Chris Richmond, Principal Clinical Consultant, Answer Digital and previous Head of Delivery, NHS England

Virtual wards are a key initiative in NHS England’s Urgent and Emergency Care Services Recovery Plan, and have grown in scale and spread since they were introduced, with the NHS meeting the 2024 target of 10,000 beds. All Integrated Care Boards (ICBs) have a virtual ward that covers at least one clinical area (frailty or respiratory) but have also expanded into other clinical domains such as paediatrics, cancer, and heart failure.

In the latest data published in December 2023 by NHS England, it shows that there are now over 11,000 virtual ward beds available, surpassing the 10,000 target. Occupancy is running at 72.7% for that month, but that ranges from 36.3% to 93%. Given that an analysis of hospital admission data suggests that a virtual ward of 50 beds delivers the equivalent of 31 additional secondary care beds through more effective utilisation of staff, the impact can be wide ranging. Some ICBs are reporting their potential virtual ward capacity as high as 758 beds over the month.

Evidence from individual trusts also shows reduced emergency department presentations and hospital admissions, relieving some of the pressure on hospitals. However, wait times are still rising, with 7.6 million patients waiting for NHS treatment. There is also a paper that suggests that the costs for a patient on a virtual ward is double that of hospital care, although I contest this finding as most studies report savings.

More importantly, being in hospital can lead to physical and mental decline, particularly for older patients. Treatment at home can be hugely positive and help patients to recover or deteriorate less quickly, as they receive care from a multidisciplinary team, and they are not separated from their family.

A GIRFT (Getting it Right First Time) site analysis relating to frailty revealed that patients were eight times less likely to experience functional decline; two and a half times fewer patients treated on a virtual ward were readmitted; and over 99% of patients on virtual wards would recommend the service.

Delivering a successful virtual ward

Our experience working with NHS Englandand system suppliers on interoperability issues for virtual wards and approaches for greater standardisation has brought in to focus three areas to consider to deliver an effective technology-enabled virtual ward.

People

Firstly, there needs to be buy-in and participation from clinical, operational and transformational teams within the systems and trusts, and participation from patients, to develop the virtual ward. Before getting started on delivery, there should be a discovery plan to see what remote care already exists, the technologies being used, and how to connect it into the service.

Acute teams generally oversee decisions and escalation, and community nurses provide the day-to-day care. Each should have defined roles, with clear lines of clinical responsibility and governance.

However, staff face significant demands on their time and require flexibility to work across pathways, teams and organisations, with clear guidance on expectations, and necessary training and appropriate support.

Process

Clear processes and pathways, supported by user journeys, will help teams to identify appropriate patients for virtual care and support referrals, operational tasks, and discharge. There should be a clear diagnosis and care plan for patients, with defined inclusion and exclusion criteria, and appropriate clinical input as though they are an inpatient. There should be a clear pathway to recognise deterioration and appropriate escalation processes to maintain patient safety.

Equally vital is accurate patient data that is integrated between services to support the referral process and enable the right decisions to be made about a patient’s care. When processes are being designed, it is important that technology integration is considered throughout.

Understanding what technologies are required to perform or support key processes will help to develop a roadmap and ensure that any risks are identified. Doing the initial process mapping can help to manage expectations amongst stakeholders as impacts are shared and visible to all stakeholders.

Technology

If we are to scale effective virtual wards, they should be technology-enabled. Then, patient information can be accessed, staff can communicate across systems, and vital signs can be monitored. Data collected from patients should include both clinical observations and questionnaire responses, to be able to monitor trends and alerts.

Teams require access to clinical systems, electronic patient records, and remote monitoring platforms, but issues arise when they are caring for patients from different hospitals with different technologies and different levels of digital maturity. For instance, capturing, storing and presenting different data points in different formats can make it difficult for remote monitoring platforms to integrate with other clinical systems.

Interoperability between IT systems, devices, and applications to exchange, access, integrate and use health data in a coordinated way is key. However, greater interoperability between systems isn’tjust about accessing clinical data for direct care - it can also help to streamline patient registration processes, medication and prescription management, and discharge processes.

Digital enabled patient-centred care

Interoperability ultimately ensures that all those caring for a patient have access to information to ensure that the right treatment and support can be delivered in the most efficient way to support the best outcomes for patients, whose needs should always be at the centre of all decision making. While the evidence of patient benefits is growing, these could be further improved if the right information is accessible in the right place by the right person.

Virtual wards show that hospital levels of care can be delivered in patients’ own homes. Following the above steps ensures that this can be done safely, while increasing capacity and efficiency, and improving patient outcomes.