More people with acute respiratory infections could receive care in virtual wards, says draft advice
An independent national committee – which includes a physiotherapy perspective provided by Naomi McVey – issued draft guidance earlier this week (19 August) on monitoring people at home with acute respiratory infections (ARIs) through using virtual wards.
Ms McVey, who is Health Education England’s regional head of allied health professions in her main job, sits on the independent medical technologies advisory committee of the National Institute for Health and Care Excellence (NICE).
The committee said that people with an ARI could be monitored from their own homes using technology platforms that will feedback vital information on their condition to clinical staff. Virtual ward platform technologies have three component parts: a patient-facing app or website, associated wearable medical devices and a digital platform for professionals.
A patient’s temperature, heart rate, oxygen saturation, blood pressure, and respiratory rate could all be monitored and fed back to clinicians – often automatically, according to NICE said. Some platforms also include patient questionnaires which are fed back to clinicians.
The NHS is under pressure and giving people with an acute respiratory infection the chance to be monitored from the safety of their own home or care home can help manage capacity in hospitals [Mark Chapman, NICE]
The platforms will be used more widely to monitor people with an ARI from the age of 16 onwards in their usual place of residence. Advances of this type mean that people can be discharged from hospital earlier or monitored from home without being admitted to hospital – freeing up hospital beds as a result. Virtual wards can also reduce pressure on other branches of the care system, such as primary care sessions and trips to emergency hospitals, the draft guidance said.
Patients should only be admitted to virtual wards after shared decision-making conversations involving them, their carers and the clinical team have taken place. Patients and/or their carers would also need training and the confidence, motivation and skills to be able to use a virtual ward platform and the associated medical devices while they are at home, NICE said.
Patients would be given a telephone number to call for advice or support from 8am to 8pm, seven days a week, with instructions on who to contact outside these hours.
'Evidence shows virtual wards are safe'
Mark Chapman, NICE's interim director of medical technology and digital evaluation, said: ‘The NHS is under pressure and giving people with an acute respiratory infection the chance to be monitored from the safety of their own home or care home can help manage capacity in hospitals.'
He added: ‘Evidence shows virtual wards are safe and can be an option for those who are comfortable using technology to have their condition monitored away from a hospital ward. Using these innovative new technology platforms within a carefully managed NHS environment will enable us to generate the evidence to understand the benefits to patients and the wider health system of using virtual wards.’
10,000 NHS virtual ward beds promised by winter
Health Minister Helen Whately said: ‘Virtual wards are already allowing thousands of patients to recover in the comfort of their own homes. Expanding them to support people with acute respiratory infections will give more patients the option of recovering at home. At the same time this frees up beds for people who need to be in hospital. This draft guidance shows that patients can be monitored at home as if they were being treated in hospital.'
The NHS will create an extra 10,000 virtual ward beds – supplemented 5,000 hospital beds by the winter, as part of the Urgent and Emergency Care Recovery Plan, she noted.
Health leaders voice cautious approval
Danny Mortimer, deputy chief executive of the NHS Confederation, welcomed the draft guidance: ‘Providing choice to patients away from acute hospital environments is vital and also gives the NHS the opportunity to relieve pressure by avoiding hospital admissions and transferring the care of people into their own surroundings.
‘At the same time politicians must be realistic about how rapidly virtual wards can be deployed, even with this welcome support from NICE. The continued short-term backdrop of workforce shortages is a limiting factor as is the need to address the long-standing challenges facing social care capacity. We reiterate in particular our call for a comprehensive workforce plan for social care.’
Naomi McVey is the regional head of allied health professions for Health Education England (HEE). She is responsible for strategic leadership and operational support to ensure employers and Integrated Care Systems develop allied health profession (AHP) workforce supply, training, and education for service delivery and transformation across the North West. She is the national lead for HEE's AHP support workforce programme and co-chair of the North West AHP Supply and Transformation Board.
In previous roles, Ms McVey led the national AHP strategy implementation programme as head of programmes for the chief AHP officer at NHS England. She was a NICE fellow from 2017 to 2020 and has also worked for NICE's implementation programme. She sat on the Chartered for Society of Physiotherapy’s council from 2013 to 2015 and has held a range of clinical, management and leadership roles in the NHS.
The 19-member committee is chaired by hospital consultant Jacob Brown, who is an emergency physician with Hampshire Hospitals NHS Foundation Trust. Prior to his appointment at NICE, Dr Brown was the clinical lead at the Royal Hampshire County Hospital, working closely across all tiers of the trust to deliver safe patient care.
Financial savings in the offing
Evidence presented to the independent committee showed there were similar outcomes for those who were treated in hospital compared with those on a virtual ward. Other evidence showed that people admitted to virtual wards were comfortable using the technology, after training given by a healthcare professional.
The evidence also showed that virtual ward platform technologies are potentially cost saving to the NHS. Analysis by NICE's external assessment group estimated the technologies saved an around £872 per person compared with inpatient care, and £115 per person compared with care at home without a technology enabled virtual ward. However, there is still some uncertainty over how much the NHS will save using virtual wards, so further evidence will be generated over the next four years to establish the benefits in practice settings, NICE added.
To take part in NICE's consultation on the recommendations, click Comments must be submitted by 1 September 2023.
To read a viewpoint about virtual wards for this patient group, written by members of the British Thoracic Society and published in June, clickAuthor: Ian A McMillan