Virtual wards and Hospital at Home services will be vital to older people's care, but nurses need the skills, knowledge and resources to deliver quality care

The COVID pandemic led to a rapid transformation in the delivery of healthcare services, with an increased role for digital monitoring and deployment of virtual wards and Hospital at Home teams.

There is now a greater focus on delivering such services for older people living with frailty, many of who have complex health and social care needs .

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Healthcare organisations are being asked to expand capacity as fast and safely as practicable, taking account of local circumstances and workforce availability. Where appropriate, they are also being asked to build on established virtual wards and digital platforms.

However, in the expansion and safe delivery of such services, we need to consider workforce capability as well as availability (Skills for Health 2022) and capacity.

Little investment has been made in developing capacity and workforce capabilities

NHS England (2021) suggests that Hospital at Home services should be led by a named consultant practitioner, such as a nurse, allied health professional (AHP) or suitably trained GP, who has access to timely specialist advice and guidance, and multidisciplinary teams of professionals.

The government’s latest plan is to discharge patients who are ‘medically fit’ to care homes, yet it is not only acute care that is stretched. There are thousands of nurse vacancies in social care and these patients are also likely to require support from primary and community care staff who are equally overwhelmed. 

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While I welcome virtual wards and Hospital at Home services, and the recommendation for strong clinical leadership and care closer to home, I wonder where we will find the workforce to deliver them and the appropriately skilled and trained consultant practitioners needed.

The skills, knowledge and resource gap in the care of older people has long been recognised. There has been too little investment in developing capacity and workforce capabilities, and reconfiguring existing roles and services will not meet the needs of an increasingly ageing population.

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There is no quick fix to this problem. There must be adequate development opportunities for nurses and AHPs with a specialist interest in older people, frailty and dementia to improve outcomes.

A longitudinal approach is vital so that we focus, not only on admission avoidance, but also on improving the quality of life of patients, their families and carers.

References

• NHS England (2021) Guidance Note: Frailty Virtual Ward (Hospital at Home for Those Living with Frailty)
• Skills for Health (2022) Virtual Ward and Urgent Community Response Capabilities Framework

Zena Aldridge is consultant editor of Nursing Older People