Virtual wards may sound like something out of a dystopian sci-fi book, but they’re a very real policy initiative being expanded by the government to ease demands on critical care in UK hospitals.
In 2012, I was responsible for setting up one of these “wards” in the Midlands. The idea was that an algorithm would use available patient data – such as age, medications, long-term conditions, previous admissions etc – to identify those most likely to be admitted to hospital in an emergency. Using this data, nurses, in conjunction with GPs, managed patients at home. My patients were mostly elderly, but anyone with multiple health problems or a history of higher than average attendances was considered for the ward.
Just over 10 years later, the government is creating more virtual wards, except this time the aim is not to prevent patients from entering hospital but to look after them once they have been discharged, including from emergency departments. After treatment, patients will return home and wear devices that will report readings and results so they can be remotely monitored by doctors and other health staff. Patients will receive home visits where necessary from community nurses.
There is simply not enough capacity in hospitals to deal with the numbers that need hospital care. Unless your discharge is basic social care or, bizarrely enough, very complex NHS-funded care, you fall into a gap where the specialised long-term care and support needed is not available.
In theory, recovering at home sounds like a much more comfortable option than a stay in hospital; however, data is an imperfect way to gather feedback on a patient’s recovery.
I have lost count of the number of times I have stopped by a patient and found that they were in need of help. That all-important “end of the bed assessment” is missing from virtual wards. These are the informal assessments nurses and doctors do whenever they look in on a patient. It might be a subtle change in colour, or responsiveness, or just that the patient didn’t greet you as they normally would. It might be noticing that a catheter bag is full to bursting or bone dry (equally as bad but for different reasons). That smile, wave or passing conversation that brings back normality to our patients will be missing too.
Also, virtual wards can ease bed numbers, but not staffing issues. These extra community nursing teams will still need to be staffed from somewhere; the government estimates that 50% of the workforce will come from hospitals, but the country is 47,000 nurses short already.
Home care is important, but it isn’t the answer to everything. What we need is investment in the right places – a long-term workforce plan; more time, not less, with our patients; and after-care that can meet the needs of increasingly aged and complex patients.
Brian Bostock is a registered nurse, independent healthcare management consultant and expert in complex long-term and end of life care