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Virtual… pronounced…
/ˈvəːtʃʊəl/
An adjective… defined as;
'...almost or nearly as described, but not completely or according to strict definition…'
In English; 'close but no cigar'.
… which makes it clear, there can be nothing virtual about care.
The consultation might be remote. The monitoring might be digital. The bed might be notional, but…
… care itself is real.
Which makes virtual-care almost an oxymoron… a conceptual paradox or a modern irony, driven by technology.
The NHS has become very good at inventing new ways of doing what obviously needs doing.
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Hospitals are full… build more hospitals.
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A&E is overwhelmed… create urgent treatment centres.
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Community services are weak… invent neighbourhood health.
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Not enough doctors… create new clinical roles.
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Beds are scarce… create virtual wards.
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Outpatients are overwhelmed…
… create an entire virtual hospital.
Oh yes…
… the new Online NHS Trust was established in June. It has a board and plans up to 8.5m appointments and assessments in its first three years.
It may be a perfectly good service. That isn't the point. The point is… what problem are we solving?
Russell Ackoff, the great systems thinker, warned about organisations becoming;
'... increasingly proficient at doing the wrong things righter.'
The NHS risks becoming a case study.
Its central problem is that demand is growing faster than our capacity and money to deal with it. Yet, policy is about finding another way, another place or another person to service the demand.
NHS Online illustrates it perfectly.
Its own description says; care will start with a primary-care consultation. Tests, scans and procedures will still happen locally. So, the consultation may move. The work doesn't necessarily disappear.
Nor, necessarily, does the cost.
The new trust's board papers say an initial budget and medium-term financial plan have already been developed.
How much? Dunno…
… the figure isn't disclosed in the public papers I can find. Bitcoin, maybe?
Trusts and ICBs have told NHSO they still want clarity about commissioning and payment models and whether its activity will be additional or substitutional.
If it is additional, it adds cost.
If it substitutes for existing services, which existing staff, clinics and costs are going to disappear?
Otherwise, we have simply invented another way of doing the same work.
It's like virtual wards.
Yer granny can be treated on Ward 6, or in her sitting room. If she needs assessment, medication, blood tests, monitoring or a visit...
... somebody still has to go and knock on her door.
Care is never virtual.
Moving care is not reducing demand. It’s relocating it. This is where NHS policy starts at the wrong end.
The biggest opportunity lies not in finding increasingly ingenious ways to look after people...
... it's stopping them getting there.
Particularly the growing number of older people where predictable deterioration, avoidable escalation and expensive acute care are concentrated.
Get to yer granny earlier…
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Before the fall.
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Before the dehydration.
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Before the confusion.
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Before the medicines become unmanageable.
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Before the carer collapses.
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Before the infection becomes an ambulance ride.
That requires nothing virtual. It needs real…
- GPs with time.
- District nurses.
- Community matrons.
- Pharmacists.
- Rehabilitation.
- Falls prevention.
- Social care.
- Continuity.
- People who know yer granny and notice when something changes.
This year's entire additional investment in the GP contract is £485m...
The annual price tag for the virtual hospital?
My guess; operating at scale, maybe £100m a year. Quite possibly nearer £200m...
... before we get into who pays for the tests, scans and procedures it generates.
Curiously, the VH's own pathway starts with primary care.
So, before we build another national provider there's a more important question.
What would £150m do if we spent it stopping them reaching the front door in the first place?
It's a lot of district nursing, community matrons, pharmacists, therapists, care coordinators and GP time... the biggest prize is prevention.
The best care is the care that means, eventually, no care is needed at all.
The question is not; 'where else can we put the patient?'
It is; 'what are we prepared to spend to stop them becoming one?'
Otherwise we'll simply become better and better…
… at doing the wrong things, righter.
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