Challenge
In 2022, the CHA developed a proposal to work together on a virtual wards programme to tackle growing demand for children’s hospital beds and help address long waiting lists, particularly during winter pressures.
Since Covid, elective waiting lists have risen 60% faster for children than for adults. This is especially significant because children are at greater risk of life-long harm from delayed care, with a greater impact over their lifetime than adults.
As the backlog has grown, there have been worrying signs that children’s health has suffered – with A&E attendances across the CHA almost 10% higher in 2022/23 compared to 2019/20, and urgent GP referrals now up 37 per cent per week on average from pre-pandemic levels.
Tackling recovery for children is challenging for many reasons, including workforce skills shortages & the need for child-appropriate facilities and equipment.
There is clearly a pressing need to increase virtual care access for children to tackle waiting times, reduce length of stay, free up beds and make the best use of skilled staff.
However, there are also special considerations for virtual wards for children, and services must be carefully designed with input from paediatric experts to meet their needs.
Approach
Virtual wards combine technology and face-to-face provision to allow hospital-level care including diagnostics and treatment, using many of the same staff that work in hospitals.
The CHA is looking to lead the next steps in developing safe, high quality virtual wards for children.
Some of our Trusts are already delivering virtual wards which are seeing real benefits for patients.
To take this to the next level, we have developed two business cases that would see the trusts rapidly pilot and evaluate children’s virtual wards with the potential for universal NHS rollout.
- A full business case delivering a 2-year programme
- And subsequently, 5 pilots focussed on implementing respiratory pathways
Paediatric virtual wards at scale
- Year 1: 11 virtual wards on 4 themes: respiratory/LTV; Hospital@Home; virtual medicine; virtual support for mental health
- Year 2: roll out most successful paediatric pilots across all the trusts
Work with ODNs & ICSs to scale nationally
Paediatric virtual wards at scale
Customised digital platform for a 'virtual hospital'
- Alder Hey have developedAnywhere™ with potential to integrate multiple remote devices
- Year 1: roll out to first wave of Trusts, linked to Trust’s’ existing EPRs (subject to vendor support)
- Year 2: roll out to all 11 Trusts. Can ultimately be used to create a national dashboard eg for a specific condition
Potential Benefits
- 392 virtual ward beds by month 24
- 66,605 hospital bed-days saved per year from month 24
- from 24,319 avoided admissions
- from 21,053 early discharges
- Equivalent cost of £37.9m per year in hospital after month 24
- Better patient experience
- Scale: standardised high quality paediatric care pathways for whole NHS
- Cutting edge technology for the NHS
- Workforce development: a ‘Paediatric Virtual Ward Academy’
Developing virtual wards for children
- Virtual ward technology for children is different: e.g. monitoring devices need to be smaller and age-appropriate
- Clinical pathways are different: Paediatrics crosses many specialities; conditions can be unpredictable – criteria must be carefully designed, early warning is essential; training must be paediatric-specific
- Children interact with technology differently – e.g. gamification can empower children and YP
- Legal and safeguarding issues are different – children must stay visible and the support needs of the child’s carer(s) at home have to be considered.
How the CHA could help address this challenge:
- CHA members have the motivation and skills to design the solutions and align the additional work needed for Children and Young People with other national digital transformation programmes.
- We are looking to work together to create national standardised pathways that can be rolled out nationally. We are aiming to help the NHS to catch up on progress with adult VW investment and contribute to the evidence base for a national virtual children’s hospital.