Dr Bushra Alam is an Acute Medicine consultant based at Salford Royal Hospital, and the Greater Manchester Clinical Lead for Virtual Wards. During the pandemic, Bushra was integral in the set-up of COVID Oximetry @Home in Greater Manchester, a service that helped closely monitor high-risk patients with COVID in their own homes.

The success of this service has highlighted how patients across multiple pathways should have the opportunity to receive hospital care in an environment of their choice. The NHS is increasingly introducing services to support people in their own homes, including in care homes. This allows patients to get the care they need at home safely and conveniently, rather than being in hospital.

In this blog, Bushra describes why these services have evolved, the benefits to patients and the wider system, and how she is working to embed this service as a sustainable model of care across Greater Manchester.

During the first wave of the COVID-19 pandemic, there was an acute realisation to urgently develop models of care to ensure patients with COVID-19 received the right care – and importantly at the right time – to ensure best outcomes for patients. Developing models of care required consideration of the needs of the patient and balancing that with what could realistically be delivered in a community and hospital healthcare setting. It was recognised that some patients may deteriorate within the first 14 days of illness and timely intervention could save lives. As a result, oxygen levels and well-being indicators were monitored closely in patients identified at high risk of deterioration, and the safest way to do this was with patients in their own homes.

As a front-line clinician the benefits of the oximetry service were immediately tangible. I remember the oximetry services contacting hypoxic patients and arranging admission with them. In one case a patient with silent hypoxia due to COVID-19 initially refused to attend hospital despite recorded oxygen levels of 79%, and that patient narrowly missed intubation and critical care admission due to early treatment with oxygen and dexamethasone.

When the service was initially set up, I recall junior doctors coming from inpatient wards to collect oximeters and diaries for inpatients that the teams wanted to discharge home with the oximetry services. I remember a patient in A&E department who I attended that had anxiety and broke down in tears relieved and immensely grateful that she didn’t have to be admitted, and there was a service that could remotely monitor her symptoms at home. This gave her reassurance and an opportunity to be cared for in her own environment with loved ones to help her convalescence.

Witnessing patients and teams benefitting from the service confirmed in my own mind that setting up these services was the right thing to do for both our patients and the health system to cope with the COVID-19 pandemic. I don’t like to think what would have been the case had this service not been available.

Whilst challenging to set up services with the uncertainties of a pandemic, the experience has demonstrated what is possible and how both the patients and the service can benefit from similar models of care. I look forward to expanding remote monitoring and virtual services to wider cohorts of patients and develop models of care that truly meet the needs of our patients.

Being able to offer people a choice of receiving hospital treatment at home is possible with the technology that is now available.  Hospitalisation is not an easy feat for most and I often observe patients finding this a very difficult experience for numerous different reasons. As a physician, being able to monitor patients at home with access to community diagnostics will allow me to discharge more patients home at an earlier stage.

Developing the virtual ward model of care offers staff the ability to work in an exciting and innovative area. By working across both community and secondary care services, staff can review patients in hospital and then be able to follow up their treatment at home. It can give them the opportunity to develop different skills and experience a new way of working – one that also benefits patients.

I’m looking forward to virtual wards becoming embedded across different pathways: from patients with acute respiratory infections or frailty, to heart failure and palliative care, all patients receiving care that truly meets their needs. Standardisation of care is important to ensure patients on virtual wards receive the same care irrespective of where they live in Greater Manchester, and enabling robust evaluation of the benefits of virtual care will assist in developing this as a sustainable model of care going forwards.

In Greater Manchester we collectively came together to develop COVID Oximetry @Home, and despite the uncertainty and challenges of the pandemic we developed a patient focused service at pace that delivered great care. I hope that we can continue that collaborative working across organisations to develop virtual care services further. The demands on the system are increasing, and we must accept that we cannot continue like we have done before. Value needs to be seen for both patients and our healthcare system to truly develop a sustainable model of care going forward.

Opportunities like this don’t really come around often, and I look forward to working together with the Greater Manchester team to develop virtual models of care that enable clinicians to have greater opportunity to care for patients in their own homes, and deliver care that is appropriate and relevant to that their individual needs.