NHSE to incentivise and increase virtual ward use and support front door services and flow through emergency departments

NHS England has shared plans to increase virtual ward use with NHSE correspondence sent to every local hospital and health system setting out actions hoped to increase urgent and emergency care performance, including plans for a new virtual wards operational framework and funding incentives to support front door services and flow through emergency departments.

The letter shares plans to improve access to virtual wards through utilisation improvements and access from home pathways, as well as a focus on frailty, acute respiratory infection, heart failure, and children and young people. Evidence-based actions to support delivery around these plans include implementing best practice as set out in the virtual ward framework, due to be produced in spring/summer this year “to help tackle variation, achieve further standardisation and ensure the benefits of virtual wards/HaH can be realised at scale.” Other actions include working together locally to increase access to virtual wards as an alternative to hospital attendance or admission, and considering specialty pathways and teams according to local demand.

Additionally, NHSE shares that a new patient-level dataset for virtual wards is being developed; once launched, providers will be required to submit their data to provide enhanced operational oversight of virtual wards and to enable national benchmarking.

The national guidance is backed by £150 million in operational capital, with the focus placed on helping to avoid A&E admission in the first place by admitting patients to virtual wards straight from home, and funding incentives around ensuring that patients do not wait more than 12 hours for A&E care.

This funding will be allocated to NHS operational capital budgets in 2025/26 in order to to incentivise highest performance and greatest improvement in performance since 2023/24. The incentive will focus on improved four-hour performance with measurement at year end; improved category two performance, incentivised throughout the year; and reduction in 12-hour delays in emergency departments, also throughout the year.

The news follows the “largest evaluation of the effectiveness and benefits of virtual wards” from the South East region which took into account 29 virtual wards (analysing 64 percent of admissions to those wards) and indicated that one non-elective hospital admission “could be avoided for every 2.5 virtual ward admissions. Other key findings included “evidence of positive net financial benefits” associated with regional virtual ward provision, with an overall annual net benefit of £10.4 million for the virtual wards analysed; and belief that “the longer they run, the more likely virtual wards are to show impact” with increasing volumes of admission and costs per admission falling.

The letter can be found in full here, and the evaluation here.

Last month, HTN shared NHSE’s guidance on access to diagnostics on virtual wards which the main requirements “for the delivery of effective virtual wards” and shares recommended priority tests, measures and assessments that “all virtual wards should consider making available to their patients”.