The roll-out of virtual wards is “being jeopardised” because the NHS does not have enough staff to run them, trust leaders have warned.
A new report from the NHS Confederation has outlined how ambitious plans for the expansion of virtual wards has been impacted by the ongoing workforce and skills shortage within the health service.
“It is very concerning to note that vital new models of innovative care like virtual wards… are being jeopardised because of a lack of staff to run them.”
The authors spoke with 20 NHS leaders, including chief executives, digital leads and clinicians, to gain their experience on delivering virtual wards within integrated care systems (ICSs).
Virtual wards, often run by nurses, allow patients who would otherwise be in hospital to receive acute care in their own home.
Senior nurses make up some of the teams which manage virtual wards, admitting and discharging patients to their virtual beds and using digital technology to monitor them remotely.
This year NHS England called on systems to scale up virtual ward capacity to above 10,000 beds by autumn, as a way of freeing up hospital beds ahead of winter.
It said it was on track to meet this target, with more than 340 virtual ward programmes currently in place across England, including a total of 7,653 virtual beds.
This goal comes as part of NHS England’s long-term ambition to eventually deliver virtual ward capacity equivalent 40-50 virtual beds per 100,000 population (around 24,000 virtual ward beds in total).
However, the NHS Confederation analysis published this week has warned that these national targets were being “severely hampered” by the lack of clinical staff available to run them.
The report explained that there was “a severe workforce and skills shortage in the NHS which is impacting on systems’ ability to fully develop, deliver and scale the full ambition of virtual wards”.
It noted that this challenge was “not new” and had been going on for some time.
“Participants told us that before the pandemic, servicing any type of digital care was a challenge for some commissioners due to lack of nurse and clinician availability to lead and absorb the responsibilities virtual wards need,” said the report.
It added that the steady lack of available workforce over the years “continues to affect the feasibility of delivering virtual wards at scale”.
The NHS Confederation argued in its latest analysis that virtual ward staffing needed to be “properly planned”.
It called for long-term staffing plans, “which provide permanent and secondment opportunities for clinical staff” from all different fields, including social, community and primary care.
“This will help reinforce the role of virtual wards as a permanent service which can offer real benefits to career development,” it said.
In addition, it suggested that virtual wards should be incorporated into student placements, to help with exposure to the new system.
To enable the roll-out of virtual wards, £200m was initially made available from the NHS Service Development Fund in 2022-23, with a further £250m being committed for 2023-24.
However, the analysis argued that investment in virtual wards needed to be “long-term and flexible”.
“Currently, short-term funding models are hindering recruitment, planning and impact assessment of virtual wards,” it said.
Virtual wards have most commonly been introduced for people with acute respiratory infections, including Covid-19, and people living with frailty.
But more recently there have also been rollouts across other clinical pathways, including heart failure, diabetes and palliative care.
The NHS Confederation argued that virtual wards working successfully due to the availability of senior nurses, was often where providers have “long-established a model of remote or virtual care”.
However, it warned that challenges had arisen with finding a workforce when a specialist pathway had been dictated to ICSs instead of being based on clinical need.
As such, the NHS Confederation argued that NHS England “should be less prescriptive about condition specific virtual pathways” and grant local systems flexibility to deliver models which reflect specific population health needs.
It said: “The overwhelming focus on respiratory infection and frailty pathways undermine systems’ ability for a more flexible approach.”
In addition the report argued that virtual wards could be adopted in other areas of the NHS beyond acute care, including mental health, primary and community care.
“This less rigid approach would need to be informed by the wider social care gap that impacts on a wider range of patients outside hospital settings,” the report said.
Matthew Taylor, chief executive of the NHS Confederation, said: “It is very concerning to note that vital new models of innovative care like virtual wards, which could go a long way to help in shoring up the health service’s defences and head off another winter crisis this year, are being jeopardised because of a lack of staff to run them.”
He added: “Support from NHS England for virtual wards has been very welcome and there is a need to get them rolled out far and wide to help address winter demand more effectively.
“However, it is also important that those setting them up are allowed more flexibility so that their use is not limited solely to frail patients or those with respiratory illnesses.”
Responding to the analysis, the Royal College of Nursing director for England, Patricia Marquis, told Nursing Times that the NHS could not meet virtual ward targets “without having the nursing staff they need to care for patients”.
She added: “Initiatives like virtual wards could help to solve some of the challenges that health and care services face – but they still need real people and experienced staff to run them and ensure they provide the very best care.
“With morale and conditions at an all-time low it is no surprise that we already have tens of thousands of nursing vacancies.
“Increasing the number of virtual wards and having to staff them adequately will only add to this pressure.”
A Department of Health and Social Care spokesperson said: “Good progress has been made with the NHS already rolling out 7,000 virtual ward beds, an increase of almost 50% since last summer – and remaining on track to deliver 10,000 ahead of winter.
“As part of our plan for recovering urgent and emergency care services we have committed to expanding NHS capacity, backed by £1bn of additional funding.
“We will shortly publish a long-term workforce plan, including projections for the number of doctors, nurses and other professionals we will need in five, 10- and 15-years’ time.”
When asked to comment on the recommendations, NHS England pointed Nursing Times to its page on virtual wards.