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Service expansion will keep more children at home with their families while providing hospital-level care. Find out more about the benefits
Services to keep children out of hospital, known as hospital at home or virtual wards, are set for a major expansion across the NHS after a string of successful pilot schemes. Already providing the largest hospital at home service of its kind in the world, the NHS expansion aims to increase the number of children and young people receiving this treatment. NHS England reported in July 2023 that more than 6,400 children had been treated during a preceding year-long pilot phase, compared to more than 160,000 adults.
Nursing Children and Young People. 35, 6, 6-7. doi: 10.7748/ncyp.35.6.6.s2
Published: 02 November 2023
Hospital at home is an acute clinical service that delivers hospital care to people in their homes, providing the same staff, equipment, technologies and medication as in hospitals.
Alongside hospital-level diagnostics at home in areas such as endoscopy, radiology and cardiology, virtual ward services offer blood and ultrasound tests and intravenous (IV) administration, with daily input from multidisciplinary teams. Hospital at home aims to provide child and family-centred care, with clear clinical pathways on a 24/7 basis.
Hope Ezard is one of about 200 children treated so far by the children’s virtual ward at Blackpool Teaching Hospital. She was born prematurely at 29 weeks, and has a rare neurodevelopmental disorder, GNB5, as well as chronic lung disease and feeding issues.
Hope had been in and out of hospital for most of her life being treated for recurring respiratory infections with high-pressure oxygen and antibiotics. The hospital visits meant she missed out on crucial family time with her parents and four siblings. Hospital at home has allowed Hope to receive the care she needs while surrounded by her family and the things she loves.
‘Hope has a high care demand, but being able to receive some of that care at home is so beneficial to Hope, and our other children,’ said her mother, Sarah. ‘Hope doesn’t sleep well in hospital and is more vulnerable to hospital infections, so there is peace of mind when she’s being cared for at home. On the virtual ward, she’s relaxed and comfortable in her own bed. The fact that the brilliant nurses are just a phone call away reduces any anxieties we might have had.’
‘Hospital at home teams offer hospital-level care in patients’ homes and if the service was not available, the patients would be in hospital. The teams often work extended hours, typically 8am until 10pm, seven days per week, and offer multiple visits a day to manage acute illness,’ explains Royal London Hospital’s senior nurse for integrated paediatrics Zoe Tribble. She is also chair of the National Paediatric Hospital at Home Forum.
‘Care is overseen by the consultant in the same way as if the patient were occupying a hospital bed. Sometimes, remote monitoring is in place so that medically trained staff can review patients without the need for a visit,’ she says.
Receiving hospital-level care at home in familiar surroundings can be particularly welcome for children, reducing extra stress associated with inpatient admission.
The ability of hospital at home nurses to visit children at school also reduces lost education time that would occur with hospital stays.
Hospital at home services can also help with cost-of-living pressures. ‘Families often cannot afford transport to the hospital, parking costs, money for medications, and do not have childcare support for patients’ siblings,’ says Northern Lincolnshire and Goole NHS Foundation Trust’s children’s staff nurse Faye Stringer, who works in the hospital at home team.
Relatives have noted how hospital at home offers more involvement in discussions about their loved ones’ care, in contrast to hospitals where they could be left in a waiting room or otherwise excluded from the conversation.
‘We are considering a new specialism of hospital at home nursing – these nurses have unique skillsets’
Zoe Tribble, senior nurse for integrated paediatrics at the Royal London Hospital
Community links and improved health awareness are other benefits. ‘Parents and patients receive health promotion and educational literacy, educating and empowering families to access community services and manage future illnesses,’ says Ms Stringer.
For hospitals, treating children safely from home boosts the availability of inpatient beds. The hospital at home expansion is expected to free up resources, creating an extra 10,000 virtual ward beds for winter 2023.
‘From an operational perspective, on average, an established hospital at home team can save upwards of 1,000 bed days per year,’ says Ms Tribble. ‘This frees up beds for patients who need to be in hospital, improving flow from emergency departments to wards.’
While some might worry that providing such high level home care would be more expensive, figures suggest the opposite.
In 2020 in Lanarkshire, for example, the reported average cost of a hospital at home bed was nearly half what it cost to treat patients in a hospital bed.
Hospital at home services are able to treat children and young people with a range of acute conditions, as outlined by the University Hospitals Dorset NHS Foundation Trust’s child health @ home team.
‘Child health @ home offers pathways for ambulatory IV antibiotics, wheeze, bronchiolitis, gastroenteritis, and respiratory physio support for children with complex needs,’ says the trust’s children’s community nursing services senior lead nurse Josie Roberts. Conditions that may be added in the future include chest infections, croup, wound care and phototherapy for babies with physiological jaundice.
In the decade or so since the introduction of hospital at home services to the NHS, the number of initiatives has grown. ‘As a result, the acuity of the children seen at home has increased and the skillset of the nurses has needed to grow,’ says Ms Tribble.
‘Some colleagues worry about new ways of working – the data we have indicates that hospital at home teams are safe’
Setting up a hospital at home service can provide other benefits for nursing staff in areas such as digital expertise. ‘There is a move to remote monitoring to support hospital at home functions, so nurses need to be tech savvy and have appropriate training on the equipment needed to support this, such as tablets, laptops, and remote enabled medical equipment,’ explains Ms Tribble.
‘Hospital at home is a new pathway children’s nurses can take while maintaining autonomy. We are considering exploring a new specialism of hospital at home nursing that recognises the unique skillsets these nurses have,’ she continues.
Through her role as chair of the National Paediatric Hospital @Home Forum, Ms Tribble is also aware of challenges for the NHS expansion. ‘We recognise that we are fishing from an ever decreasing pool of experienced staff as nurses continue to leave the NHS,’ she says.
‘Perhaps the greatest challenge comes from new ways of working that some colleagues worry about. There are also, as yet, no national standards to measure children’s hospital at home quality and safety – this is work we are exploring with NHS England and the UK H@H Society. However, the data we have indicates that hospital at home teams are safe.’
healthandcare.scot (2020) Insight: Taking Hospital to People’s Homes.
NHS England (2023) NHS virtual ward expansion will see thousands of children treated at home.
UK Hospital at Home Society. www.hospitalathome.org.uk/home