Project update (1 October 2021)

The project was originally described as ‘From Covid to Frailty; Virtual Ward implementation across the system’ but has since been reframed as ‘Remote Models of Care – a spread of innovation collaborative’.

This reflects the ambition that, rather than rolling out a programme of virtual wards based on this – very specific – experience, we want to use the opportunity to identify and amplify promising new ways of working across our system, aligned to our approach to integration and innovation.

Aim and intentions

We are working with four ICS teams (our adoption partners) to support and enable them to design, test and (where possible) implement innovative virtual models of care. Our adoption partners are working to:

· Formalise the clinical pathway for Home IV Therapy and stratify the caseload to ensure that patients get the right care, in the right way, at the right time, be that in person or monitored and reviewed remotely (digitally or by phone).

· Empower patients with Bronchiectasis to manage their own conditions ensuring that they have the appropriate clinical support, but also to co-design a (digitally enabled) system with patients that will support self-management and promote wellbeing.

· Coordinate care for patients with Frailty, providing colleagues across the ICS with access to the right patient information at the right time to:

• support case management of people with complex needs
• support collaborative personalised care planning
• establish an assets-based and resilience-promoting approach to self-management, care and support

· Support colleagues working with Diabetes patients across the system to deliver the right care, in the right place, at the right time.

In addition to the benefits for individual adoption partners in terms of patient care and quality improvement learning, we are looking to share experiences, identify common themes (e.g. right care, right way/place, right time – though we anticipate there will be others), spreading innovation, using a collaborative approach to create a best practice framework.

Approach

Whilst we are using our QI knowledge and experience to support our adoption partners, we are keen to energise the collaborative part of our project by refreshing our thinking on the spread of innovation, including from NHS Horizons 7 Interconnected Principles of Spread, which elevates the active role of adopters in the transfer of new approaches. Our overall approach is using a dynamic co-design approach to scope, design, test and develop the framework with four key activities:

· A best practice stimulus from the outcomes and learning of the COVID Virtual Ward project

· An adoption partner cohort – selected from ICS clinical development projects with a common cause for achieving patient outcomes using remote and virtual working models, and colleagues.

· A co-design hub for the Framework for Remote Models of Care Innovations

· A structured Improvement Collaborative: supporting the adoption partners to delivery of their projects, whilst testing the Framework’s emerging principles and providing live feedback to the co-design hub.

Outcomes (for patients & ICS projects)

We firmly believe that our project must add useful value to the participating improvement teams (adoption partners) so that they can deliver tangible and measurable patient benefits.

For example, better coordination of care (right place, right place, right time) has been identified as a key priority for a number of cohorts of vulnerable patient groups in our communities. Typically these may include people with frail health or those with complex or long-term health conditions living at home. High-level benefits could include:

· Patients and carers – improved health and wellbeing, and independence

· Staff – better use of clinical time (stratifying and segmenting), satisfaction, and co-working

· System value – more productive use of team resources

Outcomes (for system development and capability)

Our project is also designed to build our system collaborative strength , to create Enabling Adaptive Spaces and further build system level improvement capability, building on our learning and joint commitment to deliver potential benefits* such as:

· Evidence-based learning and implementation

· Evaluation of system working

· Building collaboration in action across ICS partners

· Building models for spread of innovation

· Supporting health management

· Supporting admission and discharge

· Focusing on addressing health inequalities

* Note: until we have evaluated our work at the end of the project, these represent our hopes rather than our expectations in terms of outcomes.

Output

Our intention is to co-design an implementation framework that explores, develops and records some of the key recommendations for teams wanting to develop cross-system remote models of care. We feel it is likely that the recommendations could be structured around a number of key question, perspectives and components. The first iteration will be drawn from the learning of the COVID virtual ward project, and then progressively developed in collaboration with the adoption partners. The role of our adoption partners will be central to the development of the framework. There may be some significant diversity in project areas and it will be important for projects led by the adoption partners to have clearly set aims and objectives in their own right, but with a good commonality of purpose.

The are really excited to be selected for Q funding.

While the landscape has changed since the bid was written, our aspirations and methods have not.

Since autumn we have rolled out a Respiratory remote supported discharge service (both Covid and non-Covid) using learning from the CCVW.  We have been able to share our experiences across the AHSN, hopefully to regional benefit.