What are virtual wards?
Virtual wards allow people to get the high-quality care they need, safely at the place they call home, if they have been diagnosed with an illness.
This care is provided using a mixture of home visits and easy-to-use remote technology, to monitor the patient’s condition.
In the virtual ward, patients are cared for by a multi-disciplinary team and may also be visited by specialised clinician staff. When their care involves more face-to-face than remote digital monitoring, these types of virtual wards are sometimes known as 'hospital at home'.
The aim of virtual wards is to ensure that outcomes for patients reduce health inequalities, not widen them.
The journey so far
In January 2021, in response to the global pandemic, NHS Cheshire and Merseyside set up pilot COVID / Acute Respiratory Infection (ARI) virtual wards, with respiratory teams across the footprint.
NHS Cheshire and Merseyside was selected as 1 of 10 virtual ward national rapid evaluation sites. Using the learnings and experience from the pilot, in 2022, we began a system-wide expansion of virtual wards across the footprint.
We are working as a system to expand virtual wards for ARI, frailty, cancer, heart failure, paediatrics, and potentially palliative care. By April 2023, we expect all Cheshire and Merseyside acute trusts to be providing ARI virtual wards and frailty / hospital at home services, with further expansion into additional specialities expected in 2023/24.
The service is designed to complement existing services, not to replace them, adding additional capacity and competency to existing services.
The Innovation Agency has been commissioned to provide the evaluation process.
- Provides safe care supporting patients through acute illness
- If appropriate, patients can safely go home earlier, or avoid hospital altogether
- Better outcomes and faster recovery for many patients
- Patients can stay connected to their families, carers and communities
- Less chance of patients de-conditioning on a virtual ward
- Reduced waiting times and fewer trips to NHS settings
- Same wrap-around, high-quality care, just as patients would have on a ward
- The patient can be treated from the comfort of their own home, which many prefer
- Constant monitoring and access to nurses in a simple, innovative way
- Reduced patient waiting times and system pressure
- Reduced staff and team pressures
- Reduced pressure on ward beds (improving system flow)
- Less pressure on elective procedures and A&E admissions
- Telehealth enables review of the patient’s vital signs between home visits
- Additional reassurance to the hospital team and patient
- Richer and faster analysis of patient data and condition
- Seamless links to multi-disciplinary teams and faster response
- Economic benefits
- Improved patient flow through the hospitals
- Increased staff and GP satisfaction
Due to the success of the virtual wards programme in Cheshire and Merseyside, our virtual wards have been showcased in the national press, most recently featuring on BBC Morning Live and BBC Radio 4 (14 minutes and 30 seconds in).
From 1 November 2022 to 17 April 2023, virtual wards across NHS Cheshire and Merseyside have supported 812 cases of admissions avoidance and 859 cases of early supported discharge.
Will virtual wards widen health inequalities?
We aim to reduce health inequalities for patients by using personalised care development and working with carer organisations to support and identify carers.
If a patient is affected by fuel or food poverty, they will be signposted locally to services to support them. For example, food banks and organisations to help with the cost-of-living crisis.
What if a patient is not digitally enabled?
Digital inclusion is also key, to ensure that outcomes for patients reduce health inequalities.
Virtual wards may not be suitable for everyone. However, we aim to not digitally exclude patients. We can offer:
- a support service from digital buddies for those who may need assistance – piloted by The British Red Cross
- a kit that can be loaned if the patient does not own a smartphone
- training that can be provided by clinical staff at the bedside during the onboarding process
- a text message or phone call alternative that can be used to submit readings.
What about personalised care and personalised care plans?
Personalised care training is a mandated requirement of all clinical staff who will be providing virtual ward (hospital at home) care.
Case finders identify eligible patients and evaluate whether the patient is suitable for admission onto the virtual ward, with the patient’s agreement.
A tailored personalised care plan is then devised with the patient and the clinician. This personalised care plan captures the patient’s condition(s) medications and preferences and supports them at the place they call home.
There is also an opportunity for patients, their families, and carers (if applicable) to work closely with the team and be involved in decisions and choices on their treatment.
What about carers?
NHS Cheshire and Merseyside is working closely with carer organisations locally and regionally.
We have created a set of questions and prompts to help clinicians identify and support hidden carers.