Can the NHS make virtual wards work at scale?

Cambridgeshire Community Trust has already made good progress on the national request to make greater use of virtual wards. So what tips can its chief executive give fellow leaders on how best to implement such setups?

Matthew Winn’s advice is simple and almost counterintuitive: stay away from it somewhat. “Us chief executives have got our benefits, but actually you need your clinicians, frontline leaders, and your broader team to really be motivated and start to see how [virtual wards] can happen. I think the role of boards is to set the ambition, to set the ingredients, and the culture and the permission to get on with it.”

Mr Winn, who also serves as NHS England and Improvement’s national director for community services, was speaking at an HSJ webinar held at the end of March. Run in association with Doccla, it was convened to specifically consider whether the NHS can make virtual wards work at scale.

The conversation was a timely one. Such setups – through which the beds of a ward are those in a patient’s home, with remote monitoring technology often used and sometimes face-to-face care offered by community-based professionals – have become particularly prominent over the past couple of years.

Virtual wards were a key part of the response to the early phases of the pandemic, and again to Omicron at the tail end of last year and the start of this one. NHSE is now making clear virtual wards are seen as a longer term fixture – the 2022-23 operational planning guidance sets a “national ambition” for all systems to have 40 to 50 virtual beds per 100,000 population by the end of 2023.

Tara Donnelly, director of digital care models at NHSE and NHSI, said she believed such an expansion could improve patient experience and reduce system pressure.

“I’ve spent the vast majority of my career running hospital services, I’ve got a great deal of respect for them,” she stressed. “They are the best place to be when you’re critically ill but they’re really not great after that and we know people can seriously decondition while in hospital.

“So it’s fantastic that technology now enables us to look after people safely in their own home, which is where the majority of people would prefer to be if that option exists. And we’ve not had enough inpatient capacity during my time in the NHS – so if these technologies can enable us to create capacity in people’s homes where they want to be, then I think that is a fantastic ambition to have.”

She said the national body was initially encouraging the development of virtual wards for acute respiratory infection and frailty, believing the biggest benefit was likely in those areas. But Ms Donnelly added that “we really welcome expanding virtual wards” in any direction that “has enthusiastic clinicians and pathways that could benefit”.

The 2022-23 operational planning guidance sets a “national ambition” for all systems to have 40 to 50 virtual beds per 100,000 population by the end of 2023

The webinar provided an example of one organisation doing exactly that. At Northampton General Hospital Trust, work to implement a virtual ward for COPD patients was underway before the pandemic. When covid hit, the team shifted to creating a setup for those with the virus – but then expanded the approach to many other areas, including the originally-planned one.

“We set up the entire virtual ward system for covid within three weeks,” explained Fiona McCann, respiratory consultant and clinical lead for respiratory medicine. “So we had contracts, we had patient leaflets, we had staffing, we had a rota, we had patient education and managed to get everything in before we started coming down off the first wave.

“That allowed us to learn absolutely loads about setting up a virtual ward. And we were in a very fortunate position, because all the red tape kind of went out the window at the time, and allowed us to kind of get a clinical pathway together really quickly.

“We then used that learning to set up a number of other pathways: we’ve put in place a maternity pathway onto our covid pathway; we’ve tried it with COPD patients; we have established a really successful asthma pathway.

“We’ve had about 300 asthma patients onboarded onto that pathway, allowing them to be either not admitted or discharged early. And by doing that we’ve cut our asthma bed days by at least 30 per cent.”

All have been set up with Doccla, which provides the monitoring technology for patients to use at home and runs the web-based dashboard allowing clinicians to monitor those on the virtual ward. Rachel Collins, a former community matron, is the company’s nurse clinical lead and told the webinar this sort of monitoring has “enabled early discharge, prevention of admission, but also the ability to take action quickly and be responsive to patient need”.

For Martin Ratz, Doccla’s founder, key to implementing such models at scale will be identifying champions in local organisations. But he also emphasised the importance of seeing virtual wards as part of, rather than separate to, “traditional” clinical care.

“There’s a risk that the NHS builds two parallel structure, one is physical, taking care of the patients at the hospital, and the other one is virtual. And it’s important to to see that they are one, and that we don’t have these two parallel structures, because otherwise we’re just pulling resources from one to another.”

It was a point echoed and reinforced by Cambridgeshire’s Mr Winn. “A key element of our virtual ward is that it was designed into and with existing pathways rather than as a separate service. And I think that’s one of the key things we would say: it’s not tangental. This is enhancing our approach and our clinicians’ approach through a remote monitoring element, a digital element, that we didn’t have before.

“You have to have it as a new weapon in your approach as a clinician, as a service to do things differently.”

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