Virtual Hospitals, good idea?

[FurForksSake]

Lots in the news today about virtual hospitals. I think it’s a great idea and a lot of already being done in this way. I have quite a few hospital appointments and often follow ups and scan results could be done remotely. Regional diagnostic centres are becoming more common and are easier to access for many and of course if you needed to be seen face to face you would be.

Telehealth has got to form part of our portfolio of health options, but those with poor access / understanding / unwilling / unable to use it should be offered face to face appointments.

I think with the way working has gone and how hard it can be to get time off for a hospital appointment it will make life easier for a lot of people.

There of course needs to be safeguards in place and we need to train doctors in how to successfully use the technology and to carry out virtual appointments clinically.

YABU - no it’s a crap idea
YANBU - it’s ok

It would be utterly ridiculous for anyone to claim it's not a good idea. We have to try these things. Let's not let the morons who say no to every type of change start vetoing this kind of progression. But they will, the conspiracy theorists will be on their way shortly...

Definitely x

There was someone on daily politics decrying the idea, but my GP hasn’t seen me for various reasons recently where a telephone appointment could do, but next week will see me in person as she needs to examine something. I feel like this will bring clinics more in line with GPs.

Ive also had bowel clinic appointments as a telephone call and that was fine, same with dieticiqn appointments.

So much is already happening virtually that this really isn’t a massive change, but they will need to get patients on board who would otherwise be reluctant.

I imagine for care homes if they are able to facilitate online appointments it would save a lot of staff time and potential distress and risk to patients from picking up bugs in the community.

i think it will be even more pressure on hospital clinicians ,easy to miss things if you're reviewing by phone ?video.

On one hand it’s a good idea. I’ve only used private healthcare for 20 years now, so I am used to private GP appointments and follow ups with consultants being phone/video call if I want them to be.

On the other, I was only diagnosed with Celiac as the consultant saw the dark circles under my eyes and asked if I’d always had them.

He said he had a hunch and ticked the box for the celiac blood test as well - he said, “it’s probably overkill, but as your insurance is paying, let’s do it.” I had symptomless celiac (common), but I have it none the less. Had that appointment has been a telephone call, he wouldn’t have seen my eyes, I would never have known and could have ended up with serious issues down the line.

Sounds great in theory, but who is staffing the virtual hospitals? BBC article says it will have its own dedicated doctors, so who will be seeing their normal list of patients? Lots of services already provide phone or video appointments. Just because it's quicker and easier for the patient to access doesn't mean it takes any less of the clinician's time. They're still sitting in a room doing the same type of work. People still miss appointments because they don't answer their phone, and it still takes time to speak to the patient, review their condition, and dictate or type their letter.

Agree @FurForksSake This is not new at all, it's been around for a while. Makes you wonder why it's suddenly in the media and who is pushing it. Virtual Wards were just gradually becoming a thing and everything was lovely. Now someone has decided to make a big deal about it, it has given all of the conspiracy theorists and fear of change types an open opportunity to find fault.

@Ohhellnooo The aim will be to do much of it by video where possible so the doctors will still be able to see a lot and certainly would have had equal chance of picking up on the example you mentioned.

But surely if literally the only benefit is that it gives patients quicker, easier access, thats enough isn't it? (Obviously it isn't the only benefit, it has huge potential). Improving service for patients is a key objective for the NHS.

I had cardiac problems all the pandemic, and afterwards. I have had the problem diagnosed and treated without ever seeing a cardiologist face to face. I had scans and all sorts of tests then all the appointments with the cardiologist were virtual which suited me much better than travelling an hour or more to the hospital.

I have most of my pain clinic follow up appointments on the phone, if I ask to be seen they book me in.

I personally think it’s an excellent idea. I very often need DH to take me to appointments but this could save him having to have time off work.

My oncologist has said she can tell a lot about a person's health, just by seeing them walk in the room. Most of my NHS care has been by phone or video, it's not great, no real rapport, no feel for the people treating you and v. v.
Obviously in some situations it's a huge benefit, but it shouldn't be for the entirety of someone's treatment. I have private care too and it is just so much more reassuring to be able to talk to a person, in person. And the doctor picks up on things that would not be clear on a phone call.

