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Virtual wards – why and how to make them a success

A New Looming Crisis for Telecare Services in the UK - A Call for Digital Innovation

A Call for Digital Innovation

The negative impact of the impending deactivation of Virgin Media O2’s 3G network during 2025 is going to be significantly increased for users of telecare devices that use this band by the additional confirmation that VMO2 is also going to restrict “Inbound Roaming” on their 2G Network (CLICK HERE).   

In short, telecare devices that are built to utilise “Roaming SIM’s” from 3rd party providers that operate on either the 2G/3G Networks will suddenly find their services become unavailable if they are in an area where using the VMO2 Network is their only option.  In fact, VMO2’s advice on the issue is, “Businesses should contact their connectivity provider to ensure any machines and applications that may use roaming to connect to our network, even occasionally, are upgraded to 4G / 5G or to find alternate ways to connect before October 2025.” 

Coupled with the overall effect of the general 3G switch off, this represents a sudden milestone in the UK’s digital evolution but also a looming crisis for telecare services that rely on this legacy technology.  

For example, we have been reliably informed that there are c50,000 connected telecare devices in Scotland alone that were bought in the last 2/3yrs that rely solely on this connectivity. According to the TSA, there are an estimated 700,000 digital TEC devices in the UK, of which c500,000 are reliant entirely on 2G networks! 

The fact is that the impact of this decision will similarly be felt across the whole of Great Britain. Telecare providers, especially in the public sector, already face daunting financial and logistical challenges to ensure continuity of these vital services. Now, they are going to be faced with the massive challenge of replacing/upgrading equipment that has only recently been purchased. 

With this in mind, it would be fair to ask the question why manufacturers continue to sell this type of equipment and industry “advisors” nor “advise” against it when they were all fully aware of the potential risks, especially with the Government first announcing that they had reached agreement on the upcoming 2G/3G Switch off back in December 2021 (CLICK HERE)?  However, these are questions for those impacted most to ask and discuss and on another day. 

What is most important now is that we look at how best to solve the issue. 

Firstly, it is especially important that the industry uses what influence it has to lobby hard to have this decision revoked or delayed.  

However, given that VMO2 have stated that the closure of its 3G network and its knock-on impact on “smart-metering” as the main reason for restricting access to 2G networks suggests clearly that something is going to have to suffer.  

Considering their huge commercial UK Contract to supply smart-metering connectivity, you must wonder where exactly that “suffering” is going to occur, so how successful will that lobbying be? 

Regardless of any lobbying, which cannot and must not be relied upon, manufacturers have a responsibility to stop selling this type of equipment IMMEDIATELY and buyers MUST stop buying it. 

Finally, manufacturers of traditional “button and box” type solutions must make the investments necessary to ensure their equipment is as “future proof” as possible, ensuring testing and roll-out of new, digital technologies such as VoLTE, SIP, and other connectivity options such as ethernet broadband, Wi-Fi etc. are all completed ASAP. 

There is clearly a great deal to do and very little time to do it in. Especially with the “double whammy” of the Analogue to Digital switch only 2 years away – Imagine if that had not been delayed!!! 

However, they say, “Every cloud has a silver lining” and with that in mind, I believe this crisis could catalyze a much-needed transformation to fully digital solutions like Yorbl, which offer not just compatibility with modern networks but a host of other benefits. 

Why the Stakes Are So High 

Telecare devices provide a lifeline for vulnerable individuals, enabling them to live independently while ensuring their safety. These devices rely on uninterrupted connectivity to function. A disruption in service could put lives at risk and undermine trust in public care systems.  The phased removal of 2G/3G by all UK mobile operators creates an urgent need for providers to act decisively NOW. 

The Scale of the Problem 

Virgin Media O2’s announcement states that less than 1% of its customers use 2G-only devices and these account for a negligible portion of its data traffic. Yet, the removal of this network is seismic for telecare providers.  

