Hospital at home/Virtual wards

[Rascal]

I have been involved with some discussions about these proposals of late. They are happening though whether you agree or not. Your old fella or mam may be sent home from hospital and monitored at home by digital devices.

Last week I was in a meeting with some Govt advisors on Health Economics and we tore them to pieces. There is not a definition of what this new policy means, we considered it a ploy to free up hospital beds and reduce pressure on the NHS by transferring that pressure to you, me and your families and friends.

It also creates an issue around discharge from hospital in that those with the ability to pay can send their loved ones private, whilst the vast majority can not, by definition a two tiered health service. It also puts pressure on Doctors and other HCPs who have to decide who can go home.

To be clear, i am not against this policy as it has merits in certain circumstances, but it appears a carte blanche approach and that concerns me greatly.

Do you have any concerns about this?

 

[mackenzie]

Like you say, it does have some merits. Lots of older and infirm patients could probably feel better at home and it gets around the increased dependency of being in a ward brings.

I just don't trust them to apply this in a measured way, smacks of kicking the can into the grass and applying to any and all.

 

[Palerider]

We need to do something for sure. I think it is well worth a go. I'd be very interested in a study of how we, as families, look after our elderly compared to other European countries. So, are we putting all the emphasis on the state to look after the elderly whilst other European countries put the burden/honour on the family? I think the two tier system issue sailed a long time ago. How many people do you meet these days with perfect, rather overly white teeth? You don't get those teeth on the NHS. I'd imagine it's exactly the same with operations.

 

[bluethrunthru]

In the words of Nye Bevan - fuck 'em

 

[bluegirl74]

I have some limited experience with this and agree that in certain circumstances it can be effective.
A colleague of mine was hospitalised in the height of covid and was offered this option after an initial week on a ward. The key factor in the success of the approach was that the patient was being discharged home where his wife and adult children were there to care for him if the necessity arose.
I would be against a blanket approach especially if a patient were being discharged with no support network in place.

 

[bluenova]

I have been involved with some discussions about these proposals of late. They are happening though whether you agree or not. Your old fella or mam may be sent home from hospital and monitored at home by digital devices.

Last week I was in a meeting with some Govt advisors on Health Economics and we tore them to pieces. There is not a definition of what this new policy means, we considered it a ploy to free up hospital beds and reduce pressure on the NHS by transferring that pressure to you, me and your families and friends.

It also creates an issue around discharge from hospital in that those with the ability to pay can send their loved ones private, whilst the vast majority can not, by definition a two tiered health service. It also puts pressure on Doctors and other HCPs who have to decide who can go home.

To be clear, i am not against this policy as it has merits in certain circumstances, but it appears a carte blanche approach and that concerns me greatly.

Do you have any concerns about this?

It makes a lot of sense - for many people I'd expect that family can provide a much greater level of care, so long as there is little risk of a medical emergency.

Surely hospitals already do assessments before discharge, with medical/physio etc? My mum was recently in hospital, and they were desperate for the bed, but she had to jump through quite a lot of hoops before everyone would give the go ahead. They had to make sure that she was capable of doing some things by herself, and spoke to us about the support we could offer.

Where that support is available, and there are proper risk assessments, then I suspect a lot of people would rather their loved ones were close.

 

[Rascal]

It makes a lot of sense - for many people I'd expect that family can provide a much greater level of care, so long as there is little risk of a medical emergency.

Surely hospitals already do assessments before discharge, with medical/physio etc? My mum was recently in hospital, and they were desperate for the bed, but she had to jump through quite a lot of hoops before everyone would give the go ahead. They had to make sure that she was capable of doing some things by herself, and spoke to us about the support we could offer.

Where that support is available, and there are proper risk assessments, then I suspect a lot of people would rather their loved ones were close.

There are points of merit in the policy, but there are points of concern.

What if the family can not provide the level of care that is needed, what if a person has no family at all. There are assessments before you leave hospital and because of the lack of social care there are people who take up beds which could be used in a more beneficial manner. That to me though is a result of the removal of beds over the last 10 years and the dearth of medical staff and nurses needed to provide care.

There is also digital exclusion to consider. Most people under the age of probably 50 are quite at easy using digital technology. My mum couldnt work a mobile phone, my Aunt who is 76 has one but does not understand apps. As one of the projected benefits are that Obs can be done at home, if this section of society can do obs but does not know how to send them on, they are useless. Will there be digital/mobile phone tests done before any discharge?

