Virtual Wards - NHS

[CUK_Membership_Team]

Virtual wards – also referred to as ‘hospital at home’ – allow patients to receive hospital-level care at home by using technology and equipment to allow healthcare teams to closely monitor patients and continue to support their care.

Whilst virtual wards can improve outcomes for patients and carers, 55% of unpaid carers surveyed in our 2023 State of Caring survey said that this would result in them providing more care, meaning it is crucial that virtual ward teams properly support unpaid carers who are looking after someone on a virtual ward.

Carers UK has worked closely with unpaid carers and NHS England over the past two years to ensure that the needs of unpaid carers are properly considered and addressed during the delivery of virtual wards, and have co-produced a suite of resources as part of the Carers Partnership through the Health and Wellbeing Alliance.

The resources we have developed provide unpaid carers with more information about virtual wards and what they can expect and are also intended to support professionals involved with their delivery to better understand the needs of unpaid carers.

Our new toolkit contains a suite of resources designed to improve the level of support unpaid carers receive when asked to care for someone on a virtual ward, which you can find here: https://go.carersuk.org/VW-toolkit

If you would like to find out more about this project, please contact policy@carersuk.org. For further information on virtual wards, please visit https://www.england.nhs.uk/virtual-wards/.

[selinakylie]

I remain very anti Virtual Wards as it makes the Carer virtually a prisoner in their own homes expected to be available 24/7. The ONLY chance I get of a break from my husband is if he is taken into hospital and even then it is only until he discharges himself telling staff, his much younger wife WANTS to look after him. I wonder if the NHS should consider implementing Convalescent Homes rather than Virtual Wards? Cottage Hospitals? I honestly see Virtual Wards as a cynical attempt to force Carers to take on more and more responsibility. Are we allowed to refuse to be part of a
Virtual Ward? Legally and Morally?

[EEG]

Surely if we can ‘refuse’ to be someone’s carer, then we can refuse to be part of the virtual ward setup in our own homes?

[selinakylie]

@EEG I would think Legally we can ? But morally I would guess if the hospital needs the bed, we would be co-erced into doing it? Victoria’s experience was distressing to read about as although she loves her mother very much, she was ill herself. For me my husband is so medically non compliant it would be horrendous. However, I know if it was mentioned he would be quick to volunteer me to do it!

[JayneyT]

Yes, in my view, this just gets the NHS off the hook. We are already paid a pittance for providing 70 hours plus a week of care. I am luckier than some, in that my mother “insists” on living independently from me, but I am still over at her house 7 days a week. As @selinakylie says, my mother has discharged herself three times from hospital now, because she tells them I look after her at home and they are only too keen to free up the bed. Some people on this forum would literally be trapped in their own homes with their caree, unable to leave, as they would have to be monitoring the “hospital level equipment” to make sure it is running correctly and providing the correct data to NHS hubs. It’s an utter disgrace, unless there is a plan to recognise the role of “voluntary” unpaid carers.

[Victoria_1806]

Why is there an assumption that the patient or their loved one or carer will take on A ROLE in the virtual ward?
Why is there NO assumption that a district nurse, GP service or social services HAVE A ROLE in the virtual ward.

It seems that underlying the suite of information, the consultations that have happened the NHS hospital has assumed an unpaid person is part of their infrastructure.
This capitalises on the need to ensure unpaid carers need to be informed in the right way.

Surely before assuming HOW a carer is involved, PAID services, health and care agencies and organisations like social services and continuing care need to be the first assumption.

I have a LOT to say given I went through Virtual Ward process When I was ill with Covid and pneumonia…the fact that I had people say to me ‘that they could accept me taking readings only twice a day instead of three times a day, that was an okay negotiable point’…or that we received calls to check on my caree after I’d sent in the reading…

WHEN did we become a ‘managed’ unpaid direct report asset in the health system? Data entry, and daily reporting to satisfy the tick box discharge feels almost useless when you’re an experienced carer who can recognise changes in our loved one’s health status

The moral/ethical burden of care is again placed on carers who are not clinically trained - so they feel obliged to comply

