Virtual wards that provide support for the frail elderly, and those with complex health and social care needs, in their own homes rather than in hospital are to be expanded across Swansea Bay.
A virtual ward is a weekly multidisciplinary team meeting, conducted over Teams, involving primary care, secondary care and voluntary services.
They combine their expertise to discuss how to manage and support frail and potentially frail patients within their own community, helping take the strain off Swansea Bay’s hospitals.
Although the concept is not new, having already proved to be beneficial in three of the health board’s eight cluster areas – and coming to the fore during the pandemic - its expansion has now been agreed..
The move will see enhanced virtual wards in four of Swansea Bay’s eight primary care clusters (Bay, Cwmtawe, Neath and Upper Valleys) with plans for the remaining four to enjoy similar roll out next year.
Recruitment is currently underway to staff the virtual wards with such roles as virtual ward clinical manger, geriatrician, pharmacist, occupational therapist, GP and clinical nurse specialists.
Dr Anjula Mehta (pictured left), SBUHB’s Group Medical Director for Primary Care, Community Services and Therapies Group, said: “We will be asking participating GP practices to identify these high-risk patients to enable us to capture the most vulnerable patients within the virtual ward by means of direct referral.
“It’s an integrated approach between primary and secondary care.
“The beauty of this model, which sometimes isn’t found in other virtual wards, is the direct and rapid access to the most appropriate multi professional teams to help stabilise and optimise these patients in their homes.
“It’s quite a shift from the current model and will undoubtedly improve patient care closer to home.
“We will provide a very patient-centred approach, targeting our efforts towards individual health and social needs to ensure patients receive the right input by the right clinician at the right time.
“The Virtual Ward concept will provide a seamless patient pathway between secondary, primary and social care to ensure we meet the needs of our patients at every stage of their health journey.
“This will improve their outcomes and ensure the patient stays well for longer.”
Dr Mehta said that the concept would provide enhanced quality holistic health and social care closer to home, where the patient wanted to be, while reducing the need for hospitalisation.
She said: “The main thrust will be an improvement in patient care and having that link with secondary care so we can even pull people back from ED or the front door, if they don’t really need to be there, and offer them a space on the virtual ward which may be better for them than being on an actual ward. Patients want to be in their own home.
“We are keeping patients at home where they are able to be looked after in their own environment, through reducing avoidable hospital admissions, and also shortening the length of hospital stays.
“This will be achieved by pulling them out of hospital that little bit earlier through providing the wraparound support they need.”
The Neath Cluster has been using a virtual ward for the past year and despite some initial scepticism sees its value towards improving patient care.
The cluster’s lead, Dr Deborah Burge-Jones (right), said: “When the virtual ward concept was initially discussed I was not fully convinced it would work.
“However, I think Covid helped accelerate a different more virtual model which has gone from strength to strength.
“I am so grateful for the dedication and support shown by all of the multidisciplinary team members.
“They have made such a huge difference to so many people. And as shown in the data, this has had a massive impact on improving patient care and saving hospital admissions.”
The Cwmtawe Cluster’s occupational therapist, Katy Silcox, is another who recommends virtual wards.
She said: “It’s still a fairly new concept in the Cwmtawe Cluster and we are delighted and extremely grateful for the range of expertise involved in the virtual ward which is having a positive impact on patients’ health and wellbeing.
“The patients and care givers value it, they feel listened to and appreciate the input of a wider range of professionals.’’
Dr Sue Morgan, a consultant in specialist palliative care in the Neath Port Talbot community, said: “The level of knowledge in the virtual room is so useful, covering the scope of needs from acute clinical, mental health, re-enablement, social work, district nursing, medicine management, pharmacy, and GPs.
“Whilst there are a lot of people together for that hour, the amount of time it saves overall, by having the right people to talk about relevant elements for the patient and those looking after.
“Having the access or facility to discuss the needs with the wider multidisciplinary team, and then members of the team to be in a position to take action depending on the needs, is incredible.”
The daughter of one patient who has benefited from the virtual ward said: “The support provided since the referral to the ward has been invaluable. It’s sped up being able to get what mum and I needed and it’s been so good to just know that we are not alone.
“We have every confidence in the service as it has been invaluable to us in helping mum stay home safely.”