Transitioning away from 2G/3G (and Analogue) means not just the significant cost of replacing unsuitable hardware but also incurring the costs of installing the new equipment, integration, and staff training. With c1.8 million connected devices in the UK and c80% of which are still analogue, the size of the problem is already huge.  

Add to that the fact that all public sector providers are already operating on an extremely tight budget, these unavoidable costs (which will run into tens of millions of pounds) will have a devastating impact on public services that are already under massive strain? 

A New Approach: Digital Solutions 

But what if there was a genuine way to significantly reduce these costs? A viable, alternative approach that could save millions and position telecare for a genuinely digitally driven future? 

We believe there already is. 

By transitioning to a genuinely digital, app-based solution such as Yorbl’s, ALL these hugely significant benefits can be achieved. For example: – 

  • Remove the cost of replacement equipment  

With between c78%-85%  of people aged 55+ in the UK already owning a Smartphone and close to 100% of those aged 16-54 (CLICK HERE), the opportunity for the end user to simply install a Telecare App directly onto their own device has never been greater and it is only going to grow year on year.  For those few who do not currently own a device, you can guarantee that a relative or a friend will have an old one they can use. 

Why spend money on new “button and box” devices when you can deploy an App such as Yorbl Vita for c80-90% less? 

  • Facilitate Easy, Rapid, Low-Cost Deployment  

Imagine a Telecare solution being provided at the point of purchase or the point of being prescribed, without the need for a physical alarm device to be ordered and installed?  

Yorbl’s app-based model facilitates this through installation directly onto users’ own smartphones or tablets, negating the need for costly hardware upgrades. This can be accomplished quickly and easily by a visiting Occupational Therapist, a family member or even by the end user themselves. 

Just how much money could be saved by providers who will have to pay for this to happen? Many £millions?  

  • Position for the Future  

The problem with most traditional telecare offerings is not just the hardware and deployment costs, it is equally about the ability to scale such a solution and to be able to dynamically adapt it to the changing needs and circumstances of the end user.  

With many of these solutions offering only their own, proprietary peripherals etc., customers are quickly locked into and held back by both what is available to them now and a significant lack of pace when it comes to innovation and adaptability.  

The simple fact is that a truly digital, software-based solution like Yorbl is hugely more capable of adapting and developing to changing needs and circumstances and can do so exponentially quicker than any traditional solution. 

 With an inbuilt openness and interoperability that connects to any Alarm Receiving Centre (ARC) Platform and allows integration with a massive and still growing range of peripherals from innovative third parties all over the world (including medically certified devices), we are already halfway there. 

 

Add a massively scalable cloud infrastructure that offers everything from the ability to view and analyse a User’s “Activities of Daily Living” to remote health monitoring and even the use of machine learning/AI to automatically predict problems and trigger actions to prevent them, what situation could not be adapted to? 

 

With this type of solution, providers can be absolutely sure that they both solve the problems directly in front of them and continue to do so well into the future. 

 These are just a few of the benefits that a solution such as Yorbl’s can bring, and you can be sure there are and will be many more. 

A Call to Action 

As we approach the 2025 deadline, public sector bodies must consider not just compliance with network changes but how to future-proof their operations. Even if lobbying creates a small delay, the changes to our mobile and fixed communications networks are inevitable and the clock is ticking inexorably. 

Investing in a robust digital solution like Yorbl addresses the immediate need for network compatibility while unlocking opportunities for enhanced care delivery and doing so in a way that can save providers £millions in unnecessary cost. 

The benefits, however, extend far beyond financial savings. They include better health outcomes, more personalised care, efficiency gains and a more sustainable model for combined Telecare and Telehealth provision. 

Virgin Media O2’s decision highlights the urgency of modernising critical services. It is an opportunity for telecare providers to embrace innovation and deliver better care for all. The question is not whether we can afford to transition to digital solutions but whether we can afford not to. 

Peter Reed-Forrester – CEO, Yorbl.

