Content by Access.
Healthcare technology has come on leaps and bounds in recent years, as has the way in which care is designed, assigned and delivered. One of the drivers of this is the emergence of virtual care; a fully remote, practical and adaptable approach to providing care – improving outcomes for patients and healthcare staff.
This end-to-end method of identifying a patient’s needs and treating them without the physical presence of a clinician or healthcare professional, has been pivotal to the NHS and has the potential to save hundreds of thousands in bed costs; relieving pressures on doctors and staff and lowering the rate of admissions.
In recent years, “virtual wards,” alongside terms like “remote monitoring”, “telecare” and “tech-enabled care”, have become commonplace under the virtual care umbrella. Though each term may have a slightly different interpretation, they all share the common theme of relying on remote monitoring tools and alarms to enable patients to receive care at home.
The NHS defines these terms as follows:
Technology enabled care refers to the use of telehealth, telecare and telemedicine in providing care for people that is convenient, accessible and cost-effective. These services use technology to support people to live safely and independently in their own homes, and can be helpful to people at risk of falls.
Virtual wards, also referred to as ‘Hospital at Home’, support patients, who would otherwise be in hospital, to receive the acute care, remote monitoring and treatment they need in their own home or usual place of residence.
Remote monitoring is the monitoring of a patient (using medical devices, applications, Clinical Investigation results, or assessment tools), to allow a care professional or service to initiate an out-patient appointment when required to manage the patient’s condition.
There are many cases where these digital-powered solutions have proven to be highly effective in reducing health risks and improving patient flow in hospitals. Virtual wards are one such solution that has the potential to streamline hospital operations and make them more efficient.
The Dawn of Virtual Wards
Virtual wards are thought to be a more cost-effective alternative to having a person on a hospital ward, and they are helping to alleviate much of the pressure on the UK health system. Using technology-enabled smart devices and software, clinicians can monitor a patient’s vital signs, behaviours and environment without needing to be there in person.
Thanks to these virtual strategies, the NHS were able to meet their 2023 winter target of 10,000 free beds ahead of schedule. Noticeable reductions in staff workloads, hospital admissions and speedier discharges are just some of the results this new, pioneering care framework has delivered, which leads to improved patient wellbeing, lower risks of infection and fewer overheads for keeping a patient in an acute ward.
The benefits of virtual wards and virtual care are evident, but numerous hospitals and care units around the country either haven’t yet adopted virtual wards or aren’t fully utilising remote patient technology. There are various reasons for this, such as insufficient funding, improper staff training, and an absence of data/case studies that support their efficiency; however, a lack of integration could also be to blame.
The Challenges
When a virtual ward is established, it should work in synergy with the rest of the ICS model. What normally happens instead is a virtual ward is set up, then neglected because it doesn’t receive a sufficient level of ongoing support. This results in siloed data that doesn’t get shared with other systems or software, increasing the administration burden on staff, adding to workloads and leading to uninformed decision making around treatment plans.
Cost and understaffing are fundamental issues also. The NHS has been given a resource budget of £168.8 billion for 2023/24, of which £114.3 billion has been allocated to Integrated Care Boards (ICBs) for commissioning local health services. High on the priority list is workforce expansion; hiring staff both domestically and internationally to reduce vacancies, growing the number of qualified health and social care professionals through training and education programmes, improving staff retention rates by creating better workplace conditions, and several other initiatives designed to nurture the workforce now and into the future.
A lack of staff creates a string of problems. Workloads become overbearing, leading to staff burnout and high absence rates, causing a backlog of tasks, leading to a drop in the standards of care, resulting in bed blocking and delays in patient discharge. Results from the NHS Staff Survey show that 49.3 percent of staff in clinical occupations reported feeling burnt out because of their work in 2022, with chronic stress and anxiety being two of the main causes. Staff that continue to come into work are then burdened with longer hours and additional workloads, which can require them to learn entirely new processes in order to cope with the handover. Inefficient processes, outdated systems and improper admin support can also hinder their ability to perform certain tasks correctly.
Wendy Preston from the Royal College of Nursing (RCN) said, “There are over 40,000 nursing vacancies across the NHS, and social care is chronically understaffed. If the UK government wants to turn around the state of the NHS and deliver the ‘hospital level’ care at home that patients expect, nursing staff need to see game-changing investment in the workforce.”
