Could virtual wards be the answer to NHS waiting lists?
Hospitals across the UK are under pressure from increasing numbers of admissions year on year and an estimated 7.2 million people – one in eight of England’s population – are on a waiting list for operations or elective treatments. Virtual wards, however, can create capacity in the system, by caring for patients at home, and not in hospitals.
NHS hospitals are under pressure on two fronts, with a huge backlog of patients following the pandemic that is compounded by a lack of social care, meaning those in hospital end up staying too long because there is nowhere for them to go.
The way we deliver healthcare in the UK needs to change. The pandemic ushered in a new era of remote monitoring and the infrastructure developed for Covid is now being expanded to create “virtual wards” to manage other conditions, such as hypertension, respiratory disease, atrial fibrillation, and diabetes.
More recently, virtual wards have been developed to deliver care for patients at home who would otherwise have to be treated in hospital, by enabling earlier supported discharge and providing alternatives to admission.
Virtual wards and the digital age
The concept of a virtual ward is not new, as over the past decade the NHS has been using digital technology to support patients with long term conditions who are managed remotely in their own homes to prevent hospital re-admission. But the intense pressure facing the NHS over the past few years has forced it to change the way it cares for patients, as hospital capacity isn’t available.
The NHS has an agreed definition of a virtual ward, based around the principle of patients agreeing to have vital signs monitored at home using approved devices. Patients enter data using a smartphone app, SMS, automated phone call, or online portal, and can also have support from wearable devices that continuously monitor and report vital signs back to the platform. Clinical teams view patient measurements through a dashboard and receive alerts when patients move outside of agreed parameters, allowing them to take appropriate action.
NHS England first introduced detailed guidance for virtual wards in March 2022 and the guidance for providers was that they needed to have virtual wards setup within their Integrated Care System (ICS) to support frail patients and those with respiratory issues by December 2022.
The announcement was backed with funding totalling £450 million, to cover FY22/23 and FY23/24. Many NHS providers have missed this target but over the next year we are likely to see the expansion of virtual wards within different NHS organisations.
Throughout the summer and autumn of 2022, NHS providers were working with NHS England to formalise their plans around virtual wards and subsequently have been working with industry partners to implement technology solutions to support their virtual ward aspirations.
Virtual wards are now able to support patients with a range of conditions, including - but not limited to - respiratory, haematology, oncology and supportive care, frailty, cardiology (particularly heart failure), specialist palliative care, and diabetes.
NHS England and NHS Improvement analysis of hospital admission data suggests that a virtual ward of 50 beds could deliver the equivalent of 31 additional secondary care beds through more effective utilisation of staff.
Critically, the benefits depend on the management of admission to and discharge from the virtual ward against clear criteria. Admission avoidance models have the potential to release greater benefit in terms of bed days saved, than models that focus on early supported discharge.
Systems put in place during the Covid pandemic further validate the potential of virtual wards, with data gathered by Covid Oximetry@Home and the Covid Virtual Ward in Sussex being one example. A survey found that the service has the potential to save over 440 A&E attendances, 1150 calls to 111, 750 GP visits, 146 pharmacy visits, and 84 clinic walk-ins. More than 25,000 people have benefitted from the Inhealthcare Oximetry@Home (CO@H) service in England, providing further information about the benefits of virtual wards.
Research shared by Dr Matt Inada-Kim, national clinical director for deterioration at NHSE, based on findings from CO@H, shows hospital length of stay was reduced by an average of 6.3 days for patients on the virtual ward in comparison to non-CO@H patients. Only 3.6% of CO@H patients were admitted to ICU compared with 8.2% for non-CO@H, and 5.8% of CO@H patients died within 30 days compared to 20.5% of non-CO@H patients.
Further data supporting virtual wards emerged in the Stanwell area of Surrey Heartlands, which found the digital Blood Pressure@Home service helped 53% of users move from high to normal threshold blood pressure within five months. Of these patients, 56% managed this through adopting lifestyle changes, such as increasing exercise or changing their diet.
Surrey Heartlands ICS believes expanding the service could help thousands of patients to manage their conditions, improve health, reduce incidence of clinical events such as death, heart attack or stroke over five years, saving millions of pounds in reduces use of NHS services. The new service is expected to save many hours of admin by automating tasks and allowing staff to concentrate on supporting patients.
Previous innovations in care pathways, such as telephone triage, have been found to create extra care needs and it’s important to evaluate the impact of virtual wards on other services.
In short, evidence is mounting to show virtual wards can increase capacity in the NHS by reducing pressure on clinicians, reducing hospital admissions, supporting safe and earlier discharge from hospital, and freeing up beds to ultimately ease pressures on waiting lists.
With around 50,000 nursing vacancies, one of the barriers to virtual wards with remote monitoring is the lack of NHS staff trained in this new way of working. We expect to see increased use of remote monitoring and there will be further demand for providers of staff with this emerging specialist ability.
Remote patient monitoring can improve health outcomes by enabling patients to take a more active role in the management of their health, whilst remaining under the remote supervision of their care team.
The NHS definition of a virtual ward
A virtual ward is a safe and efficient alternative to NHS bedded care that is enabled by technology. Virtual wards support patients who would otherwise be in hospital to receive the acute care, monitoring and treatment they need in their own home. This includes either preventing avoidable admissions into hospital or supporting early discharge out of hospital.