Helena Clements: Virtual wards - part of the net zero approach
My current job role incorporates adult safeguarding, ReSPECT, transitions (from paediatrics) and climate action and net zero NHS. After a life in paediatrics, I sometimes wonder how this portfolio hangs together and what authority I have to comment on most of this! However, in my head it is quite straightforward, and the dots really do join together. Equally, the idea of lean pathways and virtual wards are part of a coherent attempt to have a new vison for health and ill health. Every attempt to keep people out of hospital, minimise unhelpful intervention and aim for quality not quantity of life ticks the same boxes for me.
Currently I am pursuing qualitative audit in an attempt to encourage colleagues to think more holistically. Good conversations and written documentation with frail inpatients, outpatients with long term conditions, and in surgical pre-op, allows us to think differently about what really is in a patient’s best interest. Anything that gives them or their carers a plan for self-care, next steps and who to contact for help in the community, will help to avoid admissions and defensive interventions and investigations if they do come back in through the revolving doors. All the above will save precious resources and time for those who do need it - and this saves money and carbon!
Those good conversations include realistic plans for progression of disease and exploration of wishes regarding end-of-life, which can be documented in a ReSPECT form and in correspondence with GPs and community teams. We need to normalise these conversations and ensure that they happen at the right time and place rather than at the front door where most patients and staff are not in a position to really explore this.
So colleagues in adult specialties who are developing virtual wards are in a perfect place to facilitate good discharges with appropriate care plans, prevent re-admissions through the revolving door and where disease is progressive, support patients and their families to embrace symptom control and quality of their lives.
As we start to prepare for winter AGAIN, every admission we can prevent through this kind of approach is time well spent and a good investment. It will impact on flow and reduce pressure at the front and back door and any reduction in demand reduces our carbon impact. There will be fewer patient journeys, fewer investigations, less consumption of single-use items and drugs and most importantly, a better patient experience. It needs time and human resource. Whilst medical input is essential, specialist nurses are a great resource for some of the lengthy discussions and formulation of care plans. We should use them well.
A new vision of health needs to happen in parallel. Give public health specialists, paediatricians, health visitors, teachers and communities the resources to show parents and children how to stay healthy. We can deliver healthier adults and make some preventable diseases a thing of the past. My vision of the future will include empty beds, fewer respiratory and diabetes related diseases, a culture of healthier lives and good deaths in the right place. This is a low carbon vision which, given recent weather patterns, can’t be adopted and funded soon enough!