NHS England have urged ICS’s to set up frailty virtual wards as top priority and, for many providers, this will feel like a huge undertaking. We encourage you to take the journey one step at a time and learn from the experiences of others.
Based on our experience of launching a frailty virtual ward, in collaboration with NHS and social care partners, we have identified 5 small, but crucial, steps to building a successful frailty virtual ward.
These key steps were shared in our latest live panel event, bringing together NHS and social care professionals to discuss their experience with delivering a frailty virtual ward.
Although the service will have economical benefits, the overarching goal of the virtual ward should be to provide the very best care for patients. Every decision made during the planning process should take into consideration how the patients will benefit.
Jon Rouston, CCIO at Lincolnshire Community Health Services NHS Trust, said:
“We're not making a virtual ward, because NHS England have asked us to, we're making a virtual ward because we think that there's a cohort of patients that we could manage better in different places and create a better experience for them.”
This philosophy will help with identifying where the service can have the most impact. For example, we know that when frail patients are rushed into hospital, they are at a higher risk of hospital-acquired infections and delirium which can take weeks, or even months, to recover from. Implementing admission avoidance and assisted discharge virtual wards helps frail patients stay out of hospital and enables them to recover more comfortably in their place of residence.
It’s crucial that all stakeholders are engaged with the virtual ward in the early stages of planning. Working with digital champions from the beginning will help convert those who are feeling unsure about the new service.
Jon commented: “You've got a group of people who are going to absolutely run with it, a group of people who are going to be really difficult to get on side, and then a group of people in the middle.
"And working with those people in the middle using the people who are going to run with it, it's probably going to bring you along much quicker.”
It’s also important to consider how to best engage with the social care provider. To prevent the needs of the health provider from being prioritised over the needs of the social care team, both parties should be planning and designing the service together from day one.
As a result of overlapping funding opportunities, NHS teams sometimes design new pathways that end up being very similar. This is where strong communication across providers within the ICS is critical.
Melanie Weatherley MBE is the Chief Executive at Walnut Care. She commented: “Because we all talk to each other in Lincolnshire, we've been able to say, ‘Oh, I've just got funding for this’, ‘While I've got funding for that, but actually, it's the same’. So can we not do it together?”
Joining forces and combining resources to create one single pathway will have more benefits in the long run.
To ensure a smooth transition of patients through the pathway, the team need to carefully plan the clinical model and create comprehensive standard operating procedures (SOP). It should be clear where accountability lies and who is responsible for what.
The SOP will help the team identify which patients are suitable for the virtual ward and how the onboarding and off-boarding process should work. Ensuring everyone knows their role and what they are responsible for will help the team grow in confidence while providing a well-organised service.
Starting with a small cohort of patients allows the team to get used to the service and feel more confident delivering it. It gives the organisation time to notice teething issues and fix them before scaling up. The virtual ward service should grow based on learnings and feedback from both the health and social care teams.
Jon said: “We've used a PDSA kind of model, so Plan, Do, Study, Act, model where we've got people back together every week and we've talked through what's gone well, what hasn't gone well. Let's plan for that, let's implement it. And then let's come back and review it."
While it’s important to start with small steps, it’s important to build momentum and keep moving forward with the goal of the pilot becoming ‘business as usual'. As Melanie puts it:
“Don't run before you can walk, but as soon as you learn, make your strides as long as you can because there’s a long way to go.”
Building a flexible service is crucial. It should be able to adapt to the changing needs of clinicians, carers and patients. With that said, the team shouldn’t let small issues hold them back from progressing and growing the project. As Jon neatly sums it up: “Perfection is the enemy of done.”