NHS England sets ambition to improve access to virtual wards

NHS England has announced proposals to increase access to virtual wards in a bid to cut avoidable hospital admissions and reduce emergency department (ED) waiting times.

The plan follows an analysis by the Royal College of Emergency Medicine (RCEM), published in April 2024, which found there were nearly 300 deaths a week associated with long emergency care waits in 2023, with more than 1.5 million patients waiting 12 hours or longer.

Under new national guidance backed by £150 million, NHSE is asking hospitals to focus on ensuring patients do not wait beyond 12 hours in the ED.

The plan builds on the ‘Delivery plan for recovering urgent and emergency care services’, published in January 2023, which NHSE says saw the first improvement in the proportion of patients seen within four hours in EDs since 2009, outside of the pandemic.

NHSE set out its ambition in a letter dated 16 May 2024, sent to every integrated care board and NHS trust in England by Sarah-Jane Marsh, national director of urgent and emergency care (UEC) and Dr Julian Redhead, national clinical director for UEC.

The letter lists updated priorities to improve UCE performance in 2024/25, which include ensuring capacity for virtual ward beds is consistently utilised above 80%.

It also highlights a focus on access to virtual wards for “frailty, acute respiratory infection, heart failure, and children and young people”.

The letter says that a new “virtual wards operational framework” will be produced in spring/summer 2024 to ensure the benefits of virtual wards can be realised at scale.

In a press release, published on 16 May 2024, Marsh said that “with the rollout of ambitious new measures like more direct referrals to same day emergency care, more ‘step-up’ virtual wards, and targeted support for patients who regularly attend A&E, we are confident this plan can deliver further improvements for patients and continue to bring down the longest waits for care”.

Responding to the plans, Dr Adrian Boyle, president of the RCEM, said in a statement: “Clearly the continued emphasis on improving UEC is welcome, and we are glad to see a focus on addressing long A&E waits. They are dehumanising, degrading and dangerous”.

An NHS evaluation of the effectiveness and benefits of virtual wards in the south east of England, published on 16 May 2024, found that 9,000 hospital admissions were avoided in the south east of England in 2023-2024.

The analysis, carried out by the consultancy PPL concludes that if the south east virtual ward model is scaled up across England, 178,000 admissions could be avoided over the next two years.

However, the analysis found that black and ethnic minority people are consistently underrepresented in virtual ward patient cohorts and recommends “targeted research to understand the barriers to access”.

In October 2023, NHSE announced plans to expand the use of virtual wards to include heart failure patients.