Severn Hospice has a well-established community services model combining Hospice at Home service, Hospice Outreach, Day services, consultant and specialist nurse clinics and access to information and advice by self-referral. The Hospice at Home service provides hands-on nursing care through the day and night, for around 90 patients each month. The Hospice Outreach service supports a caseload of around 260 patients at any one time.
In the past when patients experienced a crisis or deteriorated as their disease progresses, they would be referred for inpatient care within the hospice or even hospital. Severn Hospice wanted to explore whether by increasing care at home, they could continue to support people’s preference for home care and reduce admissions to the hospice or hospital.
The hospice investigated the virtual ward model used by the NHS in England and realised that this did not completely meet the needs of its patients and families. People in rural areas did not have the technology infrastructure to support the use of at-home devices, and the cohort of people who were most likely to be in a virtual ward did not necessarily have the technical skills needed.
Following conversations with its partners, the hospice adapted the virtual ward model and carried out a proof-of-concept pilot.
Outcomes
Severn hospice launched its virtual ward in October 2022, which cared for 65 people in the first five months. The virtual ward has 10 ‘beds’, which are overseen by a community Palliative Care Consultant. The beds are managed in the same way as in-patient beds, with patient records being kept on the hospice system and a ‘bed’ being assigned to each patient.
The consultant and clinical team check on each patient as part of their morning rounds, agreeing what treatment and support is needed throughout the day. A Specialist Nurse visits the patient each day, and the consultant will join them if necessary.
The hospice’s model of community care is now designed around a pathway that can respond quickly to a patient’s changing needs. This might involve moving from Hospice at Home care to the virtual ward (and back again), or getting support from both teams at the same time.
Most importantly, patients are able to stay at home, in their preferred place of care, more safely.
Facilitators, challenges and advice
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Key facilitators
Families have responded positively to the virtual wards, saying that they feel much less alone and more able to cope with the challenges of caring for a seriously ill loved one.
The hospice had discussions with local hospital and community trust partners about adapting the virtual ward model, and explained the rationale to them. Being an independent charity means the hospice is more able to adapt ideas to meet the needs of its patients and community (the virtual ward is self-funded).
The hospice Board was open to the idea of virtual wards from the start, and the proof-of-concept pilot means that the hospice does not have to commit to anything until it is sure this model is the right approach.
Challenges
Severn hospice has a large geographical footprint and covers more than one local community. It has been challenging to design a model that suits everybody in the local area.
Tips and advice
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Grasp the idea of innovations like virtual wards, but apply them in a way that fits your hospice.
Test everything – make sure new ideas will work before you make a substantial commitment.
Future development
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The hospice hopes to increase the capacity of the virtual ward over time.
Early indications suggest a reduced demand for inpatient unit (IPU) beds, and the hospice is monitoring this trend to decide whether to transfer some IPU capacity to the virtual ward.
