Virtual wards summit – Tuesday 12 September 2023
Roll out of “virtual wards” across Joined Up Care Derbyshire
Providing hospital level care at home
Connect, collaborate and create
On Tuesday 12 September, leaders from across health and care in Derby and Derbyshire came together to discuss current progress with the roll out of virtual wards across Derby and Derbyshire and to understand the opportunities available to support the success of virtual wards. The aim of the summit was for colleagues to connect, collaborate and create. The event was sponsored by doccla, the company that supplies the technology to enable virtual wards.
A virtual ward is a safe and efficient alternative to hospital level care at home. Virtual wards support patients who would otherwise be in hospital to receive the acute care and treatment they need in their own home. This includes either preventing avoidable admissions into hospital, or supporting early discharge out of hospital. The ambition in Derby and Derbyshire is to have 10 wards and 255 beds by April 2024.
The journey ahead
Dr Chris Weiner, Chief Medical Officer at NHS Derby and Derbyshire Integrated Care Board, welcomed colleagues to the summit and opened the session.
Dr Weiner compared the journey ahead for the adoption of virtual wards to the transition to the care in the community model in the late 1980s and early 1990s. That change required a huge cultural change and he outlined how he felt the move to virtual wards will to.
He emphasised that this will not be a quick or short journey. Health and care professionals are still refining the care in the community model and the challenge we have today – in a similar vein – is understanding what can be safely done in the community for acute care.
Aims of the summit
Following the welcome and opening remarks, Dr Seema Kumari, Acting Executive Medical Director at Derbyshire Community Health Services NHS Foundation Trust and Senior Responsible Officer for the implementation of virtual wards in Derby and Derbyshire outlined her hopes for enabling more patients to benefit from virtual wards and the aims for the summit:
- To understand the opportunities available to support the success of virtual wards
- To raise awareness of how the different wards in the system are working and compare ideas
- To explore potential new areas for virtual wards
- To understand and agree how each organisation will promote, support and improve the use of virtual wards on a daily basis.
- Agree next steps for the Virtual Ward programme in Derby and Derbyshire
What is Derby and Derbyshire doing well?
After the aims of the summit had been outlined, Dr Nauman Ahmed, Consultant Cardiologist and ACD Cardiology at University Hospitals of Derby and Burton (UHDB), led a session looking at what Derby and Derbyshire is currently doing well. His first example was the Home Heart Failure Project which had helped reduce inpatient heart failure admissions and a reduction in readmissions of patients with heart failure. Dr Ahmed then discussed progress with the ambulatory heart failure unit and the atrial fibrillation virtual ward.
A case study – Palliative Care and Virtual Wards
After Dr Ahmed had answered questions from the group, Dr Sarah Parnacott, Palliative Medicine Consultant at Ashgate Hospice and Amanda Hall, Lead Palliative Care Specialist Nurse at Ashgate Hospice shared the journey to providing a Virtual Palliative Care Ward and some immensely powerful case studies with those in the room.
The demand for inpatient beds at Ashgate is always high and that led to the team creating a vision to be able to provide rapid access to intensive specialist palliative care support in the community to help prevent acute admissions and support patients staying in Palliative Primary Care (PPC). During summer 2022, Ashgate Hospice firmed up their vision and, at the time of the conference, the Virtual Palliative Care Ward had provided care for 95 patients.
The Virtual Palliative Care Ward is open to all patients with a GP in northern Derbyshire and with Palliative and/or End of Life needs. The virtual ward offers flexible and responsive care and aims to manage complex unstable needs at home, help patients avoid acute or hospice admissions or offer support until a bed is available, if needed.
After sharing the journey to being able to provide a Virtual Palliative Care Ward, Dr Parnacott and Amanda Hall, shared some extremely powerful case studies from the virtual ward with everybody. One of those case studies told the story of Carole Lowry who had been diagnosed with cancer of the fallopian tube during the lockdown in 2020. Carole’s husband, Peter, praised the “kindness and dedication” of nurses Amanda Hall and Sophie Dudley, who lead the service, as well as other staff who cared for his family during one of the most difficult times in their lives. He said: “I felt very lucky to have had this fantastic resource at home for us and hope that over time it can be developed further so that more people can benefit. Carole died in the home she loved with her husband of 54 years by her side and that is due to the Ashgate Palliative Care Team and its visionary approach to home-based ‘hospice’ care.”
GIRFT Review – Kirsty Osborn, Deputy Director DHU Healthcare
Getting it right first time
Kirsty Osborn, Deputy Director of DHU Healthcare, led the next part of the summit which focused on the “Getting it right first time” virtual wards pilot – GIRFT for short. The pilot was part of a national review of virtual wards in England to help identify areas of good practice and ultimately reduce variation. The aim of the review was to:
- Identify datasets
- Develop a series of metrics to help measure success
- Identify key themes and recommendations
- Identify learning and feedback
The review showed that there is still further work to do to ensure the opportunities presented by Virtual Wards are maximised. It also highlighted the importance of:
- Flexibility/expansion of pathways to ensure inclusion
- Building relationships across secondary/primary care and Urgent Community Response Services (UCR)
- Utilising lead clinician roles available other than acute consultant
Frailty Virtual Wards – Dr Ian Lawrence and Dr Barry Evans
The frailty virtual ward has been in operation since July and Dr Ian Lawrence and Dr Barry Evans talked about the development of frailty virtual wards across Derby and Derbyshire.
They spoke about the Team Up and how it brings together the below services to support Urgent Community Response:
- Falls recovery
- GP home visiting service
- Adult social care urgent response
- Rapid response nursing and therapy
They then looked at what is required to enable a ‘local navigation hub’; a central point people could call on when support is required and some of the next steps that need to be taken to further develop frailty virtual wards.
Planning for the future
The presentation on frailty virtual wards concluded the day’s presentations. For the second part of the summit, Dr Sally Davies, Respiratory Consultant and Deputy Medical Director at Chesterfield Royal Hospital and Royal Derby Hospital’s Deputy Medical Director, Dr Gisela Robinson led a conversation with delegates to look at the opportunities presented by virtual wards and how to utilise them to best effect throughout the winter period. The discussion that followed was passionate and enabled those in the room to share perspectives and better assess the opportunities available to them through the use of Virtual Wards.
As the summit approached its end, Dr Weiner and Dr Kumari, thanked everyone who had presented and summarised the feedback colleagues had given during the open session. As he did at the opening of the summit, Dr Weiner emphasised that it’s important to remember that in reality we are at the beginning of transforming the way acute care is delivered and commended the progress that has been achieved to date.
A further summit is expected to take place in December 2024.