The must-read stories and debate in health policy and leadership. 

With the NHS’s already significant discharge problems further intensifying, it is no surprise system leaders are looking to maximise every possible option to free up beds and ease pressure on hospitals. It would be negligent to do otherwise.  

But could NHS England’s plans to rapidly expand virtual wards with a hugely ambitious target be a case of too much, too soon? Leading clinicians certainly think so.

The Society for Acute Medicine warned that ‘hastily rolled out’ virtual wards could put patients at risk while taking up significant staffing capacity. Their concerns were mirrored, albeit not in such explicit terms, by others including the Royal College of Physicians.

However, some trust chiefs countered that patients are being put at risk if the NHS does not ramp up virtual capacity quickly. And we can certainly all agree that ensuring beds are freed up for patients who really need them, rather than medically fit for patients being stuck in hospital due to a lack of community capacity, is imperative.   

The good news is no one disputes the virtual ward model, in which patients are discharged home and given oximeters so clinical staff can remotely monitor blood oxygen levels, has the potential to really help ease pressure on physical hospital capacity.

The disagreements are about the scale and pace of the rollout. And as leading geriatric consultant David Oliver cautioned, it must also be remembered that the model will not be a silver bullet for solving the great discharge bottleneck, and the evidence base for its use for conditions beyond covid needs to much developed.

NHSE’s decision to set a target for hospitals to have 15 per cent of covid patients in virtual wards was understandable: the ambitious target underlined to trusts that they must crack on with this agenda.

But top-down targets are always a blunt tool for policy implementation. Different areas will find different combinations of the various models used to speed up discharges and free up beds will work in their patches.

NHSE should cede some discretion and some of the decision-making powers to local leaders to ensure the best arrangements are in place in different local health economies. 

Going nowhere fast

NHS England’s target for trusts to discharge at least half of their medically fit patients has to date proved an ask too far, with just 836 fewer patients of this type now in hospital beds than when the target was set in the week of 13 December. 

The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds. This is just 836 fewer than the average of 10,693 in the week of 13 December, when the target was announced.

Despite the small fall in absolute numbers, the proportion of medically fit for discharge patients has not budged, with this cohort still occupying around 12 per cent NHS general, acute or critical care beds. This is because the number of occupied adult hospital beds dropped from an average of 86,725 in the week of 13 December to 81,824 in the week of 27 December. Read the full data, including regional variations, in our story.