The NHS and the challenges it faces filled our newsfeeds in 2023. But despite the lengthy waiting times and unprecedented staff strikes, a radical shift in care practices is breaking through. Initially necessitated by Covid-19, virtual wards have become a quietly growing part of the NHS, which recently met its ambitious target of creating 10,000 virtual beds before winter. This provides cautious optimism for those seeking solutions to the healthcare service’s numerous ailments. Many of us can already work, shop and learn from home. Now we can receive hospital care too. As the UK faces a future where our population is set to become older and sicker, might this be a lifeline our NHS needs?
According to the NHS, virtual wards allow patients to receive hospital-level care at home thanks to remote monitoring and communication technology. Although first developed in South London in the mid-2000s, their rollout had been limited to a small number of NHS trusts. Now, thanks in part to a convergence of technological advances and an uptick in remote care spurred by shifts in practice during the pandemic, the NHS plans to make them ubiquitous. In its January 2023 delivery plan for recovering urgent and emergency care services, NHS England called for the greater use of virtual wards and we’ve seen similar efforts implemented in Scotland, Northern Ireland, and Wales.
And as the number of virtual wards grows, so too do the opportunities to explore more technologies and treat more conditions. Virtual wards now offer more widespread care at home for respiratory issues, frailty and, as of October, heart failure.
Longer-term problems facing the NHS include decreasing hospital bed stocks and more people needing treatment for longer periods. Virtual wards can help tackle these issues by giving eligible patients the choice to receive treatment at home. But what actually happens on a virtual ward? The day typically starts with a virtual round by consultants and a team of community nurses is on hand to monitor and interact with patients when needed. Collette is a heart failure patient. According to the Liverpool Echo: “Being on the virtual ward has made Colette "feel really reassured" and cut the number of hospital visits she's made”.
Virtual wards have benefits beyond reducing hospital bed occupancy. The “Getting It Right First Time” programme (the NHS initiative to improve healthcare efficiency) indicates patients on virtual wards are five times less likely to suffer an infection and eight times less likely to experience functional decline than in acute settings. There are also early signs of improved patient experiences, such as increased comfort, normalcy and reduced anxiety, as well as improved clinical outcomes including faster recovery (although further evidence is needed to draw firm conclusions). This is important given the UK’s ageing population and projections that one in five adults will have a major illness by 2040.
Advances in technology are also increasing the range of assessments available for remote care. For instance, bluetooth-enabled stethoscopes which patients apply to themselves while being advised by clinicians over video calls, and ear and throat examinations enabled by high-definition cameras with otoscopes (ear examination tools) and tongue depressor attachments.
Beyond technology, trusts are already testing different approaches; in Bradford, for example, virtual wards are being trialled to treat terminally ill patients, allowing end-of-life care to be delivered at home. This follows wider calls for virtual wards to be used beyond acute medicine in areas such as primary, mental health and community care. The conditions managed by these parts of the health system are driving the UK’s projected growth in health demands in the coming decades.
Treating patients at home reduces hospital admissions and those who are admitted to hospital can be discharged to a virtual ward earlier, potentially addressing a major backlog in hospital care. Both these effects have the potential to improve patient flows, which could be particularly beneficial in poorer parts of the country; the 10% of the population living in the most deprived areas in England are almost twice as likely to go to A&E than the 10% of the population in the least deprived areas.
Addressing healthcare inequalities is not so simple though, as people who are in less affluent socioeconomic groups like virtual wards less and are more likely to say their homes are not suitable. This highlights the importance of avoiding a one-size-fits-all approach and ensuring virtual wards are an integral part of a wider healthcare system, tailored to the communities they support.
Although people are generally in favour of them, virtual ward bed occupancy in England was 68% as of October 2023, below the NHS’s 80% winter target. People who better understand the technology involved in virtual wards think more favourably of them, particularly when they are not called ‘virtual wards’. Given admission to virtual wards is currently optional, clearer communication about what they are and how they work will evidently play a role in their success.
Achieving the milestone target of 10,000 virtual ward beds signals a potential paradigm shift in how we approach healthcare. As technology continues to evolve and the number of virtual wards increases, we will likely see a further expansion of conditions treated and the tools used to do so. To maximise their many benefits though, virtual wards have to be designed with their patients in mind, recognising that not all homes can be hospitals and not all patients want them to be. But with a population that is projected to become older and sicker, getting them right could be a lifeline for the future of our healthcare service.