The hospital-at-home model is a potentially transformative means of delivering healthcare at a time of mounting pressure on traditional services. But are patients and practitioners prepared? And are the new models creating extra work for clinical teams? Owen Hughes reports

Earlier this month, NHS England announced that it had delivered on its ambition to roll out 10,000 virtual ward beds by the end of September 2023, calling it a “huge leap forward” in its efforts to transform the way healthcare services are delivered.

By giving clinical staff the tools and technology to monitor qualifying patients at home, NHS England hopes to reduce pressure on emergency services by freeing up hospital beds and allow patients with less serious health needs to recover in the comfort of their own home.

“It’s a really exciting shift of patient management,” says Louise Hough, director of UK customer operations at Current Health. “I think patients will always prefer to be in their own home, in their own bed, [and] with their own family. They eat better, they sleep better, and they recover faster.”

According to NHS England, patients treated on virtual wards recover “at the same rate or faster” than those treated on a normal hospital ward, with some research indicating that people receiving virtual care are at lower risk of readmission and present better mental wellbeing scores that those treated in hospitals.

There are also – potentially – sizeable cost-savings to be had. One case study by Current Health at Croydon Health Services NHS Trust found that virtual wards led to savings of over £742 per patient compared to a control group, with readmissions and hospital admissions post-discharge at 12% and 9%, respectively.

“Over that 17-month period they [the trust] had saved 4,642 bed days and a 70% reduction in patient readmissions, which I think is a staggering outcome,” says Hough.

NHS England eventually hopes to see 50,000 patients treated on virtual wards every month, with some 240,000 people treated at home since January 2023.

While the ambition is commendable – and perhaps necessary to tackle the magnitude of pressure the NHS currently faces – the pace set by NHS England has led to concerns about whether trusts have the means to move at speed.

“Change management isn’t easy; it just doesn’t happen,” says Hough. “You have to have the right expertise and the right experience and the correct support to be able to do it.”

From hospital to home

Indeed, moving hospital care models into the home isn’t a clean-cut, lifting-and-shifting approach. As well as being heavily reliant on remote monitoring technology, clinicians and care staff face the prospect of being required to provide the same level of care and attention to patients as they would in a hospital setting.

One concern among clinicians and carers is the complexity of virtual wards technology: if it doesn’t simplify their work, or if there are inherent worries around false alerts, there will undoubtedly be a hesitancy to embrace it.

John Cooling, chairman at Whzan Digital Health, recognises that moving to virtual care models can require “a lot of hand-holding” for teams that are used to delivering traditional, in-person care

“I can understand that, and it’s not just restricted to the NHS – we’re asking them, and they’re asking themselves, to do something slightly different,” says Cooling.

“They come from a background of clinical safety, and therefore their understandable question is, ‘is this safe?’”

Whzan offers an “all-in-one” telehealth kit via its Blue Box system. Comprised of wireless remote monitoring equipment and a tablet the Blue Box can be used to record the vital signs of people living with long-term conditions, which are then sent cloud-based dashboard where they are monitored by care teams.

The kit automatically calculates a National Early Warning Score (NEWS2) and assigns a traffic light indicator (green, amber or red) to simplify patient health monitoring for care teams. The system offers teleconferencing so care teams can speak with users, and also sends alerts reminding users to log their health metrics and take medications, allowing one clinician to monitor several individuals simultaneously.

Keith Chessell, CEO at Whzan Digital Health, alludes to the simplicity of the technology. “We’ve got something like 150,000 patients on our system at the moment, and probably 40,000 to 50,000 clinical users…We’ve got two people on our support group, and we might only get a few support calls a day, because it’s so easy to use and intuitive,” he says.

Impact on workforce

A recent market analysis by Digital Health Intelligence, available to DHI subscribers, found that the rollout of virtual wards spearheaded by NHS England would likely amount to “pockets of innovation and success,” based on the £250 million in matched funding available in the 2023/2024 financial year, with most NHS trusts instead having to focus “on significant other pressures such as staff shortages, growing waiting lists, and local ICB and ICS politics”.