In addition to integration, cost and staffing challenges, there are various perceived barriers to the remote patient monitoring (RPM) aspect of virtual care that have prevented it from being implemented. Whether it’s financial fears around inventory management and shipping devices out to patients, worries over the technology’s efficiency, reluctance from staff to get onboard with the programme, teaching patients how to use the hardware/software, or the reliability and transparency of the data reported – these are all concerns that have stunted the adoption of RPM for numerous organisations and prevented virtual care from reaching its full potential.
Making Virtual Care A Success: Potential Fixes
These challenges will continue to inhibit the NHS from working efficiently until appropriate action is taken. While there is no one right answer, or means to solve them all overnight, a strategy that could potentially alleviate pressure and encourage the adoption of virtual care further is integration.
An Integrated Model
Integration ensures a unified approach to patient management because it promotes interoperability and enables data to be consolidated, reported and shared across different channels. With data readily available, clinicians are better equipped to make informed judgements that align with a patient’s care needs, but more importantly these decisions are more accurate, which means better care outcomes.
Whether it’s to discharge the patient, refer them to a specialist, or assign them to a virtual ward, integration reinforces these decisions and backs them up with secure, real-time data that healthcare professionals can access and interpret easily.
In the long term, a holistic approach to virtual care could make it more sustainable and viable than the current methods used to deliver care. Virtual wards, telecare, and remote care cannot be seen as another new service, nor can they be seen as something separate from the existing ecosystem. They need to be part of the ICS; available across the entire care continuum and ensuring everyone has the full patient picture.
Changing the Narrative
Misconceptions around security, privacy, cost, and the “de-humanising” aspect of virtual care have raised scepticism about the technology’s capabilities and its implementation. As a result, patients and some clinicians are reluctant to leave the comfort and familiarity of traditional methods for delivering care.
Debunking these myths and highlighting the clear benefits of virtual health may offer the peace of mind people need to get on board. Placing particular emphasis on the following points may also provide a better understanding of how and why it works:
- Most, if not all, technology-enabled care services currently used by ICSs are data secure and GDPR compliant.
- Operational efficiency is enhanced by reducing the number of face-to-face visits and relieving the burden on acute care settings.
- Clinicians have access to real-time insights and analytics and can take action quickly. This reduces the need for appointments and having to deal with long wait times, patient Did Not Attends or the unavailability of doctors.
- Drives down costs by eliminating unnecessary visits and travel expenses for patients. Money is also saved through the reduction of hospital readmissions.
- The familiarity of care in a home setting leads to improved patient wellbeing. Patients are five times less likely to pick up an infection recovering at home, and eight times less likely to experience functional decline.
Above all else, a solid foundation of trust is needed for this framework to be a success. That means strengthening the relationship between patients and doctors, so patients feel confident to use the technology and empowered to manage their own health, and doctors are given the time and resources to deliver quality, personalised care by entrusting their patients to do so. With these measures in place and integration at the core, virtual care is poised to be a success.
Where Next?
According to Nuffield Trust, more than 15 million people in the UK live with a long-term condition (LTC). Close to 70 percent of the health and social care budget is spent on caring for people in this group, which is responsible for more than 50 percent of all GP consultations and accounts for almost 70 percent of NHS bed occupancy.
Age is a natural cause of functional decline, with people becoming increasingly more frail and prone to disability, seizures, falls, and degenerative diseases after the age of 65. A sedentary lifestyle and lack of physical activity accelerates the progression of these long-term health conditions, as does a poor diet, an irregular sleep pattern, and unhealthy consumption of tobacco and alcohol.
The NHS has an existing strategy for identifying and supporting those with long-term illnesses, but this is only half the battle. Preventing patients from being admitted into hospital or needing costly ongoing treatment in the first place is the real challenge.
This is why a joined-up care model is so integral in keeping LTC patients from deteriorating once their condition(s) have been recognised and recorded. The only way this model will work is by unifying primary, acute and community services so that patients have improved access to treatment and care.
Virtual wards, remote monitoring, tech-enabled care, and telecare all have their part to play in this. Whether it’s empowering patients to self-manage their health at home using wearables and smartphone diagnostic tools, providing them access to social prescribing services and community support, or setting aside funds to build robust, personalised care plans – all these things together can have an enormously positive impact on a person’s mental and physical health, equalling a better quality of life.
Virtual care is leading the way in all of this and we at Access will continue to champion its potential to transform the health sector and provide health and care workers with the tools to make a difference.
