Themes:
- Partnership working
- Virtual wards
- Person-centred care
Background
Leicestershire Partnership NHS Trust (LPT) and Northamptonshire Healthcare NHS Foundation Trust (NHFT) are working together in a group model. In February 2023 they were selected to be part of NHSE’s provider collaboratives innovator scheme.
Initially, virtual wards focused on supporting people with lung conditions, respiratory health problems and heart failure. They also support people recovering from Covid-19 related hospitalisations.
Virtual wards were used in the early phase of the pandemic to help increase acute capacity, and throughout to support infection control measures.
More recently, within their ICSs the trusts have expanded their virtual wards capacity and begun developing relationships with other organisations and providers in the area. Taking a whole-system approach, working with colleagues across the NHS, local authorities, housing and community organisations, both trusts have increased out-of-hospital capacity, as a means to reduce average length of stay, improve patient flow and achieve better outcomes.
Results
At both LPT and NHFT, the use of virtual wards has delivered positive results:
- LPT has seen average length of stay for people with pneumonia reduce from twelve to seven days.
- Virtual wards and remote monitoring are associated with improved patient satisfaction, with people who use this model of care reporting they feel both safe and empowered.
The balance of risk and building trust
Both trusts are keen to highlight that moving more care into the community, and closer to people’s homes, should be done in a person-centred way with a focus on outcomes, which helps reduce average length of stay, reduce bed occupancy and therefore improves patient flow.
However, making the transition from a hospital-centred model of care to a more community-focused approach with remote monitoring and multi-disciplinary working, is not without challenge or risk. For example, accountability, clinical risk and capacity in the community to respond to deterioration in a person’s condition while being monitored remotely on a virtual ward.
Giles West, transformation lead at NHFT explained the vital importance of communicating with staff across the trusts and wider system partners.
Giles said: “Shared learning with clinical teams and commissioners is really important. You don’t need to try and do a whole system approach in one go, you can try one area at a time, then test it. Giving teams autonomy is important, they have to tell you within their population, within their parameters, what would work.”
This point was echoed by Samantha Leak, director of community health services at LPT. She said: “We need to focus more on prevention and supporting patients to be cared for in their homes.” In relation to rising demand she continued: “The easiest solution is to create more beds, but the right solution is to enable better care in the community; we may need to do both in the short term, but we mustn’t lose sight of our aim.”
In short, one of the key lessons was that to effectively drive change and deliver more care remotely, trust leaders had to take a ‘bottom-up’ approach to change, working with staff to understand the concerns and challenges they face, to co-produce a solution that works.
In taking this approach, avoiding imposition of a ‘top-down’ change, the trusts found colleagues were more engaged in the new model and understood the intention behind the wider rollout of virtual wards.
Targets and a caring culture
This ‘bottom-up’ approach to implementation aligns with the mindset for managing operational performance and working toward national targets.
While the national urgent and emergency care recovery plan recognises the key role reducing bed occupancy plays in improving ambulance response times and A&E waiting times, this is not the principal concern for staff working on the ground.
Instead, the focus is on improving patient experience of care and outcomes, which is done in part by increasing community-based activity.
Next steps
Both LPT and NHFT are planning to further develop their virtual ward reach as one part of an overall approach to moving care closer to home.
There will also be a focus on partnerships, particularly with the urgent community response teams to help make sure people can remain at home, safely, if their condition deteriorates.