HomeLink Healthcare Opinion:
Jill Ireland, CEO and clinical director discusses virtual wards and how the independent sector can enable their success.
Following their success during the Covid-19 pandemic, NHS England and Improvement has set challenging targets to roll-out virtual wards across the country. Jill Ireland, the chief executive and clinical director of HomeLink Healthcare agrees with NHSE/I guidelines that integrated care systems should be looking to work in partnership with the independent sector. Jill argues that the independent sector has a lot to offer and that working with a specialist provider of hospital at home services is an excellent way for them to deliver successful services.
Covid-19 put almost intolerable pressure on the country, the NHS and communities; but one of the unexpected benefits of the pandemic was the realisation that many more patients can be cared for at home.
The pandemic provided an opportunity to try out new ways of working, and we saw the rapid roll-out of virtual multidisciplinary teams, virtual clinics and consultations, remote monitoring and virtual wards.
As the health and care system looks to recover and reset, NHS England and Improvement is looking to build on these developments to address some of the challenges posed by the huge backlog of elective care.
More than 6 million people are now waiting for treatment in England, and the list is rising by 100,000 people per month. With the hospital beds that are available under enormous pressure, NHSE/I is looking to virtual wards to create additional capacity.
Virtual ward targets, guidance, and funding
NHSE/I has set a target for every integrated care system to create 40-50 virtual ward beds per 100,000 people in their population.
Guidance in April set out ‘enablers for success’ that stressed ICSs should not use virtual wards as an extension of traditional, community nursing services, which tend to support people with long-term conditions.
Instead, it said virtual wards should be used to provide hospital at home services; either ‘step up’ care (to prevent admissions to hospital) or ‘step down’ care (to support earlier discharge).
‘Enablers for success’ also advised ICSs to work in partnership with the independent sector to secure the skills and technology required and outlined how to bid for central funding.
NHSE/I is making £200 million available for virtual wards this year from its Service Development Fund on a match-funded basis. There will be an additional £250 million next year to test out ideas and after that it’s expected that these services will become ‘business as usual’.
The case for finding an expert partner
Virtual wards are an emerging space, which makes this guidance useful. It explains what NHSE/I means by ‘virtual ward’ (and what it doesn’t), sets out some clear expectations around the involvement of the independent sector, and establishes a clear direction of travel.
For HomeLink Healthcare, this is exciting. We were formed seven years ago to deliver Hospital@Home services and already run virtual wards in partnership with commissioners and Trusts in London and the East of England.
Despite this, we are sometimes challenged that NHS organisations can do this themselves. In some cases, of course, they can. However, as the ‘enablers’ guidance makes clear, virtual wards are being set up to provide additional capacity; not to stretch existing resources even more thinly.
Also, nursing acutely ill patients at home requires skill and experience. HomeLink Healthcare’s teams are built around clinicians with a backgrounds in both acute and community care, who are also experienced in handling the challenges of delivering clinical care in the home.
In addition, we have developed some really good reporting capabilities. We can report a suite of KPIs in almost real time, so commissioners have complete transparency about what we are doing and how we are doing it.
More capacity, better outcomes for patients
When the news broke about this big expansion of virtual wards, there was a criticism of the idea in the press and concern from professional bodies.
There was a feeling that patients should be in hospital and that delivering hospital-level care at home poses too great a risk to staff and patients alike.
It’s true that this model is not suitable for everybody. However, we work with our NHS partners to risk assess the patients who are referred to our services.
We know that what HomeLink Healthcare does is valued by patients and relatives, thanks to the feedback we receive through our Patient Experience questionnaire. We also have evidence that our patients can recover faster when they are treated in their own home than they would have done in hospital.
After all, few people want to spend time on a hospital ward. Most would prefer to be in their own environment, as long as they are well-supported.
So, I think that as we see virtual wards rolled out, we will see fewer challenges of this kind – as long as ICSs follow emerging best practice and deliver these new models of care in a safe and effective way.
No going back?
There are some pitfalls that could still derail this new policy. NHSE/I is funding virtual wards for the next two-years, so there is a danger that ICSs could see this as a ‘pilot’ project, when our experience is the best results come from running virtual wards at scale.
ICSs could also see virtual wards as a technology challenge, rather than a service redesign challenge. The ‘enablers’ guidance says virtual ward services should be ‘tech enabled’ – but they cannot be purely technology driven.
As the guidance itself says, virtual wards will only be successful if they combine partnership working, technology, and skilled clinical teams.
The technology required to support virtual wards is developing all the time and giving health and care professionals new telemetry to work with; and from a professional perspective, this is a very appealing way of working. In addition utlising technology can maximise face to face time with patients.
When many health and care organisations are struggling to recruit and retain staff, our teams welcome the challenge of delivering hospital-level care in patients’ homes.
The Virtual Ward model offers an opportunity for revisioning the healthcare model and I cannot imagine that the health and care system will return to how they were before Covid. There is a big opportunity to rethink how hospitals, community delivery and the patient journey work.
So, over the course of the next six to eight months, I think we will see virtual ward models refined. We will see evaluations conducted, so we create a test and learning environment.
We will see forward-thinking ICSs developing innovative partnerships with independent providers. And we will see that the end point is to deliver virtual wards at scale. NHSE/I has started an evolution, rather than a revolution; but this is the future.
This is the beginning of the change and we need to think about how much further we can go with these models.
To find out more about how HomeLink could work with your organisation or health system to increase capacity and improve flow, please contact us below.
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