Musings from the frontline on the delivery plan for recovering urgent and emergency care services
Reflections from Manager Dr Nick Burstow on the delivery plan for recovering urgent and emergency care services
It was during the second wave of the pandemic that I first saw COVID patients being discharged home from my ward with pulse oximeters, small finger-tip devices that measure oxygen levels in the blood. These patients had recovered from their COVID infections and were off oxygen, but were in that unpredictable phase where they might suddenly need oxygen again. Ideally, we would keep them on the ward a few days longer to make sure their oxygen levels were ok, but this was not feasible given the skyrocketing numbers of admissions and pressure on beds.
The solution was the introduction of some of the first widespread virtual wards: medically fit patients would be discharged with a pulse oximeter to allow their oxygen levels to be checked at home, alongside virtual review by members of the healthcare team. This way, beds could be freed up, but patients could still receive safe care and monitoring at home.
Given the huge success of these early, rudimentary virtual wards, coupled with the chronic pressure on beds, it is not surprising to see proposals to extend this service in the latest delivery plan for recovering urgent and emergency care services. As technology advances to enable improved analytics and continuous monitoring, the virtual ward may become ever-closer to delivering a similar experience to being cared for in a hospital bed, as noted by Dr Geraint Lewis, co-inventor of the first virtual ward almost twenty years ago.
Whilst an increase in virtual wards, plus the commitment to add 5,000 new beds by winter 2023, is a step in the right direction (although we will still have among the fewest beds per person relative to comparable countries) it begs the question of who will staff these additional beds?
With ever-greater rates of attrition among healthcare workers, hardly a single shift goes by where I don’t hear of a colleague who has left or is thinking of leaving medicine, and morale among many nursing colleagues is just as low. Judging by the BMA material in circulation, it seems junior doctors are likely to follow the nurses and paramedics on strike later this year. The commitments in the plan to introduce more flexible working and reduce bureaucracy could not come soon enough, if the NHS is to retain the staff needed to implement the contents of this plan.
The increased focus on community care is welcome, especially given the considerable proportion of avoidable emergency admissions, were the right care in place beyond the hospital walls. One such step is an increased recognition of the value of specialist services like Frailty Assessment Units, through incentives like the frailty Commissioning for Quality and Innovation (CQUIN). I often work shifts in such a unit and see first-hand the value-add that a dedicated service with direct consultant geriatrician input can have, both in terms of reducing unnecessary admissions and the wider patient experience.
There are many positive aspects to this plan, but of course it needs effective delivery. For this to work, conditions for its implementers (staff) must remain a priority. To tweak a quote from Richard Branson: “…if you take care of your employees, they will take care of the clients patients”
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By Dr Nick Burstow