Alan Payne, group product and engineering director at Access Group, suggests that, while virtual wards will ease pressure on care teams and clinicians, NHS trusts and care providers will still need to recruit more staff in order to run them.

“Virtual wards, in their current guise, don’t necessarily ease the workforce burden – they require more staff to run, outside of those already needed on wards,” he says.

“They do, however, reduce the burden on the workforce by leveraging reduced friction capabilities, allowing digital matching of needs (demand) with safe facilities (supply). Fewer patients in hospitals means less overcrowding in emergency departments, bed blocking and fewer numbers of patients being looked after by each member of staff.”

This reduction in pressure on care teams will have the knock-on effect of lowering staff turnover, argues Payne – critical, given that figures from the NHS’s March 2023 Staff Survey found that a third of NHS workers are thinking about quitting.

“Staff working on virtual wards are also able to work more flexibly, allowing a change from the fast-paced stressful environments that can be encountered in hospitals,” he says.

“The act of integrating systems for virtual wards and giving views of bed capacity, at an ICS level, also reduces that burden, meaning staff are not having to ring multiple people to find bed space, arrange care and referrals and discuss history and patient needs with their GP or social worker,” he adds.

Integration presents a separate challenge for delivering and scaling virtual care, with Hough pointing to challenges with the fragmented nature of the NHS IT and social care landscape.

“Some of the hospitals that we’ve been dealing with the longest still haven’t got an internal EPR system, let alone something that can be set up within primary care,” she says.

Integration isn’t a one-and-done process, either. “You can’t just integrate once with the supplier – you have to integrate locally,” says Hough. “There are [also] challenges within the NHS IT teams and their availability, because they’re extremely busy, so we have to work at their pace.”

The human element

Beyond the logistical, technological and staffing challenges surrounding virtual care, patients’ and the wider publics’ reception to virtual care is key to its ultimate success.

Current Health’s 2020 Croydon case study found that 87% of patients reported a positive experience with virtual ward care, with the service achieving a net promotor (i.e. customer experience) score of 55 – classed as ‘excellent’. This is based on a cohort of 250 patients who had been admitted to a virtual ward.

Likewise, a March 2023 survey of 7,100 members of the public and 1,251 NHS workers commissioned by the Health Foundation found 45% of the public and 63% of NHS staff either ‘very’ or ‘quite’ supportive of virtual wards. Nearly three-quarters (71%) of the UK public said they were open to being treated through a virtual ward under the right circumstances, while 27% said they would not.

Payne feels that most of the hesitancy around virtual care and virtual wards comes from the healthcare professionals’ side, as opposed to the patients. “Being responsible for a person’s care can mean there is some resistance to allowing them to go home due to the risk,” he says.

“We need to be able to provide the tools for those providing care to feel completely comfortable sending a person home, knowing that they’re receiving the same level of care and won’t fall through the cracks.”

Payne also refutes the idea that older patients might not be able to effectively use the technology needed to be monitored or to self-monitor at home.

“From all the virtual ward case studies happening across the country, it’s clear that patients of all ages are open to being on a virtual ward and that using technology isn’t holding them back,” he says.

Hough believes that the issue is less about clinicians being hesitant to put patients into virtual care – though he adds that the decision must always be based on patient choice – and more to do with the fact that some organisations simply don’t provide the resources to do it. As such, buy-in from key stakeholders within NHS organisations is essential.

“I think one of the challenges is about getting that clinical responsibility and accountability in place. That doesn’t come on day one,” she says.

“You need very strong clinical engagement and clinical buy-in, so CNIOs and CIOs are really important to get that engagement. And on the ground, [you need] those individual clinical teams and those clinical leads, because they’re the ones who know the patients better than anyone, and they’re the ones who are looking for the right solutions.”