Case study This case study is used in Questions 2 and 3. It consists of three articles addressing the implementation of virtual wards over time. Expanding use of ‘virtual wards' by NHS England Article 1: Government plans 500% expansion of virtual wards The UK government is planning to expand the use of virtual wards, with the goal of treating up to 50,000 patients a month. The expansion is part of a larger plan to reduce pressure on the NHS, reduce waiting times, and improve care for patients. Virtual wards are seen as a safe and efficient alternative to hospital care, particularly for frail and elderly patients. As well as expanding virtual wards the government says it will expand community services, including falls and frailty teams and urgent community response teams. NHS England states there is ‘growing evidence that these are a safe and efficient alternative to hospital care, particularly for frail patients'. The announcements come as part of efforts to reduce intense pressures and record waiting times for NHS services, and ongoing strike action by nurses and ambulance staff. Health and Social Care Secretary Steve Barclay said: 'The health and care service is facing significant pressures and while there is no quick fix, we can take immediate action to reduce long waits for urgent and emergency care. This includes rolling out more services to help with falls and frailty as well as supporting up to 50,000 patients a month to recover in the comfort of their own homes. Not only will patients benefit from better experiences and outcomes, it will also ease pressure on our busy emergency departments'. No details of any additional investment have yet been provided. The government and NHS England will publish an Urgent and Emergency Care Plan today, which it says will reduce waiting times and improve care for patients. An NHS England release trailing the report over the weekend stated: 'Tens of thousands of elderly and vulnerable people will receive tailored support at home each month as part of a new NHS plan to curb unnecessary trips to hospital, help at-risk patients receive faster treatment and improve ambulance response times'. The statement attributed the record pressures primarily to demographics. 'Demand on the NHS is rising, driven by a number of factors including an ageing population with increasingly complex needs. A key part of the plan will be reforming the way the NHS provides services to adapt to the population's changing needs, including by expanding care outside of hospitals'. The release said additional falls and frailty teams would be in place by 'next winter', these will use technology to monitor patients to reduce their risks of falls. These teams join up care by connecting hospital expertise with emergency services and use technology to reduce the risk of falls by remotely monitoring patients. The release states that supporting vulnerable patients at home and in the community may lead to up to 20% of linked emergency hospital admissions caused being avoided. The NHS has already introduced a patchwork of various virtual ward initiatives and pilots to aid with elective recovery efforts following the COVID-19 pandemic. According to NHS England, there has been an increase of 7,000 patients cared for through virtual wards, a 50% increase since last Summer. It promises a further 3,000 'hospital at home' beds will be created before next winter. Virtual wards currently support frail elderly patients or those with acute respiratory infections and cardiac conditions. Patients are reviewed daily by the clinical team who may visit them at home or use video technology to monitor and check how they are recovering. NHS England Chief Executive Amanda Pritchard said: 'Boosting care in the community and treating more people at home is key to recovery - it is better for patients and their families, as well as easing pressure on NHS services'. Sarah McClinton, President of ADASS said: 'We recognise the importance of expanding and joining up health and care in people's homes to stop them needing to go into hospital and enabling people to leave hospital safely with therapies and support to recover. Key to achieving this will be co-producing plans across health and social care and investment in the workforce in social care and community services and we look forward to engaging with this'. An increasing number of NHS trusts are trialling virtual wards, particularly for patients with frailty. In December, Solent NHS Trust announced it is piloting virtual wards in conjunction with Doccla, offering patients with frailty personalised care to help reduce hospital admissions. Source: Hoeksma, J. (2023), ‘Government plans 500% expansion of virtual wards', Digital Health, 30 January. Available at: https://www.digitalhealth.net/2023/01/government-plans-500- expansion-of-virtual-wards/ (Accessed 4 April 2023) Article 2: A guide to setting up technology enabled virtual wards Virtual wards should be technology enabled to maximise the opportunity they offer for both patients, carers and staff. Technology enablement means the management of patients via a digital platform. In a technology-enabled model, patients measure agreed vital signs and enter data into an app or website. In some cases, they wear a device that continuously monitors and reports vital signs. Clinical teams see individual patient measurements for the cohort of patients they are responsible for via a dashboard. The platforms or technology software ensures they are alerted when any patient moves outside agreed parameters, allowing them to take appropriate action. Patients should be considered for a technology-enabled service where one exists, however it is important that alternatives are available to avoid digital exclusion and take account of personal choice. It is also important consideration is given to other opportunities technology may offer such as the use of point of care testing or remote diagnostics to support virtual wards. Using technology can support organisations to reduce the burden on frontline staff by making the right information available to the right people at the right time to improve patient outcomes. The type of virtual ward model introduced will vary subject to what is locally established and clinically agreed. Systems may wish to consider phased approaches to implementation, for example, establishing an early discharge virtual ward model, then building on this to develop admission alternative models. The exact virtual ward model and pathway type will vary in different areas depending on workforce constraints, existing initiatives and local population needs. Systems should review and make plans to expand virtual ward capacity, including COVID-19 virtual wards and Hospital at Home services that support more complex patients. This should be done as fast as practical, taking account of local circumstances and building on existing footprint of services. The digital platform chosen to support a virtual ward is dependent on