Taking virtual wards system-wide – is your ICS ready?

Development of virtual wards is happening at pace across England, and technology is a key enabler. Integrated care systems are looking at an expansion beyond the early areas of covid and respiratory, with some even implementing virtual wards for orthopaedics and other surgical specialities.

But challenges remain, not least in terms of workforce, ensuring there is a clear vision across whole systems, and making sure that virtual wards work for patients, families, and staff.

These were the messages from Virtual wards – is your ICS ready? This HSJ webinar held in association with Spirit Health brought together a small group of experts to discuss progress so far – and what needs to happen next to drive implementation forward.

Breid O’Brien, director of innovation & digital health, NHS England and Improvement, said her background as a nurse meant that her approach was always defined by how to derive best outcomes for patients. “My team are supporting the technology enablement for virtual wards, or hospital at home, but it’s about how we improve care through technology, not tech for tech’s sake,” she said.

Some patients will always “absolutely need” to be in a hospital bed, she added, based on their illness and acuity. “That’s not in dispute at all. But we also know that for many people who are currently in hospital, having care safely delivered at home is optimum care.’

While there is an opportunity to increase capacity by deploying virtual wards, the challenges shouldn’t be underestimated, she stressed. “We can’t just create the capacity without the workforce, and we need to acknowledge that. To assist with that, we need to redesign services so that we can make sure we exploit technology to positively disrupt – and I use that word carefully. We use it where we can, to help our workforce and help our patients and perhaps [to enable] more of a self-care model as well.”

All ICSs have now submitted plans about how they are going to work to NHS England’s ambition to create 40 to 50 [virtual ward] beds by December 2023, supported by investment of £450 million over two years, said Ms O’Brien. “For me, more importantly we have weekly sessions with ICS leads on this and they are hugely well-attended. It’s not about national leads telling people what to do – they’re bringing their lived experiences, their challenges, and their learning, and are sharing together. It really is a national community of practice or community of action.”

Jon Rouston, chief clinical digital information officer, Lincolnshire Community Health Services and head of service, EATS, said that successful implementation of virtual wards was a “people” as well as a tech challenge. There is still some way to go, he said, until digital is properly embedded in healthcare, and it’s important to co-design and co-produce the tech-enabled virtual wards along with patients and clinicians. That also means making technology easy to use.

“If we start from the premise that this should be as painless as possible, this should really help to reduce the barriers to adoption that we still see in staff groups at the moment.”

Among the more unusual virtual wards in development in Lincolnshire is a children’s rapid response service for respiratory problems to keep children with long term conditions out of hospital. “That’s all come from a clinician coming to us and saying, “I’ve seen you doing this work – I think we could use it here”.

Commitment and shared vision from the highest levels of ICSs is key, he says, as is the ability to share information easily and across a whole system – while bearing in mind digital inclusion.

Noel O’Kelly, clinical director with Spirit Health, which has been working with Lincolnshire and with Leicester, Leicestershire and Rutland ICS on virtual ward deployment, said it was key to get all the right people round the table, including strategic leads and clinicians. “What they [ICSs] are looking for is a route to actually deliver on this. Everywhere I go, everybody is committed to this process. I’m seeing ICBs now doing market engagement, where they’re looking at suppliers and really engaging the frontline clinician, which I think is really good – and it’s a change I’ve seen in the last six to eight months. What they’re looking for is the information and the shared experience.”

Spirit Health can also help customers see where the technology fits into their pathways, he added. That means clinicians can make an informed decision on what should happen with a patient, whether it’s using video consulting or messaging, or going to visit them face to face. “It should be an enabler,” he added. “I think it will create a tsunami of change over time.”

An on-demand version of this webinar is available.

For those who had previously registered for the webinar, click here to view the on demand recording.

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