The push to expand the number of ‘virtual wards’ across England is set to be another opportunity for independent providers to gain NHS contracts. NHS England wants a rapid expansion of these wards to reach a target of 40 virtual beds per 100,000 population by December 2023.
In the NHSE’s recently published guidance to Integrated Care Systems (ICS), commissioners of services are reminded that:
“Given the independent sector is already a valued partner in many local health and care systems, as providers of a range of NHS healthcare services, the delivery of virtual wards is an opportunity to build on these relationships.
“Partnerships with independent sector healthcare providers (ISHCPs) may expand local capacity and enhance capability through strong local partnerships with existing acute and primary care providers”
The commissioners are also reminded that the independent sector should be considered as both a provider of healthcare and of technology for the ‘virtual wards’.
The idea of ‘virtual wards’ has been around for some time now, but the Covid-19 pandemic accelerated their development, and this has now expanded to other patient groups. The NHSE is making £450 million available over the next two years to set up these wards.
A ‘virtual ward’ allows the NHS to support people at home, or in a care home, using technology, including remote monitoring apps, wearables and medical devices, such as pulse oximeters, however support may also involve face-to-face care from a multi-disciplinary team based in the community. This latter set-up is sometimes referred to as Hospital at Home.
The popularity of such an approach for the NHS is that they are seen as a way of saving money and relieving pressure on hospitals. Patients also prefer to be in familiar surroundings, rather than in hospital.
The acceleration of ‘virtual wards’ for Covid-19 patients was due to the observation that patients with Covid-19 were arriving at hospital too late as they were unaware of having very low blood oxygen levels until they felt extremely unwell. This resulted in some patients needing invasive treatment and/or being admitted to intensive care units, and in some cases dying. If they had known earlier about their oxygen levels then they could have been treated at an earlier stage.
The Covid-19 virtual wards use pulse oximeters to monitor oxygen levels. In England, two models were used: pre-hospital, in which patients were referred via community routes and post-hospital, in which patients were referred upon early discharge from hospital.
‘Virtual wards’ now cover a variety of conditions, including cardiovascular and respiratory problems, such as chronic obstructive pulmonary disease (COPD). In December 2021 NHS England published guidance for setting up a frailty virtual ward for those with frailty aged 65 or over who have an acute exacerbation of a frailty-related condition and updated guidance for virtual wards for acute respiratory infection, which expands on the guidance for Covid-19 virtual wards.
But is this approach saving money and providing good care. Although, virtual wards were around pre-Covid, the Covid-19 situation has enabled larger-scale analysis of ‘virtual wards’. Analysis of Covid-19 virtual wards has found that they assisted with earlier discharges and reduced clinically necessary re-admissions for patients admitted with COVID-19, saved money but without compromising on patient safety.
However, other evaluations of the virtual wards have highlighted issues, predominantly around the engagement of certain patient groups, with some patient groups having more difficulty engaging with the service than others, for example, those with a disability or health condition, older adults, and ethnic minorities. Engagement was also affected by patient factors , such as knowledge and physical health, and having enough support from staff and family members or friends.
The analysis showed how important it is to consider the groups of patients that have more difficulty in engaging with a ‘virtual ward’ plus the extra burden that this approach places on carers, such as relatives or friends.
Despite the presence of technology, the Nuffield Trust, in an overview of virtual wards, noted that there is still the need for an element of human contact and sufficient staff to make the wards a success.
According to the guidance, the two-year funding being made available is expected to be spent on “workforce pay costs (including clinical, operational, administrative and programme delivery resource) to fund the staffing models required for virtual wards.”
But the money ends after two years and: “No ringfenced recurrent funding will be made available from 2024/25. Systems will therefore need to ensure virtual wards are built into long-term strategies and expenditure plans.”
To date it is the technology developers, an area not covered by the NHS, that are reaping the benefits of this push to virtual wards. Companies, such as the UK start-up Doccla, and Spirit Health.
Doccla’s technology is being used in University Hospitals Coventry and Warwickshire NHS Trust’s ‘virtual wards’ to support patients with heart conditions. The virtual wards use Doccla’s technology to care pre- and post-op patient care for those undergoing ablation procedures to treat atrial fibrillation. The trust plans to support 100 atrial fibrillation (AF) patients in the virtual wards.
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