Integration Joint Board approves second stage of the transformational virtual Hospital at Home service for the Borders

In recent years, healthcare professionals have been considering new ways to respond to the acute care needs of older adults with frailty and other long-term chronic conditions. Where inpatient care is needed, traditional hospital-based models bring a level of risk to older adults.

Safe, modern, person centred, community-based alternatives are increasingly being explored at both national and local level. This has resulted in a shift in focus within the NHS towards providing hospital-level care in a person’s home environment.

Virtual Hospital at Home is a holistic, multidisciplinary approach to care which has great benefits for patients including a reduction in deconditioning experienced when in-patient stays are necessary, enabling patients to keep their own routine, maintain greater independence and retain their existing care packages.

The Borders Virtual Hospital at Home pilot launched in April 2023 and the team behind it have gained national recognition from Healthcare Improvement Scotland for exemplary collaboration, methodology, governance, data collection and rapid implementation. The current service can be accessed by all adults over the age of 18, with various conditions including (but not limited to) outpatient parenteral antimicrobial therapy (OPAT), Heart Failure, Frailty and General Older People related illness.

The pilot was initially concentrated in the Eildon locality but since January 2024 has expanded into the Cheviot locality. Depending on demand there is sometimes an opportunity to accept patients from other localities as well.

The current Virtual Hospital at Home model coupled with the Respiratory Virtual Ward have shown huge potential for the future model of care in the Scottish Borders. The Respiratory Virtual Ward was in place between January and March 2024 and supported patients who had an inpatient episode of hospital care with a primary respiratory diagnosis and were stable or clinically improving as well as people with a primary respiratory diagnosis who required further monitoring and follow up but did not require immediate hospital admission. The virtual ward model was based on monitoring patients in their usual place of residence, enabled by digital technology and patient self-monitoring, with regular proactive clinical follow up and access to timely specialist advice and guidance.

Caring for patients in their own homes has had a positive impact by keeping their existing care support in place and preventing the deconditioning that often occurs when they are away from their normal environment.

At their meeting on Wednesday 24 July 2024 the Integration Joint Board agreed to fund the delivery of the second stage of the virtual Hospital at Home programme at a cost of £1 million over 18 months, which is additional to £600,000 awarded by Healthcare Improvement Scotland.

This funding will facilitate the necessary development, staffing, training and resources required to refine the Virtual Hospital at Home model, ensuring it can demonstrate long-term viability providing a safe alternative to hospital admission and supporting early discharge.

Laura Jones, Director of Quality and Improvement at NHS Borders, said: “I am delighted that Integration Joint Board members have shown their support for the further development of the virtual Hospital at Home service.

“The service has person-centred care at its core, and patient and staff feedback demonstrates the positive impact being cared for in your own home has on patient care and wellbeing. In addition to the direct benefits for patients and staff, virtual care helps reduce reliance on inpatient care and treatment which in turn will reduce occupied bed days, length of stay and readmission rates which have a positive impact on flow through our acute and community hospital settings.

“For the Health and Social Care Partnership to truly transform there needs to be some fundamental changes to the model of delivery for both acute and community-based services. Our vision is to seamlessly integrate community-based clinical care, creating a connected and convenient system that brings care directly to people’s homes.

“The development of the virtual Hospital at Home service breaks down the barriers between traditional health care settings and the local community by connecting patients and their families to high-quality care, demonstrating the core values of the Health and Social Care Partnership and delivering a positive impact across the full range of community health and wellbeing outcomes.

“I would like to express my thanks to all the staff who have been involved in the service to date; it is their commitment to the vision of this model of care and their ongoing dedication to their patients that have made the service the success it is to date.”