HTN at Rewired 2024: what have we learned from virtual wards?

At Rewired 2024, we sat in on a session exploring what we have learned from virtual wards so far as well as potential next steps, featuring Dr Amanda Begley (executive director of digital transformation for the Health Innovation Network); Tara Donnelly (founder of Digital Care and previous chief digital officer for NHS England); and Umesh Gadhvi (chief digital and information officer for North East London Foundation Trust).

Firstly, Amanda shared some insights from focus group work undertaken by the Health Innovation Network to gather evidence for a review into virtual wards. Patients responded well to being able to stay in their home environment, around their loved ones, with emerging evidence suggesting “overwhelmingly” that patients are very positive about virtual wards “whether they are tech or non-tech enabled”.

Amanda noted that staff were also generally “very positive” around virtual wards, with a lack of perceived problems around recruiting people onto virtual ward teams.

However, she said, there is still plenty to be learned, particularly around carers; she highlighted a need for carers to be better equipped to provide time and technical advice for people receiving care in their home environment through a virtual ward. She acknowledged that there is also work to be done around health inequalities and improving digital literacy; and in considering whether people have a suitable environment at home to receive care.

Patients also highlighted potential risks around isolation and equitable access, and what happens if virtual ward patients struggle with elements such as heating or electricity.

Amanda said that the system is seeing return on investment through virtual wards; their research suggests that on average for every one pound invested, there is a return of £2.80. This is based on small numbers, she acknowledged, but the trend is “moving in a positive direction”.

In terms of what the future holds, Amanda commented on the need to integrate virtual wards in terms of a step-model approach, with an increased focus on urgent community response and rapid response services. In terms of a step-up approach, she said, there is a need to engage with proactive care teams and long-term condition teams. She called this “an area where we can really improve quality, safety and efficiency of our virtual wards”.

There is a lot that can be done in order to enhance virtual wards, Amanda continued; she made points around the need to build confidence and awareness in virtual wards so that staff feel comfortable in referring to them, suggesting that more needs to be done around sharing patient stories and increasing knowledge of eligibility. Also on the workforce, Amanda highlighted that there has been work ongoing in London in particular around building “in-reach” and navigator roles to support virtual ward referrals.

Further advice included more consideration into the level of acuity that is suitable for virtual wards and the clinical leadership required as a result; and more learnings around technology and the “art of the possible”, with Amanda raising the need for further insight into point-of-care testing, diagnostics, the possibilities around AI its uses in identification, and more. She added that there must be a focus on interoperability too, “to make it as seamless as possible for staff whilst ensuring that they capture the right data into health records”.

Tara picked up on the conversation to highlight some of the work around virtual wards from the past year as well as her thoughts for the future. She commented that older people “are the most keen to use tech to stay out of hospital” according to a survey of over 7,000 people last year, undertaken by The Health Foundation; this survey indicated that 78 percent of all ages “would be happy” to use remote monitoring tech at home rather than go into hospital, and for people aged 65 and over this figure rose to 85 percent.

Moving on to look at the national statistics around virtual wards from NHS England, Tara pointed out that there has been “a bit of a shift” with virtual ward figures moving from “primarily early discharge” to a higher proportion being listed as “admission avoidance”.

Picking up on Amanda’s point, Tara highlighted that there is “loads more to do” around tech enablement. 59 percent of virtual wards are declared to be tech-enabled; but the statistics from December indicate that only 29 percent of patients on virtual wards received tech-enabled care.

“There is a lot of work to do in making sure that we are genuinely offering a new model of care that is supported by technology,” Tara said, “because that is where the real gains happen.”

She added that from her experience in visiting virtual wards across the country, patient and carer reluctance is “never” the main barrier to this; rather, it is “much more to do with reassuring clinicians that these pathways are safe”.

In terms of the future, Tara said that she believes the UK is largely ahead when it comes to virtual wards; but the European continent tends to be ahead when it comes to remote monitoring for long-term conditions. She noted that a high percentage of hospital admittances tend to come from loss of control over long-term conditions; therefore getting on top of this and reaching those people through virtual wards represents a step towards keeping these people out of hospital.

Umesh then described the process for virtual ward scoping at North East London Foundation Trust, sharing that the programme sought to allow eligible patients to be accepted into an acute respiratory infection virtual ward for treatment. He highlighted a number of the deliverables involved, including undertaking process mapping to establish the end-to-end requirements, ensuring that digital technology assessment criteria was completed, configuring and testing solutions, and obtaining sign off from all stakeholders involved, including patient representatives.

A key recommendation from Umesh was to avoid “just going out and buying tech” without due consideration; he pointed out that there can be a lot of pressure and it can be easy to panic and make a purchase quickly, but then you will be tied in and your clinicians may not be happy if they have not participated in the selection of the technology.

The “biggest and number one” tip from Umesh revolved around process mapping. “Do not deliver anything without a process map,” he said, encouraging organisations to ensure that they communicate with clinicians and listen to them about their needs. Engagement and listening is “so key”, he emphasised, because you need to create partnerships within your team and across teams in order for virtual wards to work.

He also highlighted the need to “be frank” with suppliers such as EPR vendors and tell them when there are problems and challenges that are making your projects difficult, because it is not just a case of accepting problems as the norm. “You have power – you have a contract with them,” he urged. “Tell them the truth about what is good and what is bad, and they will listen.”