Virtual wards – ‘realising the potential’ webinar round up
Calling upon the expertise of senior leaders and clinicians already engaging virtual ward services, ‘Realising the potential of virtual wards’ is a deep dive paper from NHS Confederation, in partnership with Acacium Group. The paper explores virtual ward best practices from the professionals at the heart of implementation. The report’s expert contributors came together to discuss the findings in this webinar, sharing insights and learnings with other organisations looking to do the same
Virtual wards require a flexible approach
Virtual wards first came into fruition in the early 2000s, a concept developed by Croydon Primary Care Trust in South London. Today, there are 340 virtual ward programmes across England, and more than 100,000 patients were treated using virtual wards in 2022.
Following COVID-19, NHS England has focused on promoting the use of virtual wards for respiratory infection and frailty pathways. However, speaking to clinicians on the ground, NHS Confederation Chief Executive, Matthew Taylor, highlighted that formalising pathways in this way could be considered ‘too prescriptive’, and Trusts need the freedom to build virtual wards programmes around their own areas of expertise.
Gurnak Dosanjh, the Clinical Virtual Ward Lead for Leicester, Leicestershire and Rutland explained how their shift from physical to digital services did not ‘align to initial expectations’ of virtual wards. However, by going ‘where the energy is’ the team have improved the patient experience across a diverse range of conditions, having successfully launched virtual wards specialising in atrial fibrillation, diabetes, various respiratory infections, post colorectal surgery and palliative care.
“It’s organic, people go with their strengths rather than necessarily what they’re told to do.”, agrees Niall Keenan, Cardiologist Lead for West Hertfordshire and Chair of the Clinical Advisory Group for Virtual Wards NHS England.
“We launched [virtual wards] before NHS England had specified Acute Respiratory Illness (ARI) and frailty in December 2001. We went with what we felt we were best able to deliver which was with COPD and heart failure. That’s been running for a year now – we’ve put about 800 patients through that…. We’re currently managing about 55 virtual beds. We’ve taken very systematic patient experience data and the patient feedback is truly exceptional.”
Virtual ward expansion should be a coherent holistic digital project
Michael Bell is the Chairman of Lewisham and Greenwich NHS Trust, which has provided him with a perspective of two different approaches to virtual wards being undertaken in South London. He highlights how a system wide approach has been more successful, with devolved models much slower to adopt the benefits of virtual wards.
“The system in Southwest London is one where we have a single infrastructure; the virtual harbours are delivered by Croydon Trust on behalf of the whole of southwest London. The virtual world programming each borough uses all that infrastructure but is of course tailored to the local circumstances.
In Southeast London, Croydon is an integrated Trust with acute and community but clearly has a significant bias towards hospital services. In terms of the portfolio, the model has been very devolved. It’s been driven by community and general practice services. To date, it hasn’t achieved anywhere near the range of beds and the utilisation rate is a lot lower.”
Beyond the immediacy of patient care and outside the clinician patient exchange, there are other practical considerations that must be made to ensure virtual wards services can fulfil their potential. Gurnak addressed this when discussing the need for holistic design and delivery of virtual ward programmes.
“We shouldn’t allow the technology to stifle us. We need to ensure that all of the pieces of the puzzle are in place to have the most effective and most appropriately utilised virtual wards. An example could be how do we get medications out to patients if we don’t have electronic prescribing? And how are we going to contribute to the net zero agenda if we’re asking patients to come back in to pick up their prescriptions? All of these little nuances are incredibly important to ensure that the virtual Ward programming itself works efficiently.”
‘A cultural shift’ must occur for virtual wards to be successful
To be successful, virtual wards need to be regarded as more than a means for changing how and where care is delivered. It requires a cultural shift – a change in mindset for system leaders, clinicians and patients.
Gurnak emphasised the importance of systems being open to changing ways of working. He believes that the success of virtual wards hinges on building the trust and confidence of both patients and staff.
