Dr Layla McCay, Director of Policy, NHS Confederation
Providing greater choice to patients and empowering them in managing their own health conditions, as well as providing independence and flexibility away from traditional hospital environments, have been long held ambitions for the NHS and for patients, who want a greater say in their care. Whilst there has been much work to enable such a shift, this has often been slow and somewhat patchy. However, the onset of the pandemic catalysed a shift away from in-hospital care, including a greater focus on virtual wards – where patients remain at home but have their condition monitored remotely.
Virtual wards, or ‘hospital at home’, uses the systems and staffing of a hospital ward while enabling the patient to get the care they need where they live safely and conveniently, rather than being in hospital. This way of delivering care can free up more capacity in hospitals by avoiding hospital admissions, discharging people back into the community, and reducing clinical time while making sure people get the care they need. With clinical workforce pressures as they are, virtual wards are an ambitious and necessary measure, which on the face of it are proving successful and popular with patients. NHS England has recently hit its target of rolling out 10,000 virtual ‘beds’.
However, as is often the case with new, innovative measures implemented at pace, the evaluation of how they are successfully supporting people into early discharge or avoiding hospital admission compared to traditional hospital care is ongoing. While data is being collected, we are yet to fully establish what effect hospital at home programmes are having on productivity, health outcomes or whether these wards are relieving pressure on systems. So, it is important we do not get ahead of ourselves and take a cautious approach, while looking in detail at how we can utilise virtual wards to the best effect, via the best practice established from where they have been rolled out successfully.
Virtual wards may also be a tool to improve healthcare access for population groups that find it challenging to engage with ‘traditional’ healthcare routes – but there is a risk that they could reinforce existing inequalities in provision as the virtual wards concept favours patients who are more digitally literate. So, there will be a need for robust evaluation through an equity lens, as well community services to be flexible and accommodating the need of local populations in new ways of working to ensure exacerbation of existing inequalities does not occur.
While they can vary and be flexible in the way they operate, a good working example of community led virtual wards is the Wandsworth and Merton hospital at home team at Central London Community Healthcare NHS Trust (CLCH). They set up one of the first community trust-led virtual wards in the country, providing hospital-level, holistic support for serious conditions, in patients’ homes. The CLCH modelling estimates that the initiative has saved approximately 3,478 hospital bed days, helping to reduce urgent and emergency care capacity pressures in the local system by improving patient discharge rates or avoiding admission altogether.
Central to the implementation of virtual wards is the utilisation of digital solutions, but we need the appropriate support of both technology and staff, which means freeing up existing staff to take on the workload, increasing the efficiency of the service and reducing costs. The success of hospital at home relies on supporting community staff to make it happen, but this will mean an increase to the caseload of an already overstretched community workforce. So, it is important to remember that virtual wards aim to reduce pressure on the health and care system as a whole and we must avoid simply transferring pressure from acute care to the community. We need a direct focus on filling the gaps in the community workforce, specifically aligning them with the health and care needs of local populations so we can cover all these bases and ensure that staff have space in their workloads to deliver patient focussed rollout.
Finally for the delivery to be smooth and equitable, we need to hit those NHSEs targets as outlined to ICSs, and to do so will require shared planning, leadership and governance across systems.
While virtual wards are a positive step in ensuring that services move more in the direction of being patient led, there is still much groundwork to be done to ensure their success and that they provide a benefit to local populations across the life course and also to the wider health and care service. Understanding and taking into account what has been missing in the rollout so far will help, and ensuring we have a focus on aspects such as workforce and flexibility, depending on the local population health needs, is essential for health leaders, patients and their teams to utilise virtual wards to their full potential.
