With the NHS under pressure as never before, novel solutions are being found to the problem of bed shortages, often caused because patients who are well enough to be discharged have no care package in place for when they go home. One of the solutions being tested is the ‘virtual ward’.
The concept of the virtual ward is that NHS treatment continues when the patient goes home, using remote consultations and online technology so their health can be monitored.
The NHS has delivered on its ambition to roll out 10,000 virtual ward beds by the end of September, new figures have shown.
More than 240,000 patients have now been treated on virtual wards thanks to the world-leading initiative, with research showing people who are treated at home recover at the same rate or faster than those treated in hospital.
England’s top doctor has praised the work of local NHS teams in introducing 10,421 virtual ward beds for patients who can get expert treatment for illnesses such as chronic obstructive pulmonary disease (COPD), heart failure or frailty conditions at home.
The ambition was delivered despite considerable pressure on urgent and emergency care – September was the busiest month for ambulance services so far this year with 827,690 calls to 999 and a record September for the most serious ambulance incidents, with 77,553 category one callouts.
Last month was also the busiest ever September for A&E staff with 2,165,741 attendances, up almost 8% on the same month last year (2,008,489 in September 2022) and 522,000 emergency admissions last month, up 7.1% on September last year.
Despite six days of industrial action in August, thanks to the significant efforts of staff, the NHS has treated 10% more patients (1,422,225) compared to the same month pre pandemic (1,292,163 in August 2019).
However, industrial action continues to impact hospital capacity and services, including discharge and routine care.
September saw four days of industrial action, including the first ever joint action by junior doctors and consultants on 20 September.
The overall number of delayed discharges was up 3.09% in September to 12,372, from 11,913 in August.
Virtual
Professor Sir Stephen Powis, NHS national medical director, said: “Our world-leading virtual ward programme is a huge leap forward in the way the NHS treats patients enabling them to receive hospital-level care in their own home.
“The NHS is embracing the latest technology, with regular check-ins from local clinicians in daily ‘ward rounds’ while freeing up hospital beds for those that need them most – it is testament to the hard work and dedication of NHS staff across the country that we have delivered on our target and rolled out more than 10,000 virtual ward beds by the end of September.
“We know that industrial action is also continuing to pile pressure on services and impact capacity adding a lot of pressure to hospitals before winter, coming on top of high levels of demand with last month seeing more 999 ambulance calls than any month this year as well as the busiest September ever for A&E attendances, up almost 8% on the same month last year.
“But despite this pressure, it is clear from today’s figures that NHS staff are working incredibly hard to deliver for patients with 10% more patients coming off the waiting list in August than the same month before the pandemic”.
August was also a record month for urgent cancer referrals seen (267,555), up more than a third on the same month pre-pandemic (200,317 in August 2019) and up from 256,942 referrals in August last year.
There were also continued high levels of people starting cancer treatment in August, a total of 28,363, up 10% on the same month pre-pandemic (25,767 in August 2019).
Virtual wards allow patients to get hospital-level care at home safely and in familiar surroundings closer to family, friends, and carers, helping speed up their recovery while freeing up hospital beds for patients that need them most.
Patients are cared for by clinicians who can provide a range of different types of care, including blood tests, prescribing medication, or administering fluids through an IV drip. They are reviewed daily with a home or virtual visit as part of the ‘ward round’, as well as the use of technology like apps, wearables, and other medical devices so staff can easily check in and monitor their recovery.
Comfort
Health and Social Care Secretary Steve Barclay said: “Thousands of patients have benefitted from the NHS’s ‘hospitals at home’, which give them the opportunity to recover in the comfort of their own homes while being monitored remotely by clinical staff. This approach, also known as ‘virtual wards’, has been shown to benefit patients and eases pressure on the NHS by freeing up hospital beds.
“We have delivered on our promise to roll out 10,000 hospital-at-home places by winter – a key target in our Urgent and Emergency Care Recovery Plan and a testament to the hard work of NHS staff.
“These ‘hospitals at home’ will speed up recovery times for patients and help cut waiting lists”.
In November 2022 West Suffolk NHS Foundation Trust launched its virtual ward, helping patients who need care and monitoring to avoid coming into hospital or to return home sooner.
Speaking of her experience on the trust’s virtual ward over Christmas last year, patient Carol Gleeson said: “It was nice to be home the day before Christmas eve, I thought I was going to be in there [hospital] over Christmas but I wasn’t, and I got to have lunch at my son’s with everybody”.
Carol’s husband Sid added: “We also got the support of the [virtual ward] as well – the nurse was here Christmas morning, at our son’s in the afternoon and then twice-a-day for a good three weeks”.
In Bolton, work is underway to increase the number of patients who can safely get the care they need in the place they call home and away from hospital. Richard was one of the first patients there to use virtual wards after experiencing a cardiac arrest in early 2023 and said: “When I was ready to be discharged, the hospital needed to continue to monitor how I was getting on.
“They asked if I wanted to go home and take part in the virtual wards scheme, they described what it entailed, and I was more than happy to.
“You’ve got your home life available to you, you’re fully mobile so you can live your life as normal”.
Conditions
Philip has several health conditions which have caused frequent stays in hospital. He became the first patient to be discharged from Good Hope Hospital onto a virtual ward where he has been able to receive hospital-level care in his own home twice. His son, Mark said: “Dad is always happier to be at home, so virtual wards worked so well for him. He is able to sleep in his own bed, move around his home safely, and more importantly, we can take trips out.
“As my dad has grown older, he has more frequent stays in hospital but there is often very little that can be done for him there. These virtual wards are a great way to get people like my dad home, more comfortable and happy”.
As a cautionary note, a reent report in Hospital Times stated: “Remote care requires an entirely different way of working, and needs new technologies to manage it and make it scalable. Right now, communication and the flow of critical information is blocked. Electronic task lists and care coordination features are not flexible enough to fulfil the unique needs of virtual wards, where patients are not co-located with healthcare staff. Integration is near non-existent, and workflows are not built for mobile access, nor do they allow tasks to be allocated and tracked in real-time.”
“We must go further for patients or clinicians. A true virtual ward solution can do more – should do more – to protect patients and make clinicians’ jobs more manageable.”
So would you want to be treated on a virtual ward? As ever, the test of time is likely to expose any weaknesses in the system, but it seems that it is a concept we will have to get used to as the NHS continues to struggle with the number of admissions and an ageing population.
See also: It’s COVID Jab Season Again – Have You Booked?