 

Written by Kath Robbins

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09/05/2023

Virtual wards are a crucial part of NHS plans to increase capacity, as highlighted in the recent delivery plan for recovering Urgent and Emergency Care services (UEC). The “twindemic” (of Covid-19 and flu) has contributed to record levels of occupancy (as high as 95% across the country) which, combined with staff burnout, has made capacity in hospitals a critical bottleneck. To address this, one of the key interventions backed is the establishment of ‘virtual wards’ in the patient’s home, facilitated by remote monitoring, to avoid admission or allow earlier discharge. The benefits of such an approach are clear but they are complex to implement. There are multiple case examples of high impact implementation leading to reduced length of stay, reduced readmission rates and lower costs, whilst also improving patient satisfaction.   

The scale of challenge in UEC and amount of investment make it vital that virtual wards are a success. It’s believed that, by Christmas 2022, 10,000 patients had used virtual wards and the government announced plans to increase this 500%. Anecdotally, however, existing capacity has not been fully utilised. £450m has been committed over 2 years to this programme, making it critical that virtual wards are effectively implemented and utilised.  

We outline below the basis of what a virtual ward is and why we need them before turning to the questions of what is the track record and how we measure success? We also identify five drivers of a successful virtual ward programme: consultation, impact measurement, good use of technology, management of clinical change and the use of flexible workforce models. 

What is a virtual ward? 

Virtual wards are shorthand for additional remote care services in health and social care provided in a home setting which allow patients to get the care they need at home, safely and conveniently, rather than being in a hospital setting. Virtual wards became a crucial part of the 2022/23 NHS England operational plan, with a target of 40-50 beds per 100,000 population (equivalent to the delivery of up to 24,000 virtual ward beds in total) by December 2023[1]. To achieve this there is a recognition that the rollout of the virtual ward model will have to be innovative and make use of digital technology where possible. 

Technology can provide the hardware and software to remotely monitor patients’ wellbeing. Clinicians can understand what is happening with their patients without needing to visit in person. Attention from multidisciplinary teams can then be focused on the patients with the greatest or most immediate need. 

The Covid-19 pandemic necessitated a shift away from in-hospital care. Patients being cared for at home with additional services provided an example of how virtual wards can be used effectively. The success of these local services has led to national support for rolling out additional capacity in virtual wards; NHS England has committed £200 million through the Service Development Fund to develop virtual wards through 2022/23 and then a further £250m of matched funding for 2023/24.  

Why do we need these services? 

There is clear evidence that caring for people in their own homes supports their recovery. Patients prefer it because it enables more autonomy and choice whilst enabling them to stay in familiar surroundings, with their local support network (family, friends) often close by. In addition, studies have shown that virtual ward models significantly reduce attendance to Accident & Emergency departments and associated unplanned hospital admissions. This is because patient needs can be met earlier, before becoming a crisis, through the provision of multidisciplinary care[2]. 

Other studies have found that following the implementation of virtual wards, hospital re-admission rates reduced by 50%[3] and average length of a hospital stay was reduced by 40%[4]. Given physical capacity constraints in acute hospitals and ongoing constraints to capital availability in the NHS infrastructure and changing population demographics increasing demand, we must continue to find new and innovative ways to safely manage more patients within their own homes. This must include finding more effective ways to discharge into other settings of care. 

What is required for implementation? 

Central to implementing virtual ward programmes will be identifying and utilising effective digital solutions. Virtual wards require clinical oversight and, with the increasing workforce availability constraints, mean that remote monitoring and workforce optimisation solutions can help more people receive high quality care within an increasingly limited resource. 

At present, there is a wide range of virtual ward services with variable use of technology. So far they are providing very effective personalised care, but the anticipated cost savings of providing a service at home versus hospital are still to be realised in full. Despite the comparatively high cost of acute hospital beds, home visits can be staff-intensive and the length of time people require care tends to be longer than in hospital, resulting in a smaller cost differential than anticipated. Incorporating digital solutions will help free up staff and increase the efficiency of the service, reducing costs.  

