Logistical friction is the largest hurdle to reaching virtual wards’ true potential

Virtual wards are a means for patients who need monitoring to remain at home and for staff to know immediately when they need urgent care. Alan Payne discusses the benefits of virtual wards and the largest issues facing their adoption

Virtual wards enable patients to be discharged from the hospital and kept under observation at home. It allows former patients to stay in contact with NHS staff, update them on their status with regular checkups, and receive any equipment they need at home. Currently, virtual wards cater primarily to two types of care: frailty and respiratory. Virtual wards have the potential to expand not only how many patients they can cater to but also different kinds of care, supporting digital-first interventions and complex health needs.

Reflecting on the benefits of virtual wards in alleviating pressures on health systems, the UK’s Health and Social Care Secretary Steve Barclay said: “The health and care service is facing significant pressures and, while there is no quick fix, we can take immediate action to reduce long waits for urgent and emergency care.

“Up to 20% of hospital admissions are avoidable with the right care in place. By expanding the care provided in the community, the most vulnerable, frail and elderly patients can be better supported to continue living independently or recover at home.

“This includes rolling out more services to help with falls and frailty, as well as supporting up to 50,000 patients a month to recover in the comfort of their own homes. Not only will patients benefit from better experiences and outcomes, it will ease pressure on our busy emergency departments.”

However, the government’s targets for scaling up virtual wards are at risk. The expectation for an additional 10,000 beds by this autumn and 40-50 people per 100,000 population on a virtual ward by the end of 2023 is already proving problematic.

The NHS Confederation set out the critical factors for successfully scaling virtual wards and presents workforce challenges as the biggest blocker. While this is a valid point, there are equally valid additional frictions that constitute the wider root cause of the workforce challenges that have been highlighted.

The many pain points, such as burnout, retention, recruitment, and demand outstripping supply, are undeniable and need addressing. However, the cause of these challenges will have a considerable influence on our ability to deliver virtual wards at scale.

We need to address the logistical friction within health and care services, specifically the pathway for putting an individual on a virtual ward, creating additional and unnecessary work for NHS staff.

For example, when a patient is considered for a virtual ward from a hospital setting, staff must manually fill out a discharge form and assess what that person requires to be safely put on the pathway. Staff also need to conduct searches and speak with relevant providers (often by making separate calls to multiple organisations) to ensure the right equipment is available for that individual’s specific needs, such as remote monitoring technology.

Then, there is communication with care providers to see if the patient has been living in residential care or received domiciliary care in the past and to organise relevant care visits while the individual is on the virtual ward. The process continues when a person is discharged, and equipment needs to be returned to the hospital and sanitised before re-use.

Connecting the digital dots

However, the solution is not simply about automating these processes. There is technology readily available that will digitise these labour-intensive tasks – which are often conducted by medically trained staff – and integrate the information to create a more dynamic process. This will enable a faster method of assessing a patient’s readiness, caring for them appropriately, and discharging them safely either in their own home or back to their care home. By connecting the digital dots, we can make virtual wards scalable, sustainable, and provide the best care for patients.

Through this dynamic process, a staff member will be able to access a single integrated platform that automatically reviews the patient’s needs, supporting staff in deciding what type of care they need and if they are able to be discharged to a virtual ward.

The same platform then integrates with a digital brokerage system to list which organisations can provide the necessary equipment needed in the person’s home to enable their care. Plus, it has surfaced information from the individual’s care record to assess their wider social condition to ensure any other vulnerabilities are accounted for, which may otherwise cause readmissions, which reduces pressure on emergency departments. It also ensures any other care providers are involved in the decision-making process.

A successful virtual ward is about much more than remote monitoring, arranged manually and separately from a person’s wider health and care needs. And there is much more scope to scale beyond the two clinical areas targeted by virtual wards: frailty and respiratory. We just need to address the existing friction in the system.

Taking this transformative approach, virtual wards can reduce length of stay by 3%, reduce hospital readmission by 50%, reduce emergency admissions by 5%, and save £1,047 per day per patient. Trusts throughout England are already using EPR systems to provide virtual wards and successfully delivering upwards of 12,000 virtual bed days. If this approach was adopted more widely the NHS could surpass government expectations.

What needs to change for virtual wards and their future?

We will not reach the government’s targets without substantial change. If virtual wards are to remain a priority, then change must happen quickly.

Virtual wards provide a tangible way to release capacity in overstretched hospitals and reserve hospital beds for patients who need them the most, while delivering the same standard of care to those at home at a fraction of the cost.

Once we have joined these digital dots, there is also great potential to standardise the data available across the system and explore even more ambitious ways to release capacity and improve patient experiences. This could be through machine learning to make bed management more interactive or using AI to power clinical decision support, regulatory requirements notwithstanding.

However, if we do not focus on overcoming the current workforce challenges, we risk seeing them fail. We need to take a new approach that addresses the logistical friction at different points in the pathway. In this instance, it is less about finding more staff and more about how to enable staff – with technology – to work differently and overcome the challenges they face.