NHSE guidance for system clinical leaders in developing virtual ward services

NHS England has published guidance designed to support ICS clinical leaders in creating and developing virtual ward services.

The guidance aims to act a starting point for virtual ward development development and produces core clinical considerations for leaders to take into consideration, in order to achieve a mature virtual ward offer.

Clinical governance

ICBs should ensure that professional and clinical leaders are fully involved as key decision-makers, with a central role in setting and implementing strategy, and clinical reference groups in place to support virtual ward development. Emphasis is placed on the importance of out-of-hours provision, with a need for formalised pathways to support recognition and actions around potential deterioration, and safeguarding, with a need for ICSs to assure themselves that commissioned organisations can demonstrate effective safeguarding arrangements.

Patient safety

Systems and providers should collaborate to develop a patient safety framework to complement existing patient safety initiatives, including consideration on the role of technology in the overall clinical safety case. Considerations include taking a core capability-based approach, investing early in workforce development and training, and ensuring that workforce models align with safeguards from the National Quality Board and NHS England.

Integrated services

Here, the guidance focuses on the role of multidisciplinary teams. It notes that virtual wards should be clinically led by a named and registered consultant practitioner, and adds that there should be a system-wide approach to ensuring that workforce skills and expertise can be shared.

Referral in

A senior clinical decision-maker should make the decision on whether a person is admitted to a virtual ward; the decision must based on the same level of clinical assessment as if the patient were being admitted to a hospital bed, and as a shared decision with the patient.

The guidance highlights the need for clear documentation; for the senior decision-maker to have access to a range of expertise, equipment and services; and the need to have other options available. It also highlights a number of actions to support providers when making referrals, such as the sharing of case studies to help referring clinicians understand virtual ward capability, and the need for interoperable digital systems to enable seamless transfer of information.

Admission and discharge criteria 

On admission criteria, the guidance states that this should be developed by clinicians and should reflect the needs of the local population, taking patient preferences into account.

Discharge criteria, it adds, should be in line with acute hospital discharge criteria. Timely planning, clinical oversight and effective communication are emphasised around criteria-led discharge, along with the need for regular reviews of treatment and care.

Personalised care 

“When developing virtual ward clinical pathways, it is important that systems build in a personalised care approach based on what matters to people and their individual strengths and needs. This should include shared decision-making when deciding a plan for current and future treatment,” the guidance says, noting that this is especially important when developing services where a significant proportion of patients will have long-term conditions and/or frailty.

It recommends shared decision-making, co-production of services with clinicians and experts, creating a personalised care and support plan, and involving third-sector groups early in the design of virtual wards.

Hospital admission

A virtual ward patient’s care plan should be under constant review with the senior registered clinician, with shared decisions to be made around continued management within the virtual ward or escalation to another setting if required.

The guidance states that the hospital admission rate should be reviewed based on patient need and should not require a reporting metric used to measure performance in isolation.

End-of-life care and advance care planning

Where possible, virtual wards should be developed and/or delivered in partnership with commissioners and other providers, in order to ensure that end-of-life care is supported and good advance care planning is in place.

There should be a system approach with workforce skills collaboratively used and integration enabled so that other services often experiencing an overlap (such as urgent care programmes and acute services) can work alongside virtual wards.

Outcome-focused care

Virtual ward service performance needs to be measurable, visible and accountable. The guidance states that data capture should be standardised across the whole system in order to facilitate quality improvement and provide assurance that the service is providing improved person-centred outcomes, with effective use of resources and positive staff experience.

NHSE adds an expectation for ICSs to link data directly from providers at patient level to evaluate the service, which should link into population health management intelligence in order to support local evaluation.

Information governance 

Finally, the guidance notes that information sharing is “essential for providing safe and effective care, with all health and care organisations having a responsibility to ensure that information is handled appropriately across partnership organisations.”

It states that ICSs should adhere to the Caldicott principles to ensure that information governance guidance, policies and procedures are in place across the provider collaboratives delivering their virtual ward services.

Please click here to access the guidance in full.