Virtual wards, or 'hospital at home', form a key part of the NHS' armour for this winter and beyond. The model is a central element of NHS England's winter resilience plan and enables people to receive care at home instead of in hospital, supported by remote monitoring and face-to-face care.
Over the last couple of years, national targets have sought to ramp them up with goals to deliver 10,000 virtual ward beds by September, and 40-50 beds per 100,000 people by December. Providers have been working hard to meet these ambitious targets despite sustained operational pressures across the health and care system.
But there is further to go. The capacity created by virtual wards varies across the country and usage is below expected. Levels of provision are increasing but remain some way off the target of 40-50 beds per 100,000 people.
Providers have identified the following three barriers to scaling up virtual wards. Overcoming them will enable the NHS to fully harness their potential for patients, staff and the wider health and care system.
The right number and mix of staff
Virtual wards are sometimes viewed as part of the solution to the staff shortages, which often underpin pressure in the NHS – particularly in the acute sector. In fact, scaling up virtual wards requires more, highly skilled staff, while existing workforce pressures act as a barrier to delivery.
The model is about consultant-led care, delivered through multi-disciplinary teams delivering care both remotely and face to face. This way of working can create new pressures on staff time. At the early stages of rollout, the model often requires training, including in new technologies, the development of new processes, including to manage clinical risk in a home setting as well as ensure the right support is in place for staff and patients alike.
Effective virtual wards also require the right mix of staff with the right skills. Senior, experienced frontline staff, including consultants and senior nurses, are needed, while clinical leadership is essential for effective decision-making and risk management.
It was promising to see the NHS long-term workforce plan recognise the need to increase the number of staff, and create the right mix of staff skills, to deliver virtual wards. However, results will take time and success will hinge on the plans for implementation. Flexibility between roles, the expansion of training and placements, and building clinical leadership will all be central to tackling these challenges.
Sustainable funding from integrated care systems (ICSs)
The expansion of virtual wards has been supported by £450m of national funding available to ICSs between 2021-23. While national funding was welcome, the short-term nature of the funding has made longer-term planning for many, including around training and recruitment, difficult.
From 2024, the expectation is that virtual wards will be built into plans as business as usual. But in the face of tight budgets and a demanding and complex delivery task for ICSs, there are concerns that funding for virtual wards could be squeezed. It is essential ICSs continue to prioritise funding for the model to deliver much-needed certainty for providers and maintain momentum to deliver results. National policymakers must remain watchful of how this plays out, and where necessary, take action to ensure that sufficient funding flows to providers to deliver virtual wards.
As national guidance outlines, virtual wards are 'the first test of ICSs'. If they are to pass that test, ensuing there is sufficient funding and capacity across the system is vital. This will require greater prioritisation of, and funding for, community health services and social care. The impact of targeted funding for virtual wards will be limited unless ICSs make further investments to build capacity in the parts of the system which play an essential role in supporting people to stay well at home.
Buy-in from staff and patients
Improving capacity in virtual wards is one part of the puzzle – the other is ensuring that existing capacity is used. The latest figures from July show that the occupancy rate of virtual wards beds stood at 64%; below NHS England's target of 80% by September.
In some ways this slower burn approach reflects the cultural shift needed for virtual wards to fulfil their potential, with clinical leadership key to supporting patients, families and staff to manage risk differently at home rather than in a traditional hospital setting.
Research by the Health Foundation also shows that 45% of the public and 63% of NHS staff were either 'very' or 'quite' supportive of virtual wards, indicating there is more to do to build public confidence in a radically different model of care. Support is higher among those who report a greater understanding of how the NHS is using technology, and lower for older people and those in lower socio-economic groups. This suggests more engagement with staff, patients, and the wider public is needed to build understanding and ensure equitable access f to these emerging services for different population groups. While a lot of work to support this is taking place at a local level, there is an important role for national leaders and politicians to play in raising the profile of virtual wards and amplifying these messages.
In short, good progress has been made over the last couple of years to scale up virtual wards in the midst of a range of competing operational priorities, with 9,700 virtual ward beds now in place ahead of winter. Providers are optimistic about this model and working hard to tackle the barriers to expanding it at a local level, but further national support – on workforce and securing public and staff buy-in – is needed to help turn these ambitions into reality.
This opinion piece was first published by HSJ.