Extending virtual wards to palliative care delivered in the community.

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A study by the Nuffield Trust (Blunt et al, 2010) .concluded that around 35% of all hospital admissions in the NHS between 2004/05 and 2008/09 were classified as emergency admissions with an estimated cost of £11 billion a year. These figures have been rising year on year, with reasons cited including people living longer, increases in chronic disease (of which cancer is arguably one), and increasing economic constraints on health-care budgets (Blunt et al, 2010). There is now a drive to prevent such unplanned admissions and to allow people to remain in their own homes. Although there is currently no clear evidence to show that preventative measures to stop emergency admissions are cheaper than admitting patients to hospital, a number of preventative measures are in place and some others are being piloted. For example, in Worcestershire, community teams use virtual wards (VWs) as a means of keeping patients at home as much as possible. VWs aim to quickly identify patients at high risk of being rushed into hospital at short notice, and to prevent such admissions. The article by Joanne Jones and Andrea Carroll on p.330 details the work of the Enhanced Care Team in Wyre Forest, Worcestershire implementing VWs and its impact on reducing unplanned hospital admissions. One question to be considered is whether VWs integrate the work of primary, community and social care at the three different levels of service provision often viewed as important for providing palliative care: macro (policy and organisational input); meso (clinical multidisciplinary working) and micro (individual Enhanced Care Team involvement with the patient). A further question then arises regarding the impact of VWs and whether they serve their purpose of reducing avoidable emergency admissions into hospital for all patients identified as being at high risk. VWs use a predictive risk model (Wennberg et al, 2006) to assess whether patients are at high risk of emergency admission. However, Wennberg et al (2006) note that the ways in which this model is used by community healthcare professionals varies across the country. For example, the model has been used to identify patients for community matrons to support, and in some instances to select which patients should be offered telephone-based health coaching and advice. Elsewhere, as in Worcestershire, the model has been used to identify patients who are offered multidisciplinary integrated care without coming into hospital—hence the idea of a virtual ward. It is clear that the tool is multi-purposed and is a welcome addition to community activities.