10 | Nursing in Practice | Winter 2022
ANALYSIS
Virtual wards : a bridge between
hospitals and the community ?
Wiliam Hunter talks to nurses and other healthcare professionals who are pioneering virtual wards in their workplaces , asking if the model can deliver on ambitious targets and examining the potential for collaboration with those already working in the community
What are virtual wards ? 1
The NHS is increasingly introducing virtual wards to support people who would otherwise be in hospital . Patients are monitored remotely ( e . g . for blood oxygen levels , blood pressure , temperature ) using technology such as apps , wearables or other medical devices . They are contacted daily as they would be on a hospital-based ward round , but by phone or video call . Additional support such as home visits can be provided by community teams , including nurses , as required .
Many virtual ward models are run by multidisciplinary teams , which may function as part of an existing in-person ward , a community team , or from a GP practice . Usually , care coordination and day-to-day operations will be led by a senior nurse or practitioner . Many virtual wards are run from hospitals , but in some areas are based in the community .
In the space of just a few years , virtual wards have gone from being a relatively obscure technological solution to a veritable buzzword in NHS circles . They now occupy a unique space in the healthcare system , acting as both a step up from the community and a step down from acute settings .
The model offers a tantalising solution to the unprecedented demand and capacity issues currently faced by the NHS . Staff talking to Nursing in Practice have been generally positive about its rollout .
However , some have raised concerns that virtual wards might not be a silver bullet for the NHS ’ s woes and might even increase the workload of nurses in the community .
To be effective , virtual wards require dedicated staff , careful patient selection , 24-hour coverage and extensive cooperation between primary and secondary care .
While they have their champions , others worry that the NHS simply is not equipped to make the most of what can be expensive investments .
At this key juncture , we ask whether virtual wards can improve patient flow and reduce demand , and what the implications are for community nurses .
Rapid expansion Interest grew in virtual wards during the Covid-19 pandemic , when they presented a solution to two big problems facing hospitals .
First , as hospitals worried wards would quickly fill up , patients who could be cared for at home under remote supervision could be moved into a virtual ward , freeing up physical beds for more critical patients .
Second , hospital staff who needed to shield and could no longer work on the ward or in people ’ s homes were still able to contribute valuable assistance . However , as the waves of Covid receded , the virtual wards remained .
‘ I don ’ t think we ’ d have thought we could provide all this care the way we do if we hadn ’ t had Covid ,’ says Dr Elizabeth Kendrick , medical director at Hertfordshire Community Trust .
‘ We were forced to change what we were doing , and we were forced to think , how can we do this differently ?’
Virtual wards are not new ; Croydon PCT won a national award for their introduction in 2006 . 2 However , their key role in the pandemic response has led to a policy push in England towards having 40-50 ‘ virtual ward beds ’ per 100,000 population by December 2023 . This could mean to up to 24,000 virtual beds .
They have also become more valuable as the extent of problems with timely hospital discharge has become increasingly apparent . A Nuffield Trust analysis published in February 3 shows a 57 % increase in delayed discharges in the 12 months between April 2021 and April this year , from 8,039 to 12,589 , with researchers estimating 15 % of patients were in hospital due to delayed discharge at the end of that period .
While the size of virtual wards varies significantly , almost all are rapidly expanding . In the Humber and North Yorkshire ICB , the 14-bed respiratory ward is set to grow over the next 12 months and has already been joined by a virtual frailty ward treating 40 patients a month .
Meanwhile , in NHS Leicester , Leicestershire and Rutland , it is hoped that the 72-bed capacity will more than triple to 231 by the end of 2022 .
A win-win situation ? Those who work in virtual wards are enthusiastic about the opportunities to improve patient care .
Amy Booth , head of nursing for the community division at Wrightington Wigan and Leigh ( WWL ), says virtual wards are ‘ groundbreaking ’.
She explains : ‘ It ’ s about facilitating quicker discharge out of hospital . We know no one wants to spend more time in hospital than needed . And the longer you stay in a hospital , the more problems can occur .’
In hospital , says Mrs Booth , older patients can quickly decondition and often see their mental health suffer , ‘ but if we can get people home , they can have that social interaction and support from their family and friends ’.
Simple benefits like being able to make yourself a cup of tea or go to bed when you want can have a big impact on patients ’ wellbeing and even on their rate of recovery .
Since Norfolk & Norwich University Hospital launched its virtual wards in 2021 , 1,600 patients have been seen , with a satisfaction rating of 98 %.
If we ’ re going to make virtual wards work , everyone in the system needs to buy into them Dr Elizabeth Kendrick