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However , she notes that such evidence is anecdotal and there is a wide variation in the management of virtual wards . All the virtual ward staff who were spoken to for this article were keen to stress that their service would not create additional workload for community and district nurses .
Managers point out that they had created new teams with additional NHS funding and that district nurses are in fact able to refer patients to the virtual ward if they require more frequent monitoring .
However , Dr Oldman questions whether it would be better to invest further in existing district nursing services and ‘ grow what you ’ ve already got ’, rather than creating a new team .
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‘ But I think every time you show it to somebody , and they see what it ’ s like and they realise patients actually get monitored more closely at home on the virtual ward , it shows them that there ’ s a safety net for patients .’
As Mr Bliss points out , virtual wards are still a new way of doing care and support can ’ t be built overnight .
The nursing point of view For nurses , virtual wards can be a mixed blessing . If implemented correctly they can reduce workloads and offer exciting career opportunities . If not , they may be more trouble than they are worth .
Mr Bangalore is one nurse who believes virtual wards can open up amazing opportunities in the community .
‘ Since I came to this country , I wanted to see what the scope of career opportunities were . Especially being an immigrant , we can often be stuck in our own shell or cocoon , so I wanted to see what the community might have to offer .
‘ At that time there were A & E closures , increasing frailty in the population , so the question was where best to treat the patient .’
Likewise , Lucy Smith , assistant clinical operations director at Provide CIC in Colchester , is currently working to implement a programme of rotations on virtual wards for newly qualified nurses .
Ms Smith explains that it is ‘ really important that they see there is a place for them to use all the skills they get during their training ’, so nurses don ’ t feel they have to start their career in a typical hospital job .
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Workforce concerns But concerns persist that virtual wards may result in even greater strain on already overstretched services across the NHS .
Mr Bliss explains that a common worry expressed by doctors is that moving patients to virtual wards only increases the number of patients under the care of a single clinician .
In the community too , virtual wards have been greeted with some scepticism over their potential impact on the workforce .
The Queen ’ s Nursing Institute chief executive Dr Crystal Oldman tells Nursing in Practice that while the intentions for virtual wards are good ‘ some district nursing services have said that patients are falling to us when the virtual ward team are not there ’.
Dr Oldman points to reports of district nurses being called on to manage virtual wards during night shifts when the ward did not have 24-hour coverage .
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What is the NHS aiming for around virtual wards ? 1
In April , NHS England announced that an initial £ 200m would be available for virtual wards in 2022 / 23 and a further £ 250m in 2023 / 24 , to help reach the goal of 40-50 virtual ward beds per 100,000 population by December 2023 .
References 1 NHS England . Virtual wards . 2022 . bit . ly / 3OxryuF 2 King ’ s Fund . Case study : Virtual wards at Croydon Primary Care Trust . London : King ’ s Fund , 2006 . bit . ly / 3OD1s9r 3 Flinders S and Scobie S . Hospitals at capacity : understanding delays in patient discharge . London : Nuffield Trust , 2022 . bit . ly / 3AJnfqc 4 Shepperd S et al . Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons ? Ann Intern Med 2021 ; 174:889-898
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Building the bridge Susan Gibbs , who created one of the country ’ s first virtual wards for Whittington Health more than nine years ago , says starting with a ‘ blank canvas ’ offered both opportunities and challenges .
Ms Gibbs says it was a ‘ very , very difficult launch because the gaining the confidence of the consultants on the boards was really challenging ’. She adds : ‘ They had never experienced a service like this before where they were responsible for patients that they couldn ’ t see .’
However , with time Ms Gibbs was able to build those relationships with the clinical staff and develop the trust that is now at the heart of the programme .
She says the virtual ward is now ‘ the lynchpin ’ between the hospital and the community .
‘ We ’ re the go-between because we ’ re based in the hospital but we work in the community , and we have colleagues in both .’
And , while building support from staff in hospitals is one way to improve collaboration , some virtual wards are looking at the situation from a different perspective .
Stephanie Dawe , CEO of Provide Health , operates a virtual ward with the Mid and South Essex Collaborative that is based not out of a hospital but in the community .
‘ At the end of the day ,’ says Mrs Dawe , ‘ a virtual ward is a community resource , and the only way it will work is if it links with other services in the community .’
‘ Confidence in the community workforce ’ In the community , says Ms Smith , the workforce is used to delivering home-based care .
‘ When you go into someone ’ s home you are everything to that person and I think there is a confidence in the community workforce to be able to look after patients in their own home .’
Ms Smith points out that another important factor is the links that community teams already have with other services , like social care . ‘ We have those personal relationships , but also those geographical links to make sure that the care is wrapped around the patient .’
Yet while Ms Dawe and Ms Smith are clear that virtual wards do not have to be based solely in hospitals , both say they could not work effectively without close ties to acute secondary care .
Ms Smith summarises the importance of that relationship : ‘ It ’ s having the confidence of the staff in A & E or the frailty unit to say we can look after a patient , and they ’ ve got to trust you to keep that patient safe .’
The future of virtual wards is still being ironed out – but one thing healthcare professionals working in hospitals and the community can agree on is that neither can make it work on their own .
And , concludes Ms Smith , it ’ s ‘ all about winning hearts and minds ’.
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