Do they work or don’t they? Are they safe, or not?
Good questions, the answers to which are; done well, in the right place, by the right people, at the right time, with the right resource, pretty well anything is safe.
Being shot out of a cannon, walking across the Grand Canyon on a high wire, fire-eating… you name it. Putting yer head in a lion’s mouth.
Right person, right circumstances, it’ll be all right.
What about parking yer granny in her front room with an iPad, a pulse-oximeter on her finger, a thing on the loo seat, to count how many times ‘she has a wee’ and a thing under the carpet to see if she falls over.
Is it safe? Is it better than being in hospital, with the risk of being parked and de-conditioned with PJ-paralysis?
Is there a collective noun for a group of grannies? What about a ‘cuddle’.
Let’s say we have a cuddle of grannies. Thirty. Let’s imagine the local hospital is choc-a-bloc and they are seduced by NHSE’s latest whacky-idea, virtual wards. Looking after people in their own homes… like they were in a ward.
They will need;
- A skilled assessment of yer granny
- Family considerations
- Case conference, figure out what else granny needs; pharmacy, physio, occupational health, aids and adaptations
- Social care package
- Meals on wheels
- The techie-bit installed
- Someone to teach granny to do the techie-bit, monitoring and alarm systems
- A team of really skilled district nurses to make sure the system works, is safe and to make personal observational visits to spot anything sinister
- A control centre to do the monitoring
- A team of skilled people who can interpret ‘red-flags’ thrown up by the kit, or yer granny… 24/7
- A 24/7 response team, multidisciplinary, practicing at the high end of their registrations
- Assessments and protocols for re-admission
- Ambulance availability
- Stand-by beds and some admission system that by-passes A&E, and…
… a discharge team, ready to start the whole thing off, again, starting at the top of the list
Alternatively, you could put our cuddle-of-grannies, in one place, where everything already is and call it a hospital.
Does this mean that virtual-wards are an actual-bad-idea?
Yes…
… and no.
On Tuesday evening I chaired an IHSCM, Power-Hour session on the very topic.
Watch a recording – here.
A super high-powered panel discussed the virtues and sins, the in’s and out’s, the high’s and low’s. These were people who’ve done them and run them, studied them, here and overseas.
Do they work or don’t they? Are they safe, or not?
Well, we know, if you are the right person at the right time and you know what you are doing… you can put yer head in the lion’s mouth.
It was left to one of the panellists, Dr Elaine Maxwell, to ask the silver-hammer question.
It is the question, the only question a manager, strategist or planner should ask before they do anything, plan anything, change anything…
‘Why are we doing this?’
Are we trying to expand capacity, sweat assets, cut admissions, save money, use fewer people, reduce the skills base.
Why?
Is it because we don’t have enough beds in hospital and yer granny has her own bed.
Is it because we don’t have enough people and one nurse looking at a dashboard can care and curate a whole cuddle of grannies?
What are we trying to do?
And, let’s not forget, there are all types of wards in a hospital, so there could be all types of virtual wards…
Frailty, post-covid, pre-covid, post-op, pre-op, long-term conditions, cancer therapies, end-of-life… as many as there are wards, so there are needs to meet and systems to develop.
Why are we doing this…
We know why; we have fewer beds and fewer staff per head of population than most of the comparable health systems across the EU and the OECD.
Virtual wards are fantastic, done right, with a highly skilled multidisciplinary team.
They cost a lot of money and need super-skilled people, with the right kit with user interfaces that are simple, reliable and work, right-first-time.
Face-to-face supervision, 24/7 monitoring and a backup protocol that doesn’t add to the work of district nurses and the ambulance service… and…
... we all know, there is only one way to cuddle yer granny. Go and see her and take a bunch of flowers.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
