North East London Foundation Trust (NELFT) - Case Study

The North East London NHS Foundation Trust (NELFT) serves a diverse community across North East London, Essex, Kent, and Medway, providing integrated mental health, community health, and acute care services.

The decision to adopt virtual wards was driven by the need to free up hospital beds and help people better manage chronic conditions like COPD, which place a heavy burden on health and social care resources.

The Impact of COPD on Hospital Resources

COPD alone accounts for 1 in 8 emergency admissions, making it the second most common cause of hospitalisations. 30% to 50% of these admissions are avoidable and cost the NHS approximately £1.9 billion every year. During winter, respiratory admissions double, exacerbating system pressures and further limiting the capacity of hospital wards.

On average, COPD patients stay in the hospital for approximately three days, but this can vary depending on the severity of their condition and any complications that arise. Hospital-acquired infections (HAIs) present an additional challenge, as they can prolong stays by up to 9.8 days and increase healthcare costs, posing risks for all inpatients, including those with COPD.

Challenges and Risks in Discharging COPD Patients

Delays are also common when discharging COPD patients from hospital, as certain resources are required to ensure a safe transition to home—particularly if the person’s needs are complex. Factors such as limited availability of community support services and delays in setting up home care arrangements, including medical equipment and caregiver support, can all contribute to patients remaining in hospital longer than necessary.

Conversely, discharging a COPD patient from hospital too early can carry significant risks, particularly for those recovering from acute exacerbations. A study from BMJOpen notes a median re-exacerbation time of 19 days, suggesting that early post-discharge deterioration is common if adequate follow-up care and support are not provided.

To address and better manage the increasing demand and provide better support for COPD patients, NELFT implemented virtual wards to deliver high-quality care to patients at home, improve their experiences, and alleviate the burden on acute services.

The Access Group’s Rio solution, integrated with admittance and discharge processes and Whzan's real-time monitoring data, allows NELFT to proactively manage and care for patients at home via a dashboard, thereby reducing avoidable hospital admissions and optimising resources to ensure more efficient and cost-effective care.

Sharing data captured with both patients and clinicians enables patients to manage their conditions at home with clinical phone support. The COPD virtual ward has enabled NELFT to free up respiratory hospital bed capacity and enhance patient experiences, with many service users reporting that they feel more in control of their health and more satisfied with their care overall.

In addition to the above, the virtual wards program has and continues to provide the following benefits:

Easy Integration and Implementation

The integration of Whzan data with Rio has been pivotal in enhancing joined-up care, removing friction, and giving the clinical command centre confidence that patient data is flowing in real time. This seamless integration ensures that virtual MDT meetings are well-coordinated, with all data is readily available.

A key element of the implementation process was the development of a digital clinical safety case designed to systematically identify, assess, and mitigate potential risks. This approach ensured that patient safety and high-quality care were consistently prioritised throughout the integration.

In addition, the use of APFM to monitor the virtual ward has provided visibility to the BHRUT Acute consultant, further improving collaboration. This has helped NELFT streamline referral and discharge processes, reduce delays, and enhance overall patient flow.

Better Patient Outcomes

The virtual ward setup has had a profound impact on how NELFT delivers patient care. Prior to launch, the Trust ran a comprehensive three-month clinical training programme to upskill general and non-specialist nurses in handling COPD cases. This initiative empowered staff with the knowledge and skills needed to provide high-quality, home-based care, improving patient confidence and recovery rates.

One service user claimed, "I sleep better at home, am more comfortable, and have my regular support from carers, family, and friends." Statements like this reflect how receiving care in a familiar environment can reduce anxiety and accelerate recovery.

Another said, “Instant feedback from my monitor gives me confidence.” In the first few days after being admitted, many people take extra readings for peace of mind. Once they are settled in and confident with the devices (typically after 48 hours), readings naturally drop to around two per day. This real-time monitoring not only helps them feel more in control but also reduces anxiety, promotes faster recovery, and ultimately enables them to be discharged from the virtual ward sooner.

Improved Clinical Efficiency via Digital Solutions

The virtual ward has significantly enhanced clinical team efficiency. The use of the Access Group’s supplied Portasana allowed NELFT’s acute partner to make bed requests (referrals) digitally into the virtual ward, making it easier to allocate beds through the electronic patient record (EPR), Access Rio, without duplicative data entry.

For the patient pathway, Bluetooth-enabled medical devices were paired with a Whzan tablet in the home. The shared workings between Access and Whzan allowed for the automatic completion of a NEWS2 assessment template.  These readings were then automated into the Rio NEWS2 and presented to the virtual ward command centre in real time. The Flow tracker board enables continuous monitoring of oxygen levels, blood pressure, respiratory rate, heart rate, and temperature, enabling clinicians to discuss the results with the patient, adjust the medication, or take immediate action, such as dispatching a nurse to visit their home.

This optimised workflow has empowered multidisciplinary teams (MDT) to collaborate effectively, while reducing administrative burdens and freeing up time to ensure that patients continue to receive proactive and personalised care. It also ensures that clinicians can quickly intervene before a person’s condition worsens.

“It’s been really good to work with Access. We were able to tell them our problems and issues and they listened to us, collaborating with us to find where the bottlenecks are, which has been key.”

David Pike, Assistant Director – Clinical Systems

Feedback from those admitted to the virtual ward and their families has been overwhelmingly positive. According to a survey conducted by NELFT:

• 86% of patients reported a reduction in anxiety due to receiving care at home
• 57% felt reassured by continuous monitoring
• 97% expressed satisfaction with the virtual ward service

One person shared, “The team was brilliant, loved their service,” highlighting the personalised care and comfort of receiving treatment at home.

Staff have found the Access software integrated with Whzan and hospital discharge to be intuitive and beneficial in their daily roles. The ability to deliver holistic, person-centred care in a home setting has been rewarding for the team. The management of the virtual ward has also improved job satisfaction, with some staff members noting that the positive impact on staff’s working lives has encouraged them to stay with the Trust. The software’s collaborative features have fostered a supportive work environment, enabling continuous professional growth.

Since the integration of Access Rio, Flow and Whzan in March 2024, the ARI virtual ward has achieved impressive results:

• ~30% reduction in readmissions
• 45% of admissions were avoided
• 55% of virtual ward admissions focused on early supported discharge

These efficiencies have resulted in approximately 400-500 bed days saved, improving capacity and optimising resource use whilst whilst improving patient outcomes.

The success of NELFT’s virtual ward demonstrates that there are potential opportunities to expand it to support even more patients. While the limited number of Whzan boxes means NELFT is currently only able to support 25 users in the pilot, the virtual ward programme has shown that it is efficient use of NHS resources.

Real-time data integration and automated alerts are now in place and could easily be scaled to enable the Trust to manage larger patient cohorts without the need to increase the number of nursing staff. For instance, if the ARI virtual ward accommodated 60 beds, NELFT projects this could amount to as much as £6.8 million in non-cash release savings by reducing admissions and bed days for various respiratory conditions.

Building on the success of the ARI virtual ward, NELFT has confirmed it is planning to expand the program to support additional chronic conditions, such as heart failure and frailty.

These expansions aim to further enhance remote monitoring capabilities to enable earlier, better, and more proactive care interventions while continuing to relieve pressure on acute hospital services.