Additionally, digital solutions can help support people’s overall health needs by improving the quality of care and patient experience. Research found that 99.5% of the patient cohort who received ‘virtual ward’ stays were likely or extremely likely to recommend virtual ward stays to family and friends. Studies also found that these service models also improve the experience of the workforce[5]. 

Implementing virtual wards effectively, with the right enabling digital services will help decrease the cost of care provision, whilst improving patient care, at home where they are comfortable. As such, it effectively responds to the Triple Aim of the NHS by improving: the health and well–being of the population; the quality of services provided; and the sustainability and efficiency of resource use. This should help focus minds on how best to advance the virtual wards agenda. 

What are the complexities of delivery? 

Ensuring that virtual wards are inclusive is a complex task. Virtual wards are designed to improve access to care for population groups which have traditionally been hard to reach, but there is a risk that they could reinforce existing inequalities in care provision by prioritising those who are more digitally literate. Therefore, it is important that technology is used and care is distributed equitably to ensure that these gaps are not widened[6].  This requirement will apply to the specific design of the monitoring technology, the approach to offering a wraparound service of support and communicating effectively with patients. 

Community services will need to adapt to accommodate new ways of working as virtual wards and their workforce caseloads become a regular feature of health and social care. Whilst virtual wards will reduce pressure on in-hospital wards, they will also increase the caseload for the community workforce, so when implementing a virtual ward, it requires both implementing operational change and the digital tools to support them.  This includes joint approaches across the care system on care model design and best use of scarce resources to create a service that can truly reduce pressures on the health and care system overall, rather than just transferring pressure from the acute to the community. 

However, this can also be viewed as an opportunity. Virtual ward programmes offer clear opportunities to create innovative workforce models in the NHS and with social care. Many clinicians leaving the NHS cite a lack of flexibility in their work, but movements away from traditional expectations as virtual wards are implemented will allow for more flexible workforce programmes, potentially helping with retention. For example, virtual wards programmes might allow clinicians more opportunity to work from home. 

Integrated Care Systems (ICSs) can help support different ways of working. Enabling staff, including community and hospital clinicians, to work across organisational boundaries within an ICS will be difficult but the rewards will be long lasting. These include improved patient and staff experience, as well as enhanced capacity within the NHS and social care. It is the responsibility of ICS leads to deliver against this ambitious transformation to improve care for patients and staff in the longer term. 

What are the key drivers for success? 

When setting up virtual ward programmes, several key drivers must be considered, to ensure that benefits are being realised. Virtual wards must be carefully tailored to the sector and area they serve. 

Consultation – Local residents must be consulted with for consideration as to whether they will benefit from virtual ward care. Programme leads must engage clinicians with the requisite expertise on local populations and create patient groups that adequately represent the patient groups targeted by the new service. 

Measuring impact – There is significant evidence that virtual wards have a positive impact, with an estimated £1,047 saving for each patient using a virtual ward[7] but this can be hard to assess given high occupancy in the acute sector at present. A patient using a virtual ward bed will free up a bed which will likely be occupied, rather than reducing occupancy in sum. 

Technology – Given the benefits technology can bring to management of virtual wards, choosing the right technology partner is crucial, with different solutions appropriate for different ward types; for example, there is a balance between continuous monitoring and spot reporting. Engaging clinical teams to understand the needs of patients will ensure that the technology used is appropriate and effective for meeting patients’ needs. Consistent innovation will be needed to ensure that virtual ward delivery continually improves. 

Managing clinical change – Those responsible for establishing virtual ward programmes must be cognisant that virtual wards increase patient acuity in the community and the associated risk must be proactively managed. For example, engagement with the local community combined with a tailored approach to the use of technology can minimise patient risk, whilst ensuring that patients who can safely remain out of hospital do so. Clear safety netting, consideration of the processes for out of hours care and well-defined routes of escalation will enable greater protection for these patients. 

