A Kent hospital is using cutting-edge technology to free up bed space to ease the latest crisis facing the NHS.
Senior reporter John Nurden spoke to the trust pioneering the use of "hospitals at home" to see how it works...
Virtual wards have been hailed as a potential way to use technology to reduce staffing pressures and cut queues on wards.
The idea is to allow eligible patients to get the care they need safely in the comfort of their own home, rather than being trapped in hospital for days or weeks.
Trusts are also reporting the service can prevent hospital admissions, enable earlier discharge and save money for the taxpayer.
In April the NHS published guidance tasking all integrated care systems (ICSs) – statutory bodies responsible for planning and funding most NHS services – to roll out around 25,000 "virtual beds" across England by the end of the year.
But just how do you go about freeing up physical hospital beds while also ensuring patients are receiving safe and effective care?
Medway Maritime Hospital in Gillingham, is among those NHS healthcare provider to have already rolled out the programme.
It has seen a team of dedicated nurses run so-called "virtual wards" across Medway and Swale using the latest state-of-the-art technology to monitor patients remotely.
I know from first-hand experience. Mrs Nurden, herself a nurse, recently underwent major surgery and was sent back home to the Isle of Sheppey after just two days in hospital.
She said: "In the past, it would have been normal to have spent up to seven days in hospital following an operation like this.
"But new technology means I could go home and sleep in my own bed while staff monitored me remotely.
"I felt totally safe. It also meant I wasn't calling the GP or going to A&E if I had a problem."
The hospital's nurse-led surgical medical acute response team (SMART) issued her with a pack which included an easy-to-follow instruction manual, wifi router which automatically links to the internet, a charger, a tablet and stand.
It also came with a small monitor, similar to a Fitbit watch and known as a "wearable", to strap to her arm to record vital signs like oxygen use and pulse rate.
There was a thermometer to take readings from her ear and a simple to use blood-pressure unit. All she had to do was take the readings and enter them onto the tablet.
A member of the hospital's team phoned at least once a day and nurses visited the house when hands-on care like physical examinations, wound dressing or intravenous drug administration was needed.
Heading up the project locally is Jackie Hammond.
The nurse has been ahead of the curve and set up Medway's pioneering unit from scratch well before the Covid-19 pandemic made other trusts begin to follow her lead.
"I felt totally safe. It also meant I wasn't calling the GP or going to A&E if I had a problem."
Last year it was nominated for a top national award.
"The only good thing about the pandemic was that it suddenly opened up funds for this type of work," explained Jackie.
Her team of 12 full-time equivalent nurses can now look after 30 patients and wants to expand.
"The sky's the limit," she adds."It has been proved that many patients recover more quickly in their own homes.
"In hospital, they might only walk from their bed to a chair. At home, they can walk to the kitchen to make a cup of tea or find out why the dog is barking.
"That rehabilitation element alone makes a lot of difference."
It can also save the NHS money. A typical stay on a hospital ward costs £657 a day. The virtual ward costs £187, a saving of £470.
It doesn't take long to meet the £36,000-a-year licence fee for the technology.
In the past six months the team has looked after 356 patients.
"It's a no-brainer," says Jackie, who points out that patients on her ward are electronically monitored every 15 minutes, far more than a nurse would be expected to do in hospital.
The whole operation is run from an open-plan office on the third floor of Medway Hospital in Windmill Road. The only clue is a Think Smart sticker stuck on the door at the end of a corridor.
The team monitors a bank of computer screens at desks along the walls and also makes house visits. Some are able to work from home.
So how did Jackie, 56, originally from Ghana in West Africa, end up running the operation?
It's a long story. She arrived in the UK in 1990 at the age of 23 after completing her nurse and mandatory midwifery training.
She explained: "I secured a place on an adaptation course in Southend Hospital to learn how to work in the UK and register as a nurse, which allowed me to work in the NHS."
She opted to specialise in orthopaedics. "I am a very practical person," she said. "I like breaking things and then learning how to mend them. I am very creative."
The nurse moved to Hampshire to specialise in orthopaedic nursing and then switched to Luton and Dunstable Hospital on August 31, 1997 – the same day Princess Diana died.
She explained: "I wanted more challenging experiences with trauma and orthopaedics to learn more.
