In response to an enquiry from The Guardian regarding virtual wards, Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, said: “NHS urgent and emergency care is under unbearable strain; strain that is increasingly causing harm to patients.
“Emergency department overcrowding and stasis in acute medical units prevents timely and high-quality care and is driven by workforce and capacity constraints. This accentuates low staff morale, perpetuating burnout and high absence levels which currently dominate.
“The fundamental problem remains that demand has exceeded healthcare capacity in all settings for a significant period. A key component of the current recovery plan is an increase in the number of virtual ward beds to help mitigate the current crisis.
“Virtual wards, encompassing hospital at home, are not new. They have been used in various guises and models both in the UK and internationally for decades.
“The term “virtual ward bed” is used to define a patient who can be managed in their own home and whose care would traditionally have been delivered in an inpatient setting. This is both a laudable and achievable aim.
“Key elements of acute care that have been traditionally delivered in hospital can be provided in the patient’s home. These include senior clinician decision making, multi-disciplinary assessment and rehabilitation, physiological monitoring utilising digital technologies and delivery of intravenous treatments.
“A range of common clinical presentations, including those relating to frailty and exacerbations of heart failure have been demonstrated to be amenable to hospital at home type approaches.
“Hospital at home care requires the same clinical approach as hospital based acute medical care. The right treatments based on individualised clinical decisions in accordance with the patient’s wishes delivered in a timely manner.
“Virtual wards require skilled staff and significant carer support to function. Nursing, pharmacists, therapy and care provision are fundamental to the delivery of high-quality treatment, whether that be in a hospital or home setting.
“Workforce shortages in these areas continue to be a significant barrier to the delivery and expansion of virtual wards which utilise a Hospital at Home model.
“It is essential that patients treated in virtual ward beds would otherwise have required an inpatient admission. This needs to be carefully monitored.
“Creating extra streams of work for patients who would traditionally have been managed at home is an extra burden and resource that cannot be sustained or absorbed with the current workforce and funding limits.
“It is imperative that patients are not subject to increased monitoring or clinical reviews simply to develop a virtual ward programme. If patients are well enough to be at home without any acute intervention, the clinical rationale for remote monitoring is very limited.
“The demand for acute care will continue to rise for the foreseeable future. NHS pressures are at unsustainable levels and current results are scant justice for urgent and emergency care teams who continue to strive to deliver high quality care for their patients.
“Virtual wards, if they deliver hospital level processes of care are just one part of the solution – not a panacea.
“The current situation in emergency departments and acute medical units perfectly illustrates this. They must not distract from the need for urgent long-term workforce, clinical and capacity plans that are essential to rebuild urgent and emergency care and the wider NHS.”
https://amp.theguardian.com/society/2024/feb/07/how-virtual-nhs-wards-now-reality