The Royal College of Physicians of Edinburgh (RCPE) has commented on plans to increase the use of virtual wards and Hospital at Home Services, as set out in the recent Urgent and emergency care recovery plan by the UK Department of Health & Social Care.

While welcoming moves to increase virtual wards, the College has warned that these services must be in addition to and not instead of current provision and that further investment in staffing to support these new services is required.

The RCPE recognises that Hospital at Home services and “Virtual Wards” can support selected older people through periods of acute and subacute illness and we welcome their more widespread development.

However, access to acute care for older people has been hard won over many years and their right to access such care should not be eroded by the development of alternative domiciliary services. The pace of demographic change in the UK is such that all services for older people, in patient and domiciliary, will need to expand dramatically in coming years.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

Hospital at Home services must be developed and resourced in addition to existing services, not instead of existing services, and they cannot be resourced at the expense of existing services, particularly in the hospital sector. 

These services require the input of adequate numbers of well-trained medical, nursing, rehabilitation therapy and care staff. We do not have sufficient numbers of such staff at present. Furthermore, they may place additional responsibility on families, and particularly female members, who may be unable to provide support unless, for example, employment regulations surrounding care leave are developed.

Many older people, particularly those with sensory impairment or cognitive impairment or both, will not be able to access the technology used to manage a “virtual ward”. Ethical issues surrounding the use of remote monitoring, particularly consent, also require consideration. The person should also be able to exercise choice – if they prefer hospital admission they should be offered it.

Sudden decline of an older person at home often reveals unmet support needs or unaddressed medical problems. New services based at home must be able to seamlessly address these needs and problems.

Health care is relational not transactional. So called “virtual wards” must maintain the strong relational support that is often necessary to see older people through a period of intercurrent illness, particularly when they are already socially isolated. No amount of technology can replace human presence.


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