A virtual wards operational framework has been published by NHS England, designed to help support consistency and the achievement of goals set out in the urgent and emergency care recovery plan and 2024/25 priorities and operational planning guidance around maintaining a virtual ward capacity of over 80 percent. The framework details a vision of What Good Looks Like for virtual wards, as well as scaling virtual wards, assessing progress, building an evidence base, recommended indicators and outcomes, through to operational and implementation requirements for integrated care boards.
The framework for virtual ward services
The operational framework begins by setting out key benefits of the virtual wards approach, including the prevention of hospital admissions and attendances, reduced length of hospital stay, enhanced cost-effectiveness, and improved patient choice and experience.
The framework sets out “core service components” for virtual wards that all providers should work towards, including clear, effective governance, accountability, and clinical leadership with consultant or GP oversight; staffing for a minimum of 12 hours per day with out-of-hours provision; clear admission criteria and assessment processes; personalised care and support planning and shared decision-making; and technology-enabled care, including remote monitoring.
When it comes to technology-enabled care, the guidance highlights that virtual wards should have “the capability and capacity to use technology-enabled monitoring” to “improve access to information that supports clinical decision-making, and support remote consultation and connections between the patient and their care team”. EPR configuration to enable access to information across delivery partners, and the optimisation of ePMA and e-prescribing systems, are also recommended.
Included in the guidance are a number of operational and implementation requirements for ICBs, including dedicated ICB-level leadership and coordinated strategic oversight and planning “to provide appropriate governance and risk management of the delivery of virtual wards at a system level”; the ongoing management of capacity and demand, with ICBs tasked with considering “how to support the flow of operational data, including real-time capacity” to ensure accurate occupancy data; taking the lead and supporting providers on the alignment of referral pathways and system flow; and supporting workforce capacity and capability.
For measuring outcomes, the guidance calls for “robust and consistent” data, which should be gathered on clinical effectiveness, patient safety, patient and carer experience, staff experience, and use of resources. The “ambition”, according to the guidance, is “to automate the flow of a new Minimum Data Set (MDS) via the Federated Data Platform (FDP), which will provide daily operational data providers and systems require as well as data for secondary use and evaluation”; with data being collected through the Virtual Wards Situation Report “until providers supply a patient-level flow via the FDP and the Faster Data Flows Programme”.
In line with these requirements for data, the guidance sets out a series of recommended indicators and outcomes across categories such as effective governance and clinical leadership; equity of access; productivity; virtual ward scale and maturity; attendance and admission avoidance; reduction in hospital length of stay; high-quality, comprehensive assessment and treatment; improved recovery following acute illness or injury; positive experience of care at home; and patient safety.
A range of further reading materials and resources are provided toward the end of the guidance, including the Getting It Right First Time (GIRFT) guidance for virtual wards; NHS England guidance on building an integrated care system intelligence function, and a link to the Virtual Wards Network on the FutureNHS platform.
To read the virtual wards operational framework and guidance in full, please click here.
Recovering access and building capacity
Virtual wards were highlighted in NHS England’s 2024/25 priorities and operational planning guidance, which noted the significance of reaching a capacity of more than 11,000 virtual wards beds in helping to improve the 4-hour A&E performance “for the first time since 2009”. The guidance asked systems to focus on continuing to improve access to virtual wards by “ensuring utilisation is consistently above 80 percent”, supported by remote monitoring tech and rapid access to diagnostics such as point of care testing.
In April of this year, NHSE published new guidance on access to diagnostics on virtual wards, noting the main requirements “for the delivery of effective virtual wards” and sharing recommended priority tests, measures and assessments that all virtual wards should consider making available to their patients.
Case studies: virtual wards in action
Last month, West Hertfordshire Teaching Hospitals highlighted its “virtual hospital” approach in helping it free up “thousands of beds”, and supporting its rise from 102nd place in trust rankings for A&E waiting times to seventh place in two years.
The latest figures indicate an increase from 60.5 percent of patients being seen in A&E within four hours in June of 2022, to 82.6 percent this year, despite the trust citing “higher demand for the service than ever before”.
Chief executive Matthew Coats commented that over the last 18 months the trust’s focus has been on “improving the flow of patients throughout the hospital rather than simply treating one symptom of a much bigger problem.” He said that approaching the situation “in a truly holistic way” has helped free up beds and speed up discharge, with technology used to monitor people from their own homes.
Earlier in August, we were joined by Heather Young, virtual ward programme manager at Nottingham University Hospitals NHS Trust, and Christina (Chris) Prada, virtual ward service lead at Northampton General Hospital, for a HTN Now panel discussion to talk about learnings and experiences around virtual wards.
Chris explained that Northampton General Hospital is currently home to three virtual wards: a remote monitoring virtual ward focusing predominantly on respiratory and colorectal care; a diagnostic waits model which sees patients sent home who are waiting for investigations; and a face-to-face model which adopted from orthopaedics and was running prior to the programme’s launch.
From the Nottingham University Hospitals perspective, Heather shared that the trust’s virtual wards are predominantly step-down, with “acutely unwell patients who are still being monitored by consultants and who still need a degree of face-to-face care”. The virtual wards see a lot of activity from surgery, respiratory, frailty, and palliative.
Heather and Chris shared key challenges including getting organisations who have never worked closely together before to collaborate on a programme of care and care pathways; helping to boost clinician trust in the safety of the virtual wards approach, and facilitating information sharing between different teams and services.
Looking to what “good” would look like for virtual wards, Heather said that on a technical level, “good” is “supposed to look like meeting the numbers”, but that for her team, the focus is on making sure patients are receiving “good care at home, so their care quality doesn’t change, they’ve just got a different person at the door”.
Chris said that her main priorities for a ‘good’ virtual ward focused on patient safety, patient experience, and value for money. “You need to be prepared, because this is basically building another hospital or an extension to the hospital. You’ve got your operational challenges, your digital challenges, and your clinical challenges. It’s all about change management, undertaking proper stakeholder engagement right at the beginning, and finding your clinical champions who are prepared to lead.”