local need and local system digital maturity and strategy. To support this, the NHS Transformation Directorate (NHSX) has introduced a set of Digital Technology Assessment Criteria for health and social care which all digital platforms are expected to meet. Systems procuring new digital platforms should ensure this is part of their requirement specification. This gives staff, patients and people confidence that the digital health tools they use meet NHSX's clinical safety, data protection, technical security, interoperability and usability and accessibility standards. This assessment criteria provides information on designing and assessing digital health services. It describes apps and tools that could be used for patient care, including example procurement frameworks. Technology is an enabler of a clinical model based on local need and guided by national and locally agreed pathways of care. It is essential to start by considering the clinical and business requirements of the virtual ward service and define a service specification for technology based on those. Teams should consider the technology partnerships and platforms already in place across their geographical area in alignment with their digital strategy to support future scalability. Once the clinical and business needs are determined, a local requirement specification for the use of technology in a virtual ward can be developed. This should ideally be completed at a regional level even if different technology platforms are in use in the short term to facilitate a regional solution longer term. NHS England (2021), ‘A guide to setting up technology-enabled virtual wards', Transformation Directorate, 21 December. Available at: https://transform.england.nhs.uk/key-tools-and-info/a- guide-to-setting-up-technology-enabled-virtual-wards/ (Accessed 4 April 2023) Article 3: A critical perspective Virtual wards may sound like something out of a dystopian sci-fi book, but they're a very real policy initiative being expanded by the government to ease demands on critical care in UK hospitals. - In 2012, I was responsible for setting up one of these ‘wards' in the Midlands. The idea was that an algorithm would use available patient data – such as age, medications, long-term conditions, previous admissions etc - to identify those most likely to be admitted to hospital in an emergency. Using this data, nurses, in conjunction with GPs, managed patients at home. My patients were mostly elderly, but anyone with multiple health problems or a history of higher than average attendances was considered for the ward. Just over 10 years later, the government is creating more virtual wards, except this time the aim is not to prevent patients from entering hospital but to look after them once they have been discharged, including from emergency departments. After treatment, patients will return home and wear devices that will report readings and results so they can be remotely monitored by doctors and other health staff. Patients will receive home visits where necessary from community nurses. There is simply not enough capacity in hospitals to deal with the numbers that need hospital care. Unless your discharge is basic social care or, bizarrely enough, very complex NHS-funded care, you fall into a gap where the specialised long-term care and support needed is not available. In theory, recovering at home sounds like a much more comfortable option than a stay in hospital; however, data is an imperfect way to gather feedback on a patient's recovery. I have lost count of the number of times I have stopped by a patient and found that they were in need of help. That all-important 'end of the bed assessment' is missing from virtual wards. These are the informal assessments nurses and doctors do whenever they look in on a patient. It might be a subtle change in colour, or responsiveness, or just that the patient didn't greet you as they normally would. It might be noticing that a catheter bag is full to bursting or bone dry (equally as bad but for different reasons). That smile, wave or passing conversation that brings back normality to our patients will be missing too. Also, virtual wards can ease bed numbers, but not staffing issues. These extra community nursing teams will still need to be staffed from somewhere; the government estimates that 50% of the workforce will come from hospitals, but the country is 47,000 nurses short already. Home care is important, but it isn't the answer to everything. What we need is investment in the right places - a long-term workforce plan; more time, not less, with our patients; and after-care that can meet the needs of increasingly aged and complex patients. Bostock, B. (2023), 'I helped set up the NHS's dystopian-sounding 'virtual wards'. They aren't the panacea Rishi Sunak thinks', The Guardian, 3 February. Available at: https://www.theguardian.com/commentisfree/2023/feb/03/virtual-wards-rishi-sunak-patients- hospitals-nhs (Accessed 4 April 2023) Question 1 (20 marks) This question tests your understanding of Block 3 Part 1. ● a.List five factors that can explain why an IT system becomes a legacy system. You should write no more than 100 words for part (a). (5 marks) b.Describe an example of a legacy IT system with which you are familiar or have read about in a newspaper, magazine or website. Explain clearly why it should be considered as a legacy system. You must choose a system other than those presented in the module texts. You should write no more than 150 words for part (b). (8 marks) c.Outline one or more ways in which the legacy nature of the IT system you described in part (b) may be assisted or solved. Explain why the solution(s) you describe are suitable for this specific system. You should write no more than 150 words for part (c). (7 marks) Block 3 Part 1 Resources Software evolution: past, present and future - ScienceDirect On the evolution of Lehman's Laws - Godfrey - 2014 - Journal of Software: Evolution and Process - Wiley Online Library Four integration patterns: a socio-technical approach to integration in IS development projects - Bygstad - 2010 - Information Systems Journal - Wiley Online Library Control, trust, power, and the dynamics of information system outsourcing relationships: A process study of contractual software development - ScienceDirect Vendors' perspectives on trust and control in offshore information systems outsourcing - ScienceDirect Question 2 (20 marks) This question tests your understanding of Block 3 Part 2, and is based upon the case study. Build a set of scenarios for the future of the IT systems described in the case study. Your analysis should look beyond the present situation and consider a wide range of alternative future scenarios over a suitable timescale. You should do this using one of the two main methods for scenario planning presented in Block 3 Part 2 (Davis' three-stage method, see Section 2.4.1, and the key uncertainties method, see Section 2.4.2). You should produce: