Realising the potential of virtual wards

Virtual wards are increasingly being used by the NHS to provide care to patients where they live, whether in a care setting or at home. The NHS has been set a target of 40–50 virtual wards per 100,000 people and, more immediately, to scale up capacity ahead of next winter, to above 10,000 beds by this autumn. This report sets out the critical factors needed to enable the NHS to succeed in achieving these targets and to make virtual wards a sustainable model in the longer term, where patient demand and satisfaction are met, as well as better productivity.

It sets out the findings of research involving a range of NHS leaders, including integrated care system (ICS) chairs and chief executives, integrated care board (ICB) digital leads, clinicians, and senior operational and finance staff. It focuses on the delivery process of virtual wards; the opportunities they bring to the quality of care and impact on demand; the challenges leaders face in implementing virtual wards, including the implications for the NHS workforce; and potential solutions to improving virtual wards as they become commonplace in the NHS.

To be truly impactful on both patients’ quality of care and NHS productivity, 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. While we await both the national workforce plan and the digital, data and technology workforce plan, it cannot be underestimated how this steady lack of available workforce over the years continues to affect the feasibility of delivering virtual wards at scale.

Virtual ward staffing needs to be properly planned. Long-term establishments should be set and regularly reviewed for virtual wards and staffing plans implemented, which provide both permanent and secondment-based opportunities for clinical staff (including from social, community and primary care). This will help reinforce the role of virtual wards as a permanent service which can offer real benefits to career development. Placements for students should include exposure to virtual wards alongside other traditional placements.

The government and NHS England should approach virtual ward expansion as a coherent larger-scale and holistic digital project. There is considerable enthusiasm among clinicians and local health leaders for increasing the use of virtual wards; their experience shows that when done well, virtual wards can help keep people out of hospital, discharge patients early, reduce clinical time and give patients autonomy and choice.

In implementing new virtual wards, local providers should ensure that clinicians and patients are involved in co-design from the start of development. Successful examples of virtual wards have depended on creating understanding, confidence and credibility among patients and clinicians, and work best when people identified for virtual ward care being supported through admission by their clinician.

For virtual wards to fulfil their potential to relieve pressure on the NHS in winter 2023, local data should be used to make bespoke, local healthcare decisions that address the needs of that population in every ICS. Currently the potential for increasing effective use of virtual wards is undermined by lack of access to good data on local population needs and demands.

NHS England should be less prescriptive about condition specific virtual ward pathways and allow local systems greater flexibility to deliver and monitor virtual ward models which reflect specific population health needs. The overwhelming focus on respiratory infection and frailty pathways undermine systems’ ability for a more flexible approach. This could harness virtual care in other areas of the NHS beyond acute care, including mental health, primary and community care. This less rigid approach would need to be informed by the wider social care gap that impacts on a wider range of patients outside hospital settings.

ICSs leaders should promote the use of ‘virtual ward champions’ to spread awareness across the hospital and multidisciplinary and integrated care pathways. Our participants found that this was an effective way of marshalling the good will and ability of senior clinicians and consultants who have a long-term investment in their success.

Investment in virtual wards need to be long-term and flexible. In addition, adequate social care support is essential in delivering fully integrated successful virtual wards. Currently, short-term funding models are hindering recruitment, planning and impact assessment of virtual wards. The absence of adequate funding for social care funding is preventing systems from fully addressing the holistic and wrap-around needs of patients away from only clinical virtual ward support.