“One of the biggest learnings that we’ve had over the past year, is to recognise that we’re changing behaviours. We are changing clinical behaviours; consultants, doctors, nurses, clinicians, who are very much used to seeing patients face to face, and now we’re asking them to send patients home when typically, they might still have been in hospital. On the flip side, we’re asking patients to be treated at home – we want to make sure that patients see this is a benefit for them, not a benefit for the NHS system.”
Peer-to-peer engagement and the use of virtual champions has shown to be effective in supporting the early adoption of virtual ward services. Services with ample ‘clinical enthusiasm’, with a network of leaders and clinicians proactively backing virtual ward programmes was shown to have a significant impact on how quickly and effectively virtual wards had been set up in each Trust.
Dr Niall Keenan believes, “A lot of [the apprehension to get involved in virtual wards] is to do with, ‘we’ve always done it this way, we don’t want to do it that way’. Local champions are very important in trying to overcome that. But there’s still a huge piece of work to do.
Let’s say you’re a GP running a virtual ward, you want to take heart failure patients, but the local cardiologists say, ‘No, we always look after heart failure patients in our acute hospital, and we’re not sending you any heart failure patients to go into a virtual ward’. That’s the sort of stories that people are hearing day in day out around the country. There needs to be people getting together talking, sharing data, and making people realise that this is highly safe, highly acceptable to patients and can make a difference.”
Matthew Taylor, the Chief Executive of NHS Confederation stressed the importance of including patients in the design and delivery of virtual wards, and how misconceptions around the purpose and benefits of digital services could limit their potential.
“The response to virtual wards], during COVID-19 was somehow portrayed, both by the media and politicians, as offering something second class to people or denying them face to face care. It’s really important that we don’t get to a situation where patients think that virtual wards are primarily a way of helping us manage our challenges. Critically, it’s got to be seen as a way of providing care that is more convenient, safer, and more flexible for patients and their families.”
Staffing virtual wards must not be an afterthought
While there is a lot of onus on the technology behind virtual wards, it’s the workforce who make virtual ward services a success. “Staffing is key. It’s our staff that have really made this happen,” explained Niall. “We have recruited internally – mainly amazing nurses. It’s so important for staff development. The staff have really enjoyed being brought over and doing something new and different, something innovative. Obviously, their roles have had to be backfilled, and that is a challenge. But when 80% of the cost of virtual wards is staff, staffing is absolutely key.”
By embracing digital services and putting the skills of the existing workforce to work in new ways, some of the staff and skills shortages impacting patient care can be relieved. Mike Barnard, Acacium Group’s CEO, considered virtual wards as an opportunity to attract healthcare workers back to the profession.
“Rather than workforce being an obstacle, it should draw in people who potentially had qualified out of the substantive workforce. It might be retirees, it might be people who want to work part time. We should think together imaginatively about those constituents as we look to resource virtual wards. I think we can make the workforce component of virtual wards additive rather than substitutional, which I think is one of the pressures that experts in the provider network are finding.”
Move beyond competition to collaboration
There is a long history of public and private partnership innovation in the NHS. Early adopters of virtual wards, including the experts on this panel and contributors to the whitepaper championed collaboration as a means of driving successful patient outcomes.
“We can become constrained by the limitations of the technology, especially when we find or procure technology first, and then we try and develop our pathways around that.”, said Gurnak. “I think it’s incredibly important to co-design co-produce and collaborate in that process.
It’s equally important to look at what others are doing out there and other partnerships that are available to support the virtual ward program, be that workforce, strategy or change management. If we’re struggling within the NHS to do this ourselves, it’s not unreasonable to reach out to other colleagues and partners in the healthcare system to seek that extra support”.
These partnerships will play an important role in supporting the NHS’ target of establishing 40–50 virtual wards per 100,000 people. Mike Barnard was in agreement, believing that, “Shifting away from a procurement response into more collaborative ways of working, you get a more creative intersection of tech process, clinical governance, pathway design that can actually facilitate that the work that’s being done within your local hospital and recognising that many of us are working across the footprint of therefore a seeing great practice, from different parts of the system.”
Are you looking to establish or expand your virtual wards programme?
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