enabling at-home treatment and monitoring while needing to make fewer trips to hospitals and NHS settings.
As well as the demand and discharge, technological advances are also making virtual care easier, safer and cheaper to deliver. The emphasis in systems and places on integration creates a benign context for models of care which both rely on and enhance collaboration between different parts of the NHS and with local government, private care providers and the voluntary sector partners.
Seeing what's possible
A recent visit to Northampton General Hospital (NGH) to meet members of the virtual ward team showed me what is already possible.
NGH used virtual care during COVID-19 and working with its technology provider, Doccla, has built on the experience as the pandemic receded. I spoke to the nurse who oversees the asthma virtual ward. She takes referrals from A&E, the urgent care centre, acute wards and community settings. After assessment, the majority of patients can go home with the remote asthma monitoring kit provided by Doccla.
The monitoring kit enables self-management and the technology offered to patients means it can be monitored remotely and any issues can be resolved remotely. Patients have reported the service is easy to use, provides the ongoing direct support which they may not always get on a busy ward and more importantly, feels like they are continuously in charge of their own care. Indeed, hospital admissions for asthma and asthma-related conditions have fallen by nearly three quarters with only 1 in 20 patients now admitted to hospital wards. I was particularly impressed by the testimony of a long-time chronic asthma sufferer who clearly found his care empowering and liberating.
The hub model allows for scaling of services, pooling of resources and reducing costs, which means more patients are seen than before
Another aspect of the Northampton model, underling the importance of system working, is a virtual care hub co-designed and delivered by health, social care and third sector partners. This model has led to fewer hospital admissions for elderly patients by enhancing and supporting the skills of care home staff. Among the benefits has been a reduction in ambulance and GP callouts and admission avoidance, something reflected in CQC ratings. The hub model allows for scaling of services, pooling of resources and reducing costs, which means more patients are seen than before.
Workforce challenges
But there are also challenges to the virtual care model, particularly with virtual care wards, which are not fulfilling their full potential with occupancy levels below the total numbers of virtual beds available nationally. Further, workforce constraints are impacting virtual care overall, just like every other aspect of the system. Recruiting staff to deliver virtual care pathways can be problematic if the training and role needs are niche.
Leaders I spoke with recently told me about the need to focus on clinical support and harness enthusiasm for a virtual ward in order to fully implement a successful system. In fact, in Northampton they have employed an independent role which is tasked to inform and champion virtual care across the hospital and support cross-departmental working.
There are also technology challenges like interoperability and data sharing between departments and specialities. Current IT departments are overwhelmed, and back-office functions are also hit by the workforce challenges. Trusts and integrated care systems (ICSs) are finding it hard to recruit data analysts and IT and digital roles which are essential to keeping virtual wards running.
Building on success
...innovation in virtual care shows that the energy for change can come from anywhere in the system
Support for virtual wards from NHS England (NHSE) has been welcome, particularly as the NHS headed into winter planning recently. However, some leaders argue that by directing resources to two pathways – frailty and respiratory illness – NHSE has limited clinical enthusiasm and expertise. The current picture of innovation in virtual wards shows that the energy for change can come from anywhere in the system and that once a virtual ward is seen to work in one area, it becomes easier to adopt by other pathways. This was evident at NGH where there is much enthusiasm and workforce zeal for making the asthma virtual ward a success.
While things are very tough this winter, the strides trusts and ICSs have been making in implementing virtual wards means there is a genuine opportunity to make virtual wards successful across the country. Combining additional discharge and match funding; accelerating and adopting technological innovation; harnessing growing clinical awareness and confidence with greater whole system integration - we are on the path to achieving a real step change in delivering virtual care.
Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on Twitter @FRSAMatthew
