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NHS NORTH CENTRAL LONDON ICB / WHITTINGTON HEALTH
Recent research , conducted by the National Institute of Health and Care Research 4 , found older patients in homecare were less prone to delirium and required smaller social care packages on discharge .
This is a ‘ win-win situation ’, says Arul Bangalore , an advanced clinical practitioner and registered nurse , who is associate matron for the Whittington Health NHS Trust virtual ward in north London .
‘ The patient gets to live in surroundings known to him or her . But also , we are also looking at bed days saved and reducing the amount of time in hospital . This is economical , this is efficient , and this is best practice .’
And greater technological innovation has increased the variety and complexity of conditions that can be safely treated in the community . Many more trusts are also in the early stages of expanding virtual wards to include postoperative , cardiac and diabetes care .
Mr Bangalore ( pictured above ) says : ‘ With education , with learning , with guidance and with technology , I think we are able to safely manage high acuity of patients in the community ’.
The impact on community However , to live up to their potential , virtual wards will need more than technological innovation and enthusiasm ; they must begin to act as a bridge between the community and acute care .
Pritesh Mistry is a policy fellow at the King ’ s Fund think-tank , specialising in digital innovation and how technology can improve healthcare . He says virtual wards are still often seen as a ‘ solution to a problem in a set organisation ’, such as demand for bed space or capacity issues .
‘ But it ’ s a healthcare system ,’ he says , ‘ and that ’ s one of the things we need to consider . When you implement a solution like virtual wards , it might solve capacity issues within an acute setting , but you ’ ve got knock-on implications for people in the community setting .
‘ Something like virtual wards can be seen as a solution to a problem in an organisation , but because it has ramifications across hospitals into the community , it needs to be seen more as a transformation that happens across walls and across organisations .’
In their early stages , virtual wards often struggled to win trust among clinicians . The issue was that even when a patient was released to a virtual ward in the community , the hospital clinician would still retain clinical responsibility .
If anything happened in the community , then the hospital doctor or advanced clinical practitioner would still be held accountable . This , says Dr Kendrick , initially led to some ‘ push back ’ from doctors .
‘ One of the things we discovered when we started doing this work is that the doctors don ’ t really understand all that happens in community ,’ she says . ‘ There are people who don ’ t like the thought that people leave hospital early , and are really concerned about it .
‘ If we ’ re really going to make virtual wards and remote monitoring work , everybody in the system needs to be brought into it .’
However , getting people to buy into a new system isn ’ t always easy . ‘ You can ’ t just tell people : this is what you ’ re doing , you ’ ve got discharge to the virtual ward ,’ says Phillip Bliss , chair of the WWL virtual ward programme . ‘ Doctors aren ’ t going to use the service if they think it ’ s unsafe or patients aren ’ t going to get good care .