In recent times, virtual wards have been a hot topic of conversation in healthcare.
With the NHS seeing increasing demand in urgent care services and across the system as a whole, virtual wards have become one of the ‘silver bullets’ to solving current capacity challenges. Indeed, targets have been set for systems to have 40 to 50 virtual ‘beds’ per 100,000 population by December 2023.
Virtual wards have many benefits of course. Whether it’s helping to reduce ambulance response and waiting times, supporting timely discharge or providing round the clock care to patients outside of hospital.
But going beyond the buzz term, have virtual wards yet to realise their full potential? And if not, what do virtual wards need to make the concept truly work? We take a closer look.
Current models and utilisation
Virtual wards have been shown to mean different things to people with a range of approaches in place across the UK at present. This in part may be due to the pandemic which precipitated a need for some models to be mobilised at speed.
Whether it’s step-up, step-down, a focus on remote monitoring or more face-to-face visits to a patient’s home, models are said to be ‘widely variable’ today. And differing opinions and definitions of the concept have been cited as a barrier to implementation and securing buy-in from both patients and clinical staff.
“A lack of clarity on the concept of virtual wards emerged as a fundamental barrier to building momentum behind the concept.” - HSJ, How can virtual wards be scaled up?
Certainly, in March 2023, it was announced that 340 virtual wards were in operation with 7,653 virtual beds. However, the HSJ believes just 50% were occupied as of the end of last year, based on internal figures.
This leaves some distance to reach the target of 80 percent occupancy set by NHS England by September 2023. While others have similarly highlighted how previous evidence bears out a need to increase use and uptake of virtual wards.
“As well as increasing capacity, NHS England guidance also reflects on the need to increase the use of virtual wards. Previous evaluations have generally found low uptake of virtual wards, despite additional efforts to involve people who may be at greater risk of health inequalities.” - Nuffield Trust, Virtual wards: the lessons so far and future priorities
The need for clear guidance
Key to the uptake of virtual wards will be fostering greater understanding of ways of working, and providing clear guidance and processes to follow. Particularly with regards to establishing lines of working with community care.
Indeed, in recent roundtables with clinical, system and trust leaders, participants highlighted this as a key area of focus.
And while the answer to which specific models is said to be still unclear, evidence has shown virtual wards have the most success when clear procedures are in place.
“Clear guidance on how to implement virtual wards effectively is essential to ensure the proper adoption of the solution, otherwise, trusts may fail to deliver the expected benefits and may in fact jeopardise care.” - HETT, Key benefits and challenges of virtual wards
The role of data
Data will also be vital to decision making, both at a clinical and system level.
The Nuffield Trust has highlighted how virtual wards models work best where clinicians have access to a person’s clinical history. This can help provide a long-term view and identify which patients will benefit most from virtual wards.
In addition, the availability of integrated data across services can help pinpoint where potential prevention opportunities lie. And quality data at a local level can inform decision making within systems to ensure that virtual wards meet the needs of specific populations.
Addressing the skills gap
We must also remember that many of these models are still relatively new. The management of chronic patients in digital settings is an area where the system is still learning exactly what will work best.
Teams need support, training and time. And ongoing capacity shortages will be a key challenge to address in order to effectively scale virtual ward models for the long term.
“It must be recognised that there is a severe workforce and skills shortage in the NHS which is impacting on systems’ ability to fully develop, deliver and scale the full ambition of virtual wards." - NHS Confederation, Realising the potential of virtual wards
Integral to building momentum and credibility behind the concept will be ensuring the role of technology is one of enablement, finely balanced to serve the needs of patients.
In one of the aforementioned roundtables on virtual wards, one participant noted, “Patients should be made to feel that they will receive the same quality of care and attention in a virtual ward as in a hospital, and not be left feeling that they are being ‘held at arm’s length’ by the care system.”
Indeed, virtual wards must be shown to provide the right care appropriate to the needs of patients, to dispel any misconceptions that their existence is wholly to silo demand away from an overstretched system.
Furthermore, the involvement of patients and clinicians in the co-design of virtual wards will also help to build confidence.
Looking to the future
Of course, the potential of virtual wards is huge and there have been many success stories so far. Some studies point to reductions in hospital re-admission rates by 50% and average length of a hospital stay by 40%.
At the same time, some trusts have reported average combined cost savings of £742.44 per patient. And most importantly, there have been positive patient stories.
“Hospital at home was a life saver for me at a time where I was severely in pain and experiencing mental challenges. The help in providing me with the right medication and home equipment relieved my distress and pain.” - Patient
Looking to the future, this article highlights some potential areas of focus. From provision of clear guidance, integrated data and training, through to the ongoing need to balance the role of technology with patient needs. All will be essential to making virtual wards work.
How Livi can help
Our Livi Practice and Population services deliver video consultations at scale, enabling clinicians to provide medical advice and remote condition management. Mjog, our patient engagement platform, provides an extensive suite of digital patient questionnaires that support remote monitoring.
HSJ Guides. Roundtable: How can virtual wards be scaled up? guides.hsj.co.uk/6081.guide.
Nuffield Trust. Virtual wards: the lessons so far and future priorities. nuffieldtrust.org.uk/news-item/virtual-wards-the-lessons-so-far-and-future-priorities.
NHS England. World-leading NHS virtual wards treat 100,000 patients in a year. england.nhs.uk/2023/03/world-leading-nhs-virtual-wards-treat-100000-patients-in-a-year/.
JAMA Netw Open. 2021;4(6):e2111568.doi:10.1001/jamanetworkopen.2021.1156.8
NHS England. Remote monitoring for patients with chronic conditions in the Midlands. nhsx.nhs.uk/covid-19-response/technology-nhs/remote-monitoring-for-patients-with-chronic-conditions-in-the-midlands/.
NHS Confederation. Realising the potential of virtual wards. nhsconfed.org/publications/realising-potential-virtual-wards.
Swift, J. et al, 2022. An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting. British Journal of Healthcare Management, 28(1), pp.7-15.
Hett Insights. The Key Benefits and Challenges of Virtual Wards. Available online: blog.hettshow.co.uk/benefits-and-challenges-of-virtual-wards