Agenda item

To receive a presentation on NHS@Home Wiltshire (Virtual Wards) and Urgent Community Response (UCR) which are two acute healthcare services supporting people at home and in the community aiming to reduce admission into hospital.

The Chairman remarked that it was part of an ongoing focus of the Health Select Committee to review the impact of preventative measures in health and social care in Wiltshire and that this was one of the key outcomes of the Committee’s Inquiry into Urgent Care in July 2023.  Neighbourhood Collaboratives were considered by the Committee in January 2024, and they would today receive a presentation on urgent care support delivered at home and in the community.

Lisa Haywood (Chief Operating Officer - Wiltshire Health and Care) gave a brief introduction to the services to set the scene and the Chairman then introduced Sam Olden (Consultant Physiotherapist) and Gemma Pugh (Head of NHS@Home) from Wiltshire Health and Care to present the item and Emma Townsend (Head of Living and Ageing Well Service, Wiltshire Council).

Summarising the more detailed presentation included in the agenda pack, the following was highlighted:

Urgent Care Response (UCR)

·            The types of staff that enable delivery of the UCR and their skills that provide urgent support for a variety of health emergencies such as catheter care, diabetes, palliative care, or end of life care as well as a rapid response for non-injury falls and support for informal carer breakdown, which if not resolved will result in a ‘social’ admission to hospital.  70% of patients are seen within 2 hours of referral and treatment can usually be provided in their own home;

·            The capacity of the service was unpredictable due to varying interventions that may be required.  The service works to prevent hospital admissions and enables patients/carers and those that are cared for to stay at home in most circumstances which is what is usually the preferred option to stay at safe and independent at home;

·            There was an ever increasing pressure in services and with the UCR service they were able to assess and treat referrals swiftly with 94% of those being completed within 2 contacts. Only 1.6% of patients were admitted to hospital after being seen by the UCR service. 

·            There had been over 8000 referrals over the last year which related to 3500 individual repeated referrals which would have otherwise resulted in a hospital admission for a stay or long term intervention.

The Committee asked questions about how the UCR and Virtual Wards services complemented each other and how they were differently resourced, if some patients felt overwhelmed when a number of services were involved in their care, if the planned two hour response time was adequately resourced and the possible challenges around this, and if was planned to extend the current hours of operation beyond 8am to 8pm.  There were also questions on the general awareness of the service and how carers might seek support if they become ill themselves and have concerns about those that they care for at home.

It was further highlighted that the work with a cared for person was for up to 4 weeks in their own home, if possible, with a temporary visiting carer or a live in carer being provided as necessary.  Some may need a temporary care home place, but the team would stay in touch with the carer that had been admitted to hospital so that they were able to focus on their own recovery and be involved with the planning of what would happen at end of the 4 weeks period.  There were Social Workers and Clinicians working in hospitals to co-ordinate the safe transfer home of patients or into a care home setting.

There were further questions about the available support following the 4 week period, how the service collaborates with the Police and the multi-agency safeguarding hub, particularly in relation to find the most appropriate response when there are issues with mental capacity and the best interventions.

NHS@Home (virtual wards)

·            This was a new service giving patients who are unwell the choice to receive their acute care at home.  This was in relation to a short term episode of being unwell which was aimed to prevent a hospital admission with planned care with the patient being seen every day to treat their acute condition;

·            Evidence from virtual wards showed that when care is received at home rather than in hospital patients are less likely to acquire an infection and have a decline in their mobility and strength; and

·            The service was particularly geared up for those patients that are frail usually in their later years of life and have respiratory or heart conditions and they can choose to receive their treatments at home where they feel much more comfortable.

The Committee asked questions about how the service works with partners in neighbouring areas, if the service provided end of life care at home, how the NHS@Home and UCR teams integrate, if there was data available on the impact of fewer hospital admissions and those that that service were unable to support, if the service were involved with the Caring Steps Together Programme and independent advocacy for those patients that may need support or not have capacity and for the plans to extend the service to 24 hours a day in the future.

The Committee welcomed the excellent case studies which they felt provided excellent context to the services.

Resolved: That the Select Committee

1.          Thanks Wiltshire Health and Care for providing the overview of NHS@Home and the Urgent Community Response Service. 

2.          Recommends promotion of the Urgent Community Response Service to increase awareness of the provision in Wiltshire, particularly with carers. 

3.          Requests updates, to include performance data, on the services and will explore with colleagues the frequency and format for updates.