There is a piece of paper that we sign as the patient/carer stating WHAT we will do, how many times of day and that IF we do not do this and refuse then the hospital has the right to readmit the patient because the patient is still ‘under the care’ of the hospital not fully discharged
that definitely felt like a it’s your responsability and your fault if your loved one can’t go home

https://www.carersuk.org/media/uskf4k0v/virtual-wards-policy-briefing-september-2022
this doc seems the most informative -

There is NO scenario about COVID and the liklihood of the carer being ill - I had full blown symptoms and was being told what to do, NO thought to support from district nurses

IF unpaid carer were FULLY considered as partners in the interview to discuss virtual wards the first question would be - I’ll tell you what the role requires, if YOU’re an experienced carer and just need to have us on the phone so you can tell us if symptoms are escalating and if you think your loved one needs to be seen/examined for possible new prescription or review we’ll leave you with this number to call that enables DIRECT hospital support - especially for COVID-pneumonia. PERIOD. Because of course both my mother and I both had covid and pneumonia still while at home, me doing virtual ward AND VERY VERY worried I’d reinfect her

[Chris_22081]

This is something I fear happening with them trying to force Graham into discharge. Currently he can only walk about six feet to the loo and back - whilst still on 3 litres of oxygen a minute. How would I manage that at home? I WOULD be a prisoner - unable to walk the dog or go out for anything.

We live in a rural area where an ambulance on a Grade 1 call takes 25+ minutes to get to us (I have timed them on four occasions now). 2 weeks ago we had a Community First Responder get to us (he came from a village some 13 miles away) and got G on oxygen and the ambulance took over an hour from the first call from GP ! If I was the one calling or the hospital had to send an ambulance to my “Virtual Ward” what would the delay be then and what would happen if they took over an hour? I would be left needing a second crew to deal with me going out of my mind with worry?

I am - mostly - level-headed and can understand and follow instructions. In fact I understand the Obs taken in hospital as well as the nurses and HCAs these days. However, if suddenly G was go have a major relapse as he had a few days ago when his SATS fell dramatically - or yesterday when he hit 97% O2 for no apparent reason and they had to cut the oxygen supply urgently as he was hyperventilating - how would I be expected to deal with that with no medical training. Also what happens when we get one of our regular power cuts as soon as we get high winds - our power supply is still mostly served by old fashioned pole mounted transformers and a couple of years ago there was a surge and one blew a fuse - then a cascade of events blew out four other transformers - it took more than 24 hours before everyone was restored… Now we are all on fibre, if we lose power we lose the phones. Oh and our mobile signal here is intermittent at best. I have installed a UPS for our phone and router so we should keep a line for about an hour and I should be able to use the laptop with maintained wi-fi but that’s not a long time. Indeed that was to stop everything resetting when we get the 2 - 10 second interruptions which happen every few weeks (and something half a dozen of them in 15 minutes).

I’m sure in an ideal world with devoted carers who have boundless energy and no other demands on their time, the system could work, but I have just had a burn-out. Last Saturday I had to have a duvet day and then today I felt so ill I couldn’t do anything. With no support backup what do we do, kill ourselves for our £80 a week CA?

[Chris_22081]

Sorry to say @Victoria_1806 that link is broken - I get 404 message…

[Michael_1910123]

Though I know it for NHS England, I have had dealings with virtrual wards in Wales and I have found them a mix bag in response. The 1st and 2nd time we used them/refered to them, the staff tries to be helpful but also not so great in communication department. I had to ask the GP for the wards number as no one phoned back to tell us the outcome. I phoned and got a telling off for ringing but once I let the nurse finish, then I had a go back and we were discharged as they couldn’t help, we were asked a few time if we wanted to be referred again but said no and explained why.
The 3rd time was a few weeks back and was not impressed as no one had asked us before the hospital had sent mum home and said this virtrual ward team were going to help us due to shortage of bed in the hospital. We had different nurse visited us unannounced which was on times awkward as you were never sure when they were going to turn up. Despite this virtural ward, mum is still not right and confusion over her aftercare.