The article suggests it aims to cut waiting times. I can't see how it'll make a difference without additional staff.

New online NHS hospital service by 2027, PM to promise - BBC News

It's not always better for the patient either, just because it's theoretically easier to access. Speaking from personal experience, a GP phone appointment at any time between 9 and 12 doesn't work for me as I'm at work, on a ward, with no privacy. Secondary care appointments seem to be more time-slotted at least.

When I was diagnosed with diabetes last year I was assigned to the virtual diabetes ward and it was great. I got a weekly phone call, they gave me a continuous monitor that they could remotely access so they could monitor m6 sugar levels daily, there were a couple of times when they called me because they were high and tweaked my medicine dosage in real time, and I had access to a physical appt if I needed it.

Having worked in the NHS I absolutely agree this is a great idea… I’ve conducted home visits when a phone call would do. I think it’s great for relaying test results (unless it’s bad news eg cancer diagnosis), great for discussing plans/auditing care/follow ups etc. would love to see urgent GP units attached to A&E.. a lot of a&e visits are down to no GP access. Better use could be made of nurse practitioners… but yes, so much could be done virtually.

I’m so glad you had such a positive experience. This is great to hear!

I’d agree with OP that for many older, frail, people for whom travelling to appointments can be a real struggle this could very well be a boon. I had an elderly aunt who was forever attending appointments so they could keep an eye on one of the half dozen conditions she had. It was all quite painful and distressing for her though, I think she’d of done better to sit in her comfy reclining chair and have a chat over an IPad. District nurses were in frequently so easy to get blood / measurements done.

I am not against them per se, but they are in no sense hospitals, virtual or otherwise.

They are pretty much an admission of how bad the NHS has become that a virtual appointment by someone you don’t know and will never meet is better than waiting months for a normal appointment that you would get within a few days in every other developed country.

And meanwhile, private medicine will continue to be face-to-face with all the rapport and ability to see the need for further tests and evaluations where necessary, including the rather important ability to poke and prod.

Virtual, on-line... do the staff have to be in the UK? UK trained?
Or are we outsourcing? Due to lack of available GPs and the obvious financial savings.
I want to be positive, it would suit me, I hate having to go in for test results etc. But so many of these things get down to the lowest cost really quickly.

To work in the NHS as a healthcare professional you need to be regulated by the UK regulatory body, whether that's the GMC, NMC, GPhC, HCPC etc. Not necessarily UK-trained. I can't see that virtual hospitals would change that. You would also need access to the confidential computer systems the NHS use, so chances are the clinicians would be on-site or maybe working from their home.

As long as it was properly organised and the tech worked I think it would be a useful addition to existing services.
I have had numerous telephone consults with GPs and hospital doctors and the quality is extremely variable.
The most recent was dreadful. The doctor had speaker phone on and it sounded as if mayhem was going on around him. He might have been working from home...

I think it’s a very good idea. I have had various hospital appointments that could have been a phone call, slotted around the days clinic.

I don't think it's a good idea for elderly people. My mum is in a nursing home and a prescriber is the one who visits weekly. They only see the doctor if there's a problem.

@FurForksSake Virtual hospital is a very different thing to a telephone consultation.
I have multiple health conditions and I often have telephone appointments with hospital consultant. This is quite different from a virtual ward.

In 2021 I was very ill with covid. Admitted to hospital, then discharged, then readmitted. During much of the time I was at home and after my discharge for a couple of weeks I was classed as on a " virtual ward".
I got daily telephone calls from a nurse or doctor, had to report some obs and symptoms. If I deteriorated they readmitted me to hospital, or on one occasion sent out a district nurse.
It worked pretty well for me under those circumstances with DH looking after me. I can see it wouldn't be ideal with all illnesses or patients.

When my DD was 3 she was referred to SALT, not knowing how long things would take on the NHS i opted for a private assessment and because of where we live the nearest private paediatric SALT was miles away so had it via Teams. I was extremely sceptical but the SALT did an amazing job, kept DD engaged throughout and managed to complete the full assessment just as well as the NHS SALT (who was also fantastic) did via a face-to-face appointment some months later.

I figure if it is possible to assess a 3yo online in that detail virtually anything is possible so long as the HCP is suitably trained and the patient isn't delebratly obstructive to the process.