Listening to the system - implementing virtual wards 

Virtual wards (also known as hospital at home) provide hospital level care and monitoring outside of a hospital setting. They are a great way for patients to get the care they need at home, in a safe and familiar environment. 

Although we are seeing many areas embrace virtual wards, we know that there is still some scepticism among clinicians – and in some places they are not being utilised as much as they could.

I was interested to discover more about the reasons behind this. So, I spoke to people from across the system, including people working in clinical settings, to learn more about the benefits and challenges they had identified.

We’ve used this intelligence to plan a robust programme of work to provide useful and useable virtual wards guidance using the available evidence. You can find out more about our virtual wards programme by visiting our new webpage. 

Naming this service

One thing everyone I spoke to agrees on is that the term ‘virtual ward’ is quite confusing. Not just to patients, but to practitioners too. It doesn’t really explain the complexity behind the treatment given to patients, and the technology needed to deliver this. That’s why there has been a recent shift to using hospital at home or step up/step down support.  

Interoperability challenges

Lots of areas said that interoperability between clinical systems was their biggest challenge. This includes the fact that GP teams often use different clinical systems which can make it difficult for virtual wards teams to share information with GPs. Also, the roll out of electronic prescriptions is challenging where not already in place.

Staffing the system

I wasn’t surprised to hear that developing a workforce has been a challenge in some places. Recruitment has been taking much longer than expected. However, one team I spoke to had great success by holding a recruitment day, with applicants interviewed there and then for roles. Some teams are worried that by recruiting virtual ward teams, they are just creating pressures in other parts of the system.  

Evidence generation

As we know, it is early days for virtual wards. And although they proved successful for covid-19 patients there is still a lot to understand about how well they support other conditions. Some say they haven’t seen enough evidence on the benefits of virtual wards, and there are some concerns that people could be put on virtual wards that don’t need to be there. This is not unusual when we are implementing new and promising technology. This is why the work NICE is doing is so important.

However, from my conversations it is already noticeable that virtual wards can be particularly suitable for some conditions. For example, some of the people I spoke to said virtual wards worked well for respiratory patients – particularly those with COPD.  

Monitoring effectiveness

Although, it may take a while to see long term cost effectiveness some areas are already reporting benefits such as a reduction in hospital admissions. There have also been reports of reduced readmissions, conveyance to hospital and length of stays. This can only be a benefit as we approach the winter months. 

Keeping it simple

In most cases, simple is best. Many sites talked about the benefits of having a single point of access for the virtual ward, with a multidisciplinary team sitting behind it.  

The hours are also important. Being available during evenings and weekends has helped reduce hospital admissions. 

Not surprisingly, people felt it was all about having the right workforce in place. A good mix of staff that are appropriately qualified to support patients.  

When asked what people would do differently

I asked the people I spoke to what they would have found helpful to know if they were just starting out. Engagement with others came out loud and clear. This includes making early contact with care homes and domiciliary care providers, as well as early engagement with pharmacy. Additionally, consideration of carers is essential. One area had done lots of work with their local carers centre. They had worked with the centre to co-produce patient information, to make sure patients and their carers were fully informed. Carers UK has provided a useful checklist to help answer any questions, worries or concerns carers might have about virtual wards.  

Not surprisingly, the set-up of virtual wards has worked much better where there has been strong clinical leadership from the outset – not to mention project management capacity to support the set up. 

To summarise... 

Based on these conversations, we know that the health and care system needs answers to the following questions: 

• Are virtual wards effective in providing safe care? 

• Are virtual wards cost effective? 

• What does the evidence say?  

To answer these questions, NICE is carrying out a robust programme of work to provide useful guidance using the available evidence.  

You can find out more about our virtual wards programme by visiting our new webpage.