Flexible workforce models – Requires learning to adapt to new technologies, as well as novel ways of working making best use of multi-disciplinary teams. We must ensure that training is aligned to advances and changes in how care is delivered, so that all members of a multi-disciplinary team are equipped to deliver care in the best possible way. 

Whilst technology is advancing to aid efficiency in care and providing patients with choice and flexibility in how they receive their care, we must be aware that human factors play a significant role in care delivery; a balance must be struck between technology and the human element of care. 

However, creating capacity will not help resolve pressures in the NHS unless actually utilised. There must be an active effort to encourage utilisation of services and embed change, beyond the initial creation phase. Otherwise, additional virtual ward capacity risks underuse, a significant boost to capacity which is not taken advantage of. 

How can CF support? 

CF is an expert healthcare and analytics consultancy which is well-placed to help systems embrace and implement virtual wards. We bring a wealth of experience in the health and care space and can support virtual ward development. Our support includes: 

  • On-course evaluation – CF can provide data innovation expertise, products, and solutions, including monitoring the benefits of virtual wards to patients. An example of the evaluation tool is provided below.
  • Financial sustainability and planning – Use CF’s extensive financial expertise to understand the system impact of virtual wards and develop a sustainable funding model for the services.
  • Digital adoption – CF can support the adoption of new technologies within NHS organisations and unlock the potential of digital solutions, understanding the remote monitoring requirements and needs for digital inclusion. 
  • Clinical engagement – We can link digital capabilities with deep clinical insight to provide a holistic approach and support clinicians to adopt virtual wards as part of new approaches to emergency care. 
  • Change management – We can provide expert input to support a change management programme into the new ways of working. 
  • Programme oversight – We can lead virtual ward change and support programmes to delivery against ICS planning. 

Our insight engine can be used to review the data available for metrics around virtual wards to assess their impact on a system, as set out in the examples above.  There is a wide variation on the level of impact of virtual wards and it is important to monitor their effectiveness. If you would like to learn more, click here.

[1] NHSE. 2022/23 priorities and operational planning guidance. 2022. https://www.england.nhs.uk/wp-content/uploads/2022/02/20211223-B1160-2022-23-priorities-and-operational-planning-guidance-v3.2.pdf

[2] Lewis C, Moore Z, Doyle F, Martin A, Patton D, Nugent L (2017). A community virtual ward model to support older persons with complex health care and social care needs. Clin Interv Aging 12: 985–993;

[3] NHSX. 2022. Remote monitoring for patients with chronic conditions in the Midlands. [online] Available at: <https://www.nhsx.nhs.uk/covid-19-response/technology-nhs/remote-monitoring-for-patients-with-chronic-conditions-in-the-midlands/

[4] Swift, J. et al, 2022. An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting. British Journal of Healthcare Management, 28(1), pp.7-15.

[5] Schultz K, Vickery H, Campbell K, Wheeldon M, Barrett-Beck L, Rushbrook E (2021). Implementation of a virtual ward as a response to the COVID-19 pandemic. Aust Health Rev 45(4): 433–441. doi:10.1071/AH20240. PMID: 33840420.

[6] NHSE. Enablers for success: virtual wards including hospital at home. 2022. https://www.england.nhs.uk/wp-content/uploads/2022/04/B1382_supporting-information-for-integrated-care-system-leads_enablers-for-success_virtual-wards-including-hos.pdf

[7] Swift, J. et al, 2022. An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting. British Journal of Healthcare Management, 28(1), pp.7-15.

FULL CREDIT: Rhys Thomson, Will Fryer & Tom Brogden, carnallfarrar.com

YOU CAN GO TO THE FULL ARTICLE HERE: https://www.carnallfarrar.com/virtual-wards-why-and-how-to-make-them-a-success/

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