"So I looked on the map and picked Luton because it was near a motorway which would mean the possibility of working with major trauma cases."
She ended up in the world-leading Royal National Orthopaedic Hospital at Stanmore in Harrow where she gained more experience in spinal and complex orthopaedic care. That secured her a job back at Luton as an orthopaedic nurse practitioner.
In 2005 she moved to Medway.
She said: "I saw a job advertised for a nurse practitioner in orthopaedics and applied and then found it was a new post. It was great being able to use my knowledge.
"I loved that role. There were three nurse practitioners. Having nurses as part of the orthopaedic team enhanced clinical decision making by addressing patients in a holistic way."
In 2013 she was asked to take charge and expand a small bridging team covering urology and breast post-operative cancer care by introducing the concept to other surgical and orthopaedic specialities to encourage more patients to recover at home.
She renamed it SPET – the Surgical Patients Enhancement Team.
Medway had already been operating its own early hospital-at-home service since 2010 which could look after 12 patients. But it was often full.
Jackie was asked to merge the two services and with help from the then nurse lead Christine Martin, physiotherapist Lorna Flisher, acute physician Dr Kate Smith, microbiologist Dr Laza-Stanca and a few dedicated and passionate clinical nurses, the SMART team was launched in 2016 with 15 inpatient virtual beds at home and limitless support discharge beds.
During Covid, the service increased to 20 inpatient beds allowing sick patients to recover at home but still under the care of the hospital.
Jackie explained: "With just two trained nurses and a registered nurse associate visiting patients across Swale and Medway it was impossible to expand further. So we began investigating new technology to help us manage a bigger case load.
"The best thing Covid did for the NHS was to open peoples' eyes to remote monitoring as well as virtual care. Not everyone needs hands-on care every day."
Jackie recalled: "I remember one Christmas, a patient was crying and asking to come back to hospital because she had a very painful broken leg.
"She had been told to elevate it but by using the video I could see it wasn't high enough.
"I explained how high it needed to be and by the end of my shift her pain had gone away. That one video call made so much difference."
In the past six months the SMART team has performed 2,400 'visits' of which less than a half have needed to be seen face-to-face at home by a nurse.
In 2021 they introduced the use of balloon-like pumps which can automatically deliver doses of specially selected antibiotics directly into veins throughout the day.
Many other hospitals run virtual wards but based on one condition.
Jackie's team can look after surgical patients, those with breathing difficulties, those with heart failure and even gynaecological patients.
They are even about to introduce pain-management at home, too.
Jackie said: "The unique thing about Medway is that we see this as a general adult ward irrespective of the condition.
"If you buy a Ferrari you don't take it to the Ford garage. Behind the scenes, we can reassess specialised cases including hip and knee replacements to keep people from returning to hospital unnecessarily.
"This avoids repetitive visits to GPs or our accident and emergency department and helps patients be involved in their own recovery."
She encourages her team to read about healthcare practises used abroad and to study scientific and evidence-based work which might improve the service.
The team leader adds: "The NHS is not known for welcoming change but I am lucky to work with dedicated nurses eager to expand their knowledge and skills for the benefit of the patients. Sometimes we have to think outside the box."
Anyone, if they are eligible, can ask to be treated at home. Only three have so far refused the service.
One was 84 and said they felt too old to use new technology. Another wanted to see a nurse every day and the other preferred to stay in hospital.
The SMART team is on duty 8am to 6pm, seven days a week and has a dedicated phone line for patients to call for help.
The equipment is provided by Current Health. Its leaflet states: "We help your physician understand if you might need further treatment. Together, our aim is to keep you safe and healthy in your own home and out of hospital."
Other pilots are taking place in Oxfordshire, Lancashire and West Lothian.
In England, £200 million was made available last year to develop virtual wards. A further £250 million is available this year.
The NHS says more than 14,000 patients fit enough to be discharged are kept in hospital because there is no social care in the community for them.
Jayne Black, chief executive of Medway NHS Foundation Trust, said: "We are very proud of the excellent and innovative work of our Surgical, Medical and Acute Recovery Team.
"They provide a range of acute nursing, therapy and remote monitoring care that allows our patients to continue their recovery at home on a virtual ward.
"This service is vital for the trust and the wider NHS, as it helps free up hospital beds and improve patient flow, which is particularly important during the challenging winter months.’’