Growing numbers of NHS patients could be treated at home as a "virtual hospital" frees up physical beds.
With the aim of replicating hospital care in the comfort of patients' homes, so-called "virtual wards" are being rolled out across the country. Merseyside has already seen success with respiratory virtual wards for patients with COPD and covid, and doctors hope to free up thousands of hospital bed days by expanding the service into other areas.
A new heart failure virtual ward - the second in the country - has had roughly 40 patients, as old as 94, in the six weeks since it was jointly launched by Mersey Care and Liverpool University Hospitals (LUHFT), in partnership with digital health company Docobo.
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According to Dr Rajiv Sankaranarayanan, a consultant cardiologist and heart failure lead at LUHFT, "it's taking pressure off some of the hospital services already" by allowing patients who'd have spent 10 to 12 days in hospital to stay at home instead. Over the six month pilot, they hope to prevent hospitalisation for 200 to 250 people, which is up to 1,750 bed days and roughly £450k saved for the NHS.
As NHS trusts gradually increase the number of virtual beds through the development of new wards for frailty, oncology and palliative care, the region will "have something the size of a virtual hospital", according to Dr Sarah Sibley, who leads virtual ward development in Cheshire and Merseyside, and across the North West.
Dr Sibley, a respiratory consultant at Liverpool Heart and Chest Hospital, was worried about the concept before getting involved. She said: "I thought that patients really valued the face-to-face contact, and I didn't want people to feel as though they were being managed by a computer. But you do get a very sort of personal relationship with patients when they're on a virtual ward and telehealth. It's not all done virtually, despite what the title says."
Patients get equipment and training in how to use it, with the option of in-person visits to support them in getting to grips with the technology in the first few days they spend on a virtual ward. One heart failure patient, Collette, has used a smart device, blood pressure monitor, scales, thermometer, pedometer and a device to measure oxygen in the blood, all delivered by a technician, since she was invited to join the new heart failure virtual ward in March. After some "very quick and easy training", she got the hang of the Docobo system.
Each day, consultants do a 'virtual ward round', the tech carries out tests like ECGs, and patients record their symptoms and observations, with readings sent to the Telehealth Clinical Hub. The regular recording of symptoms, and the need for patients to be engaged with the process and their own health, means changes in condition can be detected sooner. A team of "really experienced community nurses", monitoring results at the hub, are on hand seven days a week to call patients or take their calls.
Being on the virtual ward has made Colette "feel really reassured" and cut the number of hospital visits she's made. She said: "If there is anything the nurses are concerned about from my data, they can contact the on-call consultant cardiologist - perhaps they will advise that I reduce or increase medication. It's almost like having a doctor on tap. It's a really personalised service and is really tailored to my needs. The nurses are so well trained, so it gives you confidence."
Dr Nisha Jose, clinical team leader at the Mersey Care Clinical Telehealth Hub, remembers having to say no to coronary care patients wanting to go home for Christmas, "because they were tied to a an IV diuretic drip or red CPAP mask". She said: "It'd be good to make that happen in the community with our virtual wards, and that is the most important part or beauty of these virtual ward - keeping them close to their home while at the same time providing the optimised care."
Being at home can help their recovery because they're more comfortable, they don't lose as much muscle mass from the reduced mobility of spending time in a hospital bed, and they're not exposed to hospital-acquired infections like covid and pneumonia.
Colette said: "Before the virtual ward, mentally it was a worry for me and my family. But now I'm so closely monitored, it's great, I feel so much more positive and I'm spending more time with family. It also allows more time for me to spend on basic pleasures – reading and things like that. I couldn't concentrate before as I was so worried. It gives you your life back."
But, although the hospitals can provide tech and internet access for people whose lack of these is the main barrier to being on a virtual ward, "it's not the right choice for everybody", according to Dr Sibley. She said: "For many patients when they're unwell, particularly if they've got a long term condition, they would rather be at home where they feel safe. with their family and carers and their usual environment around them.
"However, that's not right for everybody because it depends on whether they're able to cope at home with their current level of care, whether they live in a nice, warm, safe house with food and heating, so being at home isn't the right thing for everyone."
Overall, virtual wards can "improve responsiveness of services" by allowing nearly round-the-clock access to specialists, according to Dr Sibley. It reduces A&E assessment times and ambulance wait times by cutting the number of people whose conditions need to be assessed in person, and it opens up bed space for people "who truly need to be hospitalised", according to Dr Sankaranarayanan.
For now, this is work done over and above the existing hours and duties of healthcare workers, at a time when staff shortages and a mental health crisis are putting pressure on "exhausted" nurses and doctors. Dr Sibley said "this is really additional capacity within the NHS", which, "if you really want to do this properly", requires the recruitment of more healthcare works "so that we don't exhaust people".
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