NHS England (NHSE)’s planning guidance has set out an ambitious plan for systems to establish 40 to 50 virtual beds per 100,000 population by 31 December 2023. This equates to 22,400 - 28,000 beds in total.
Up to £200m of central funding is available for trusts in 2022-23, and a further £250m will be available in the following year to support nationwide implementation plans.
This means the additional funding provided to integrated care systems (ICSs) per bed is £7,100 - £9,000 in 2022-23. Assuming a 90% occupancy rate, this equates to roughly £22 per bed day, which is less than 10% of a normal hospital bed cost.
Clinical staffing accounts for approximately 80% of hospital bed costs. This figure does not differ between a hospital bed or a virtual ward bed. The £22 covers a couple of minutes of clinical staffing time per day, excluding the costs of medication administration, technical solutions [KM1] and home monitoring equipment needed to provide safe and effective virtual care.
It is difficult to see how this economic equation will be solved.
Despite carefully looking for recommended staffing levels for a NHS virtual ward, we haven’t found a clear desirable or mandated standardised number.
Are we focused on the right ambition for virtual wards?
The HSJ recently reported that the NHS is “on trajectory to fall short of a flagship pledge to have around 24,000 virtual ward beds in place by December 2023.”
This is not surprising as neither the financial resources nor the clinical workforce is in place to provide virtual ward beds at the current ambition level.
There is nothing wrong with the ambition to provide remote care and free up physical hospital beds for elective recovery. The problem however, is that an organisational solution of ‘the virtual ward’ has been put at the centre of this ambition, rather than outcomes such as better evidenced prevention, freed up hospital resources and cost effectiveness.
As Professors Elaine Maxwell and Alison Leary from London South Bank University point out: “If the aim is to reduce hospital attendances, patients need more than technical care, they need reassurance and advice. They also need proactive, vigilant care”. Further they stated, “All the evidence shows junior staff will need more not less supervision.”
Seven outcomes the sector needs to enable a system wide reduction in hospital care
Having worked with integrated and remote care models for many years in the UK and Europe, we feel it is imperative to enhance the current virtual ward drive, and back it up with adequate funding, to achieve the intended outcomes that are so urgently needed.
We believe that it is imperative to include the following seven factors if we are to enable ICSs to focus on the key goal of reducing the population’s need of hospital care in an effective, safe and equitable way.
Ultimately, we need to look at the bigger picture when it comes to virtual wards. If we are solely focused on the number of beds that are in place by December 2023 without having the evidence to back up the model of care that works for the individual patient, we are missing a trick. We should be looking at predictive and preventive care intervention with a focus on the outcomes it can have for both the individual and the sector. This needs to be achieved in a safe, effective and equitable way for us to see the true benefit long term.