Virtual wards are no use as the staff could be used in the hospital where needed. If make people prisoners in their own house due to not working with family members over a person care. Also no one is being trained to be a nurse which if they want home to be wards then they should as the person who is under the care of the different teams from the virtual ward could have medical items in their arms like for taking blood or giving medication via injection and the person might take it out and then you got to make sure you have a sharps box but also if they bleed from it then you got to try and stop it as well as phone for help.

Maybe we should be paid the same as a nurse.

[selinakylie]

@Chris_22081 Agree I tried to access link and got the 404 message.
@Michael_1910123 Even if we got paid the same as a nurse, please remember that THEY would not be expected to be available 24/7…

[Victoria_1806]

https://www.carersuk.org/reports/virtual-wards-toolkit-getting-it-right-for-unpaid-carers/
in the moment days of hospitalisation, advocating, pushing communication and suffering covid myself I would NOT have been able to read all this.
I did read what they gave me, and in the moment ‘access to nurse services’ and ‘being able to directly get readmitted’ were the 2 reasons I went along with it.

What happens If we refuse Virtual wards?

I appreciate the work that’s gone into ensuring carers are ‘part’ of the discussion
BUT virtual wards ASSUMES, the OLD hierarchy, command control management is necessary here,
the old premise of ‘bed blocking’ is not the premise for discharge its safety versus risks for the patient AND carer
Partnering WITH the carer to hear if the carer can or can’t manage is the first question
These days there is no due-space given to listening to carers needs, concerns - productivity to discharge and tick-box actions and of course no one really wants to know/discuss the health of the carer themselves

IF the carer says they can manage the virtual ward needs to focus MORE on RESPONSIVE, services, advice and fast-prescription service and fast ambulance ready if something changes. There’s too much emphasis on getting the carer to do readings

[Victoria_1806]

ALSO, please could someone consider that NOT all carers are at the same stage or level of experience - the virtual ward right now is a one size fits all solution…
There are differences between long term chronic patient-caregivers versus early stage caregivers, or caring for someone who will 99.9% get back on their feet (literally) after an op…

Speaking as a long term carer, I’m hypervigilant about changes, and we have our own ‘O2, BP, temp machines’ - how about respecting and DEFERRING to what WE SAY WE NEED post hospitalisation instead of cookie-cutting, command instructions onto us when we’re enabling the best rest, recuperation at home on the timetable that’s best for our loved one…ie don’t call to check when it’s convenient for virtual ward checks, or expect readings to be done to feed the info system for the MDT.

[Victoria_1806]

(I DO NOT CONSENT to use of this image beyond the Carers UK forum)
@Michael_1910123 did you have to sign a similar form?

This is the form I needed to sign
the readings were agreed on twice a day not 3 times.

How many command-control statements can you see?
How much emotional strain can this put on a carer - imagine elderly carers who are less tech savvy
Imagine doing this with Covid pneumonia

Is the ‘welfare check’ seem like a reassurance statement or a possible safeguarding threat

TBH I can see where this is all going given Wes Streeting’s focus on digital and productivity.

@Michael_CarersUK @CUK_Membership_Team
https://www.carersuk.org/help-and-advice/practical-support/virtual-wards
Points 5,6,7,8 on the checklist re. hospital discharge needs to be heavily reinforced
There is a big assumption and automatic action - Doctor activates virtual ward people to talk to patient and carer (if they happen to be camped out in the room like I was) and then the ball rolls downhill onto us

[Michael_1910123]

No we didn’t had a form to sign.

One thing that nobody thought about is with a virtual ward, will it affect people who gets carers allowance? And the person who is being treated by the ward? Reading some of the information from the dwp that you got to tell them if you orthe person is going to be in hospital more than 30 days. So if the person is under the ward but been sent home will it affect people money or not? It’s something people might not have thought about but someone in dwp might have.

