What is a virtual ward?
A virtual ward or Hospital at Home is where a patient receives hospital standards of care in the comfort of their own home.
The NHS England definition is ‘a safe and efficient alternative to bedded hospital care that is enabled by technology’.
Virtual wards help patients who would otherwise be in hospital to receive the level of care, monitoring and treatment they need in the place they call home using straightforward medical and technological devices. They prevent avoidable admissions into hospital and support early discharge out of hospital.
What a virtual ward is not?
- A virtual ward is not for every patient. Patients are assessed to make sure they will be safe to be admitted onto a virtual ward.
- It is not about keeping very ill people out of hospital.
- It is not just for young patients or people who are good with technology.
- It is not only ‘virtual’ care, but in person care too.
Are ‘virtual wards’ and ‘hospital at home’ the same thing?
"Virtual wards" and "hospital at home" are often used interchangeably, and both refer to programs that provide hospital-level care to patients in their own homes.
The goal is to avoid hospitalisation, or to allow patients to go home sooner by providing care to patients after they have been discharged from the hospital. While there may be some differences in the way these programs are set up or operated, they generally share the same core concept of providing comprehensive healthcare services in a home setting.
What are the benefits of virtual wards for patients?
Virtual wards can improve patient experience:
- Patients along with friends and family know they’re being monitored on an ongoing basis.
- Patients can receive care and treatment at home, where they often prefer to be, rather than in a clinical setting.
- Research shows that being at home – where patients can see friends, family and pets – is much better for their physical health, mental wellbeing and overall recovery rate.
We also know that if people stay too long in hospital, they can experience serious deconditioning with reduction in muscle strength that affects their mobility, which can be hard to recover from. The virtual ward approach enables patients to have all the benefits of home – such as privacy, their own bed, peace and quiet – with the wraparound care of a dedicated clinical team reviewing them remotely, and face-to-face when needed.
We know that the positive impact of this is that more patients maintain their independence and ability to remain in their own home and are less likely to need to be re-admitted to hospital.
What are the benefits of virtual wards for the NHS?
Virtual wards can support alternatives to a hospital admission as well as the safe and earlier discharge of patients from hospital, enabling patients to be monitored until their treatment is complete. This can:
- Reduce hospital admissions and free up beds.
- Reduce the length of time a patient spends in hospital.
In addition NHS staff tell us:
- People on virtual wards have access to a range of health and care professionals enabling more holistic and person-centred care.
- Virtual wards help develop a more collaborative culture.
- Professional development is actively promoted and staff derive more professional satisfaction.
Since December 2022 and up to May 2024 there have been 22,662 patients admitted to virtual wards – this has saved around 80,000 in-hospital bed days meaning those beds could be used by other, more seriously ill patients.
Around 90 per cent of patients who are admitted to a virtual ward/hospital at home are discharged without the need for any further care.
What health conditions is hospital at home suitable for?
There are various health conditions that may require ongoing medical attention but can be managed at home with proper support through a virtual ward. If your health condition could be suitable, then your healthcare clinician will assess whether you can be managed at home by a virtual ward team. This can often avoid a stay in hospital, or get you home sooner if you have already been in hospital. The decision whether or not a virtual ward is suitable for a patient is based on several factors including your medical condition, level of support needed, and personal circumstances and preferences.
What virtual wards are there in Lancashire and South Cumbria?
Each of the Acute Hospital Trusts in Lancashire and South Cumbria has a number of virtual wards. They offer support for different conditions based on analysis of need in the area they cover. In general virtual wards cover: respiratory, frailty, paediatric, IV therapy, palliative care and acute medicine.
Your healthcare team will assess whether your condition can be managed on a virtual ward.
How are people referred / chosen as fit for the virtual ward?
There are various health conditions that may require ongoing medical attention but can be managed at home with proper support through a virtual ward. If your health condition could be suitable, then your healthcare clinician will assess whether you can be managed at home by a virtual ward team. The decision whether or not a virtual ward is suitable for a patient is based on several factors including your medical condition, level of support needed, and personal circumstances and preferences.
What happens when you are referred to hospital at home?
There are two routes to be referred on to hospital at home. Either through your GP, community services or even the Emergency Department to avoid being admitted in to hospital, or through a hospital team if you are already in hospital but ready for discharge back to home with some extra monitoring.
Whichever route you are referred you may be given monitoring equipment (usually a portable device) and details of how to record your results (this may be done automatically depending on the equipment you are provided with). You will usually be asked to record your blood oxygen levels along with some other measurements but the equipment provided will do this for you.
You will be given contact details for your Hospital at Home teams and you will be able to contact them 24 hours a day if needed. They will also arrange to contact you at specific times. They will be able to visit you at home if needed.
Once the team are happy that your condition has improved, and you do not need this level of monitoring you will be discharged from the virtual ward and asked to return the equipment.
How big does my room have to be to accommodate the technology?
If you need to have things like your blood pressure or oxygen levels monitored, you will be given equipment that can take readings at home, these are compact or wearable devices.
You will also be provided a tablet computer or mobile phone to send your readings back to the virtual ward team. So the equipment and space needed is minimal.
Do I need to be tech savvy to use the equipment?