Another concern is that community nursing numbers are down drastically, in some areas of the UK they are now numbered in tens rather than hundreds. Will it add extra strain to a service that is already on its knees.

Another concern raised was phone consultations. Sometimes these are fine especially if it is a routine check in, I had one the other day with my neurologist and it suited all concerned, but speaking with my Prof in another dept he believed that face to face appointments were vital. Not so much for medical diagnosis but because he had a chance to read body language which he considered a big part of the process. Therefore if a person does get discharged and receives hospital at home, the body language factor goes, its a phone call. With us Brits being so deferential to people of higher social standing we will say yes I am fine even when not fine.

Anyways, it appears I am going to be part of the team from Manchester Uni who will be doing research into how they working or not working and would welcome anybody's experiences, hopes or fears on the matter.

 

[bluethrunthru]

Heck of a way of cutting the numbers of hospital deaths due to lack of staff and equipment and cutting ambulance wait times outside the hospital if they stay at home. Probably does little for a patients recovery but hey why do they care?

 

[bluenova]

There are points of merit in the policy, but there are points of concern.

What if the family can not provide the level of care that is needed, what if a person has no family at all. There are assessments before you leave hospital and because of the lack of social care there are people who take up beds which could be used in a more beneficial manner. That to me though is a result of the removal of beds over the last 10 years and the dearth of medical staff and nurses needed to provide care.

There is also digital exclusion to consider. Most people under the age of probably 50 are quite at easy using digital technology. My mum couldnt work a mobile phone, my Aunt who is 76 has one but does not understand apps. As one of the projected benefits are that Obs can be done at home, if this section of society can do obs but does not know how to send them on, they are useless. Will there be digital/mobile phone tests done before any discharge?

Another concern is that community nursing numbers are down drastically, in some areas of the UK they are now numbered in tens rather than hundreds. Will it add extra strain to a service that is already on its knees.

Another concern raised was phone consultations. Sometimes these are fine especially if it is a routine check in, I had one the other day with my neurologist and it suited all concerned, but speaking with my Prof in another dept he believed that face to face appointments were vital. Not so much for medical diagnosis but because he had a chance to read body language which he considered a big part of the process. Therefore if a person does get discharged and receives hospital at home, the body language factor goes, its a phone call. With us Brits being so deferential to people of higher social standing we will say yes I am fine even when not fine.

Anyways, it appears I am going to be part of the team from Manchester Uni who will be doing research into how they working or not working and would welcome anybody's experiences, hopes or fears on the matter.

If you're part of the team doing research, then it's great that you have those concerns, because they're exactly the issues that will need to be addressed if it's going to work.

My point was that hospitals are already having to assess the home/support situation when they want to discharge someone (or at least they did in the case of my mum, even when there was apparently a LOT of pressure to get space on the ward). If they're going to be expanding the group of people who can be discharged then this obviously requires an even more robust discharge procedure.

I would expect that given the cost of a hospital bed, you'd hope there may be significant savings available, and that moving money into community/district nursing will be possible. What limited experience I have of doctor's doing rounds, you're not talking about a hugely high level of care, or attention being paid to body language. Certainly community nurses seem to pay a lot more attention.

Hospitals aren't wonderful places to be, and if you don't need access to immediate medical interventions, and have the support of family, then it may be the healthier option.

 

[Rascal]

If you're part of the team doing research, then it's great that you have those concerns, because they're exactly the issues that will need to be addressed if it's going to work.

My point was that hospitals are already having to assess the home/support situation when they want to discharge someone (or at least they did in the case of my mum, even when there was apparently a LOT of pressure to get space on the ward). If they're going to be expanding the group of people who can be discharged then this obviously requires an even more robust discharge procedure.

I would expect that given the cost of a hospital bed, you'd hope there may be significant savings available, and that moving money into community/district nursing will be possible. What limited experience I have of doctor's doing rounds, you're not talking about a hugely high level of care, or attention being paid to body language. Certainly community nurses seem to pay a lot more attention.

Hospitals aren't wonderful places to be, and if you don't need access to immediate medical interventions, and have the support of family, then it may be the healthier option.

Absolutely, thanks for that. There are benefits, there are downsides, but as far as I can make out they have not been considered which made our team think straight away its a cost cutting exercise. I am never comfortable when peoples health depends on cost and a balance sheet.

I am Public engagement lead into research around community nursing and the initial findings into actual numbers was shocking. In Somerset I think they had 2 for the whole county. We are not sure as of yet if that is because of external factors such as role designation. There maybe more but have roles that are not specified. We are meeting NHS England on Friday to get clarification.