Matter for discussion: Virtual wards – the pros and cons

Led by NHS England (2022), with clinical guidance from professional groups, a national programme for virtual wards was established, aiming to expand virtual wards and hospital at home services (NHS England and NHS Improvement, 2022).

NHS Scotland, hospital at home models have expanded with similar services in Wales and Northern Ireland (Royal College of Physicians, 2023). The Scottish Government (2023) announced funding to increase capacity by more than 150 virtual beds and Healthcare Improvement Scotland’s evaluation (2022) shows hospital at home services contributed to 27% reduction in length of stay. 

The broader work introduced by NHS England uses the term ‘virtual wards’ and includes models based on remote monitoring and advice, including face-to-face care provided by hospital at home models. These are used across the UK to support patients to stay at home and discharge patients from hospital sooner.

Analysis by the South Eastern Health and Social Care Trust in Northern Ireland demonstrated that staff gained knowledge and clinical skills in supporting patients with complex chronic disease, reported higher levels of satisfaction, and benefitted from an environment of continuous improvement and development (Sheasby, 2023).

In Wales in 2023, the Minister for Health and Social Services expressed how focus needs to shift to strengthening community-based services helping patients live at home independently as long as possible (Welsh Government, 2023).

The National Institute for Health and Care Excellence (NICE, 2017) investigated the benefits of virtual wards. They reported the savings per patient for each study, by up to £9,081 per patient. 

NHS England commissioned Skills for Health (2022), to develop a core skills and capabilities framework to inform workforce education, training, and career progression, including informing local workforce models. This framework hopes to create a standard of practice for staff within virtual wards and urgent community response teams.

NHS England has created a virtual ward online hub, focussing on patients, clinical conditions and supporting family members, but less on education and skills needed to nurse in a virtual ward. Consideration should be given as to whether staff receive appropriate training to use technology for remote management and future workforce training needs. Are staff equipped with innovative technology or older less appropriate tools to manage remote patients in this new landscape? And is there a risk that virtual wards become remote, with minimal impact on clinical time saving, and patient outcomes?

In Wales, a workstream on virtual wards exists within the Strategic Programme for Primary Care. It aims to address the community infrastructure needed to provide 24/7 wraparound primary and community care. If virtual wards are to live up to their potential, it’s essential to invest in education and development of the nursing workforce. This will have a positive impact on patients’ outcomes and provide a pathway for nursing’s career development.

Considering the impact of education and technology, are we enabling the nursing workforce of the future to gain experience and understanding within virtual wards? And have we taken the time to listen to the patients receiving virtual care?

The reading list for this debate is available here.

References

Healthcare Improvement Scotland (2023) Expanding hospital at home across Scotland. Available at: https://ihub.scot/news/expanding-hospital-at-home-across-scotland/ (Accessed 15th March 2024).

NICE (2017) Chapter 12 Alternatives to hospital care: Emergency and acute medical care in over 16s: service delivery and organisation. Available at: www.nice.org.uk/guidance/ng94/evidence/12alternatives-to-hospital-care-pdf-172397464599 (Accessed 15th March 2024).

NHS England and NHS Improvement (2022) Supporting information for ICS leads: Enablers for success: virtual wards including hospital at home. Available at: www.england.nhs.uk/publication/enablers-for-success-virtual-wards/ (Accessed 15th March 2024).

Royal College of Physicians (2023) The RCP view: Hospital at home and virtual wards. Available at: www.rcplondon.ac.uk/guidelines-policy/rcp-view-hospital-home-and-virtual-wards (Accessed 15th March 2024).

Sheasby L (2023) Impact of virtual wards, The Access Group, 14 April. Available at: www.theaccessgroup.com/en-gb/blog/hsc-impact-of-virtual-wards/ (Accessed 15th March 2024).

Skills for Health (2022) Virtual ward and urgent community response capability framework. Available at: www.skillsforhealth.org.uk/resources/virtual-wards-and-urgent-community-response-framework/ (Accessed 15th March 2024).

Welsh Government (2023) Funding to increase allied health professionals and access to community-based care. Available at: www.gov.wales/funding-increase-allied-health-professionals-and-access-community-based-care (Accessed 15th March 2024).


Further reading

Edgar K, Iliffe S, Doll H A, Clarke M J, Gonçalves-Bradley D C, Wong E and Shepperd S (2024) Admission avoidance hospital at home, Cochrane Database of Systematic Reviews, (3). Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007491.pub3/full?highlightAbstract=hospital%7Chospit%7Chome (Accessed 8 March 2024).

Wallis J A, Shepperd S, Makela P, Han J X, Tripp E M, Gearon E, Disher G, Buchbinder R and O’Connor D (2024) Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis, Cochrane Database of Systematic Reviews, (3). Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014765.pub2/full (Accessed 8 March 2024).