Virtual wards: a prescription for NHS winter resilience

When implemented and utilised well, virtual care solutions can meet patient demand and satisfaction. They dovetail and complement urgent care response (UCR), unscheduled care hubs, acute respiratory hubs, and ambulance service improvement plans, which are the staple of most winter resilience plans.  

Workforce challenge vs. workforce opportunity 

A lack of a sufficient workforce continues jeopardising the pace and scale of delivering virtual ward programmes nationally. For example, some systems delay establishing new pathways because they don’t have access to the specialist workforce to support them. And yet other systems are embracing a flexible workforce, moving forward with plans to develop regional monitoring hubs for managing patients across all clinical pathways.  

However, virtual wards can be a valuable opportunity to entice healthcare workers back into the profession. By considering how to attract individuals who may have previously left the workforce, such as retirees or those seeking part-time employment, we can transform a substitutional challenge into an additive solution by taking an imaginative and inclusive approach to resourcing virtual wards to create much-needed capacity in the winter months.  

A holistic, blended approach 

From protecting patients with compromised immune systems to improving patient flow, the benefits of virtual wards are clear for early adopters. However, those at the delivery end acknowledge virtual wards cannot exist in a vacuum, and a multifaceted approach is needed to ensure virtual wards are adopted and embedded well within winter resilience plans. 

… embedding virtual wards into community care should be the cornerstone of winter resilience plans

Accident and emergency overcrowding and ambulance performance are perennial challenges that make winter difficult for the NHS. The NHS Confederation recently found that areas spending more on community care have lower non-elective admissions and ambulance conveyance rates. This is perhaps unsurprising but further emphasises that embedding virtual wards into community care should be the cornerstone of winter resilience plans.  

While virtual wards can expedite hospital discharges or prevent unnecessary hospital admissions, where admission cannot be avoided, proactive trusts including Mid and South Essex NHS Foundation Trust and South Tees Hospital NHS Foundation Trust, set up additional capacity to ensure they can flex to meet the additional demands of winter. Some strong examples include strategically placed ambulance handover bays offering baseline assessments for patients, reducing the time they spend waiting for care. Another best practice example is urgent treatment centres, which divert non-emergency cases from the emergency department, allowing staff to focus on more critically ill and injured patients. 

Involving clinicians and patients 

Successful implementation of virtual wards hinges on the involvement of clinicians and patients from the inception of development. Co-designing virtual ward pathways with the active participation of these stakeholders builds understanding, confidence and credibility. Patients benefit from continuity of care as they transition into virtual ward settings with support from their clinicians. 

ICS leaders can promote virtual wards by appointing ‘virtual ward champions’ to advocate for their implementation across the healthcare ecosystem. These champions harness the expertise and goodwill of senior clinicians and consultants who are invested in the long-term success of virtual wards. 

This approach has seen great success in Leicester, Leicestershire and Rutland, where champions for digital change were crucial to the rollout of an ambitious virtual wards programme. Based on the trust’s existing skillsets, the virtual ward programmes extended beyond frailty and acute respiratory infections, encompassing post-colorectal surgery, diabetes, and palliative care. The success of these programmes was attributed to the champions who advocated passionately for digital transformation, changing the perception of digital care with patients and clinical colleagues.

Flexibility in pathways 

Just as healthcare is not a one-size-fits-all approach, neither should virtual wards be. Local data must be leveraged to make informed healthcare decisions tailored to each ICS. The underutilisation of local data hinders the effective deployment of virtual wards, as it fails to address each ICS's specific needs and demands. 

Local systems should have the flexibility to deliver and monitor virtual ward models that reflect specific population health needs

Realising the Potential of Virtual Wards recommends that NHS England adopts a less prescriptive approach regarding condition-specific virtual ward pathways. Local systems should have the flexibility to deliver and monitor virtual ward models that reflect specific population health needs. Expanding the focus beyond respiratory infections and frailty to include areas such as mental health, primary, and community care can unlock the full potential of virtual care. 

Long-term investment and social care 

Lastly, it is essential to emphasise the need for long-term and flexible investment in virtual wards. Current short-term funding models hinder recruitment, planning, and impact assessment. Adequate social care support is equally essential for the success of virtual wards, as it addresses the holistic needs of patients beyond clinical care. 

The benefits of virtual wards are now well established. They support patients by delivering high-quality care in the comfort of their homes, concurrently alleviating the strain on NHS resources. Virtual wards can be a central pillar of a holistic approach to winter resilience plans. 

Nicola Ellis Webb is healthcare services director at Acacium Group . You can follow Nicola on LinkedIn