As NHS England ask providers to share learnings on rolling out virtual wards at scale, Stephen Boyle explores whether a virtual ward maturity assessment could be more insightful in understanding what’s needed to release both capacity and wider benefits
With virtual ward deployment now embedded in most regions, even if some are still at pilot stage, NHS England are asking providers to share learnings on rolling out virtual wards at scale. This ranges from how they are identifying patients who benefit from virtual ward care to what approaches are needed to manage risk and improve safety. Critically, NHSE are looking for guidance on leadership and clinical governance models to assure clinical efficacy and achieving positive patient centric outcomes.
At this stage, could virtual ward maturity assessment be more insightful? What if we consider both the level of maturity of a virtual ward and what level of maturity is needed to release wider benefits, in addition to capacity?
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NHSE’s expectations of virtual wards are clear – including but not limited to improved independent care outcomes for virtual ward patients versus hospital patients, high levels of patient and staff satisfaction, reduced acquired infection compared to in-patient care and fewer readmissions. All of this with no significant difference or lower mortality than with hospital care.
Assessing the maturity of virtual wards will help us gain insights into efficacy, scalability and sustainability to show systems how they can scale the number of beds sustainably. To ascertain maturity, we believe the following areas need examination.
Efficacy – are virtual wards supporting the right patients with the right care? Is the model specifically designed to avoid harm in the care given and are virtual wards delivering care based on sound clinical knowledge, in a timely fashion? Have virtual wards centred their care on a patient’s needs and concerns and is there any duplication of effort? Critically, are virtual wards delivering an equal quality of care for all, not varying based on personal characteristics?
Experience and perception – do we have the capability to capture patient experience, assessing impact and enabling continuous improvement. In addition, two-way communication is essential to understand local clinical perceptions and overcome any local clinical reticence in referring patients. Much of this will be built on clinical trust, demonstrating effective performance on patient-centric outcomes.
Capacity, demand and cost – are simple but essential factors for assessment. Without the ability to assess and report on its overall virtual ward capacity, how can a system create effective plans to grow capacity while ensuring safe occupancy is achieved and operating within allocated resources?
Stages of maturity
To support systems to scale and achieve sustainable virtual wards, we use the following definitions to gauge a system’s capabilities and virtual ward maturity.
Foundational – is only partially meeting the requirements of NHSE virtual ward operating guidance, with no route to achieve growth other than replicating the virtual wards already deployed. We believe this level of capability will not be able to manage risk and safety nor support sustainability or scalability.
Minimal viable level – virtual wards are meeting the operating model required by NHSE, but with limited route achieve growth by replicating the virtual wards already deployed with a clinical governance model and partial tracking of patient-centric outcomes. We believe every ICS virtual ward should be at this level but question the capacity to create sustainability or scalability at the pace required by NHSE.
Making progress – here a system’s virtual wards comply with NHSE operating guidance and are increasing bed numbers, but inconsistently. They do have a secure clinical governance model however and are actively tracking patient-centric outcomes. This level of maturity is showing scalability but unlikely to be unsustainable.
Aspirational level – A system demonstrating sustained virtual ward growth, with a secure clinical governance model and tracking of patient-centric outcomes that demonstrates objectives are being met. A full execution plan measuring and tracking patient-centric outcomes and patient experience is needed along with technology functionality and performance reporting. Proactive use of data and intelligence to support flexible operations in times of low and surge demand, including workforce planning and support logistics. Finally, capable leadership, clear operating standards and training capability will all enable the route to successful scalability and sustainability.
Where next?
Acknowledging your own readiness is key; consider how your system is positioned with leadership, resourcing, processes and clinical governance. And look at your capacity to stand up processes, enabling services, digital and physical infrastructure while managing results, medicines, decision support, remote monitoring and intelligence and data to inform efficacy.
Consider the opportunities to innovate, measuring maturity is essential to drive innovative services helping us focus on care quality, whilst giving the opportunity to share and receive learnings from other sectors.
Assessing maturity will help systems develop structured plans for virtual wards to scale safely and sustainably. In progressing the maturity of virtual wards, systems should also consider the roles of enabling services, working in partnership with local teams, to address the challenges to be met when improving maturity.
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