Laura McGowan and Fiona Graham
Virtual wards (VWs), also known as ‘Hospital at Home’ services, provide hospital-level care to patients in their usual place of residence, including care homes. Multidisciplinary teams care for patients using a blended approach of in-person visits and/or remote monitoring by video/telephone call, wearable devices, or apps. We spoke to NHS commissioners and leaders to explore their views and experiences of rolling-out these services across England.
We conducted interviews with twenty individuals from different geographical areas of England (mainly the North), at two timepoints, six months apart. We aimed to understand what was working well, not so well, and whether additional support was needed.
NHS leaders expressed support for VWs, believing they could improve patient experience and health outcomes. Key challenges included: staff recruitment; concerns about who was legally responsible for patients on VWs; problems with getting new technologies to work with NHS computer systems; long and complicated financial and legal processes to purchase new technologies; not enough time to set-up services by the deadlines set; and measures of success that do not reflect the best interests of patients. Patients’ home circumstances and social support were considered key to deciding who would benefit from being on a VW. As such, not everyone would be deemed suited to being cared for on a VW, highlighting a risk of worsening health-related inequalities.
VWs could transform patient-centred care, but require longer term funding to get set-up and running. Organisations need more time to understand how well they are working to reduce pressure on hospital beds and whether they are improving care quality and patient satisfaction. To avoid worsening inequalities, the needs of each patient should be assessed and tailored support provided to enable them to be cared for on a VW, if they consider this preferable to hospital-based care.
Laura McGowan, laura.mcgowan@newcastle.ac.uk and Fiona Graham, fiona.graham@newcastle.ac.uk