[bowlingbun]

I have had some major surgery and been very ill. In the summer I had cellulitis (again) and one day it took every ounce of will power to get from my bed to en-suite, only 8 feet away. Fortunately my eldest son lives with me, but he works during the day. I was told if my condition worsened I must dial 999 immediately. From this and other experiences, I’m wondering how patients will be selected for a Virtual Ward? Those with an unpaid family carer at home would probably be seen as an easy target? Our parents were all seriously ill for a long time before they died. They repeatedly said they didn’t need help as “my son/daughter will do it” completely ignoring all the other demands on our time from the other 3 parents and out brain damaged son, plus our business of course. CA is a pittance, paid at a flat rate for 35-168 hours a week. Surely for someone who would otherwise be in an expensive hospital bed with nurses on 3 shifts, there should be some sort of additional allowance? Especially with set times for obs?! It’s all very well asking the patient to agree to all this, we all know they want to be home and stay home, but what about asking the carer if they are willing and able to provide 24/7 care?! From my experience, elderly people go downhill over a long period until they die. During that time there will be a number of crisis periods, but they never get truly better. I shall always believe that my husbands death from a massive heart attack in his sleep at the age of 58 was brought on by the stress of us having 4 elderly ill parents, a brain damaged son, and me having major cancer surgery and a very long period of recuperation. Carers are not invincible.

[selinakylie]

@bowlingbun Totally agree with what you have said especially that elderly patients with co morbidities go downhill for a very long time before they actually die. I think if anyone tried to make me have E back for a ‘Virtual Ward’ I would be very tempted to threaten to go and see a solicitor. I think frankly with not having a hospital bed and the number of cats, I would have a strong case NOT to have to agree to this. But issue would be if E said that I WANTED to care for him which he has done in the past. Our compassion is used against us as most would go the extra mile for the caree. The Welfare check worries me too. I would imagine that the NHS would be wary of discharging people to a Virtual Ward if they lived alone. Yet they did this to my 85 year old mother and she had a Virtual Consultant. Never did get to the bottom of this but I do not think it lasted very long as she is mega deaf and probably would not hear the phone if anyone checked. I agree with getting District Nurses involved but if the person is deaf and/or lacks mobility it still means the Carer being a prisoner 24/7 as they are never sure about what time they will come. Frankly I really hope Carers UK fight this as I think it is an utter and complete nightmare. Carers are supposed to get jobs and have some ‘quality of life’ but how on earth can we do this when the system is set up to blackmail us into doing more and more?

[bowlingbun]

Our council has a new Carers Charter. Interestingly they still have the old one on their website! They both talk about supporting carers, recognising that carers may not be willing or able to care etc etc but it’s pointless if hospitals don’t have the same policy. In any case, who is going to police it, to make sure it’s applied? After major surgery 20 years ago I was told never to care for anyone ever again. Totally ignored by Health and Social Services. No one will even talk to me properly.

[Sue24]

As most of you know from my previous experience I refused to have Phil home from hospital when he wasn’t mobile and they were talking about sending him home to be bed bound. I had to fight to get them to agree to send him to physio rehab centre rather than home. It shouldn’t be like that and things should be done in the best interests of the patient. We shouldn’t be forced into a caring role that we are unable to do.

[Chris_22081]

Oh Sue - we’re heading in that direction. The consultant has been round this morning and said G is improving greatly but they are still not certain what has caused this particular problem… Then there was that comment ‘so if things continue, we may be able to get you home before much longer…’ My ears pricked up and I quickly chipped in ‘that’s fine but Graham cannot walk more than about 12 feet to the loo and back and then he is exhausted. At home he would have to walk a lot further and would not be able to manage stairs…’ No further comment from her…

The Carer’s Liaison Officer is back from sick leave now so part of her job is ensuring Discharge Discussions take place properly and protocols are followed… Oh boy - wait til I dig in my heels…

[EEG]

@Victoria_1806, it was wrong of the NHS to assume you would be okay with the virtual ward situation and especially wrong that they expected you to do it whilst ill.

I can only think that before a patient is discharged home, the relevant carer would have to explicitly state whether they would or would not agree to do it, and if not then it’s up to the hospital to provide continuing care. They cannot assume that just because a patient has someone at home, that it is okay for them to discharge the patient.

Also where does the duty of care responsibility lie, with the hospital (who should be overseeing the virtual ward care) or the carer? It sounds a hell of a minefield and one which has not been properly considered or thought out.