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VIRTUAL WARDS – Will this increase in NHS capacity widen Inequalities?

The NHS Operational and Planning Guidance for 2022/3 sets out a significant target for the system level roll out of virtual wards.

Here is the target

“By December 2023 to have completed the comprehensive development of virtual wards towards a national ambition of 40-50 virtual beds per 100,000 population.”

According to my maths – England has a population of 56 million which equates to (560*45) the creation of a minimum of 25,200 virtual beds in England. According to the Kings Fund, England has experienced a significant decline in acute hospital beds and currently has just over 100,000.

So this proposal equates to a 20% increase in beds – assuming that actual hospital beds are not reduced further.

Here is the money

NHSEI has allocated a total of £200m in 2022/3 and £250m in 2023/4 subject to targets being met (pp23/4 of operational planning guidance).

This £450m is transition funding only, and the second tranche of £250m has to be match funded by local systems in order to be released. This means that after 2023/4 local health systems will have to manage costs of running 20% plus beds from within their own resources.

The implementation costs equate to £450m/25200 = £17,900 per new virtual bed.

What is a virtual ward?

According to the NHS Supporting Information virtual wards:

“Support patients who would otherwise be in hospital to receive the acute care, remote monitoring they need in their own home or usual place of residence (I assume this means a care home).

..provide acute clinical care at home for a short duration (up to 14 days) as an alternative to care in hospital. 

…are suitable for …. People with respiratory problems, COVID-19, heart failure or acute exacerbations of a frailty led condition”

What’s not to like?

I think there are two areas to be concerned about – which need more thought and action.

Inequality and Equality

The supporting information document I mention above is prefaced by a standard NHS statement – see below.

However the subsequent document makes no mention of why equality and inequality are relevant to this agenda and what actions might need to be taken with regard to the implementation of virtual wards.

Here are some suggestions:

The government has an ambition that 20% of acute beds will be provided at home in Communities. We know that:

If we are to develop virtual wards in a way that does not widen inequality we need to consider how these will impact on people whose ‘virtual ward’ experience may be significantly worse than someone with a secure income, decent housing and good digital connectivity.

This leads me on to my second point…..

Integrated Health and Care systems

The current proposal feels like lifting and shifting a clinical model from a hospital to a community setting. Just because it is not in a hospital does not make it any more of a community based service – unless it is integrated into the local voluntary and community sector.

The ‘virtual ward’ patient is likely to require greater support from family or other carers, may require access to welfare rights and housing assessments etc. All of these can be addressed through a stronger funded connection with local voluntary organisations and local government etc. 

What needs to happen

The NHS talks about the need to have a stronger focus on inequality and about shifting investment towards community and the voluntary sector, the virtual ward process needs to have: 

What do you think?

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