No, you do not need to have any experience or knowledge of technology.
You can use your own technology if you have it and are comfortable to by downloading an app to your mobile phone.
If you do not have access to your own technology then you will be given a mobile phone or tablet computer to enter your readings, this is designed to be easy to use and has it’s own access to the internet so you don’t even have to have your own internet service. You will be shown how to use it for everything you need during your stay on the virtual ward.
There is a patient app on the mobile phone or tablet which allows you to:
- complete questionnaires about how you feel and enter your vital signs;
- send non-urgent messages to your care team; and
- receive video calls from your care team.
When you first receive the kit, you will get a phone call to talk you through how to use it.
The majority of our patients tell us the equipment is “surprisingly easy to use.”
Do I need to have the Internet?
NO.
You may be given a mobile phone or tablet with the health monitoring equipment if you do not have access to the internet. The mobile phone or tablet is designed to be easy to use. It is already set up and connected to the internet, so you do not need to have internet or Wi-Fi at home, but you will need to have good mobile phone coverage with a data signal.
Does somebody from my family or a friend need to stay with me?
No. When it comes to the virtual ward, having someone from your family or a friend stay with you is not a requirement. The virtual ward is designed to provide support and care remotely, and healthcare professionals will guide you regarding any specific needs or support you may require during your treatment. If there are any particular concerns or questions you have about this, it's recommended to reach out to the virtual ward team for further clarification.
What if person needs blood test or something not done remotely?
In some instances the virtual ward team can carry out blood tests by visiting your home using their own equipment. In some cases you will be asked to go for a blood test or other diagnostic tests at your nearest health centre or your GP.
How do you know if a person is getting worse if you can’t see them 24 hours a day?
Measurements are taken throughout the day at intervals that are suitable for your condition that will allow the virtual ward team to notice any possible decline in your health. You will also have a number that you can call at any time if you feel you are becoming more unwell.
Once admitted to the virtual ward a personalised care plan will be discussed between you, your carer, and your healthcare team. This will explain what to do if you become unwell at home. If you have a family member or a friend looking after you, the care plan will be shared with them as well.
Obviously, if you feel it is an emergency you should call 999 as normal.
What if there is an emergency?
Once admitted to the virtual ward a personalised care plan will be discussed between you, your carer, and your healthcare team. This will explain what to do if you become unwell at home. If you have a family member or a friend looking after you, the care plan will be shared with them as well.
If you have equipment to take readings at home (e.g. blood pressure or oxygen levels), you will be told how often you need to take health measurements using the equipment you've been given, and the readings will be looked at regularly by your health care team. If these worsen or you are not responding to treatment as expected then changes to your care plan can be made by your clinical team, for example, altering your medication, providing additional equipment to aid with your recovery, or visiting you at home.
If you have any non-urgent questions about your health, your readings, or your treatment you can send a message to the virtual ward team using the mobile phone or tablet you've been loaned.
The virtual ward is not an emergency service. If you feel your health gets worse suddenly you must call 111 (for urgent help) or 999 (in an emergency).
How does this affect the care given by the people already looking after me?
Hospital at Home does not replace the care given by the healthcare professionals who are already looking after you. Instead, it serves as a complementary and supportive measure to ensure that appropriate steps are taken in the event of a deterioration in your condition. The virtual ward's escalation process reinforces the coordination of care, facilitates timely interventions, and provides additional reassurance to both patients and their primary healthcare providers.
If people are offered the Hospital at Home option, do they have to take it even if they prefer going to hospital?
Feedback from patients is that most people would prefer to avoid a hospital stay if it is safe to do so. There are also many health benefits to recovering at home, in familiar and comfortable surroundings.
Your health care team will assess whether your condition can be managed safely at home, and will then work with you, your family or carer to decide whether you are suitable to be treated through a virtual ward. A member of the team will explain how the service works and why they think it would be the best option for you. If you and your carer consent to this, they will refer you into the virtual ward. If you have any questions or concerns you can talk to the care team about them to agree which option would be best for you.
How safe is my data? What happens to my information?
Personal information about your health will only be shared with those directly involved in your care. This may include hospital staff, community teams, care homes, emergency services, GPs and Docobo (technology) support staff. Personal information that may be shared includes your name, address, date of birth, gender, medical history, ethnicity and next of kin details. It also includes your vital signs and your responses to the questionnaire in the patient app.
What targets and guidance has NHS England set for virtual wards?
Integrated care systems (ICSs) are being asked to maximise the roll-out of virtual wards to deliver care for patients at home who would otherwise have to be treated in hospital, by enabling earlier supported discharge and providing alternatives to admission.
The latest guidance states that virtual wards should:
- Fully exploit remote monitoring technology and wider digital platforms to deliver effective and efficient care.
- Manage length of stay in virtual wards through establishing clear criteria for admission into and residing on services.
- Only be used for patients who would otherwise be admitted to an NHS acute hospital bed or to facilitate early discharge.
The 2024/25 priorities and operational planning guidance asks systems to improve access to virtual wards by ensuring utilisation is consistently above 80%, with a focus on frailty, acute respiratory infection and heart failure. This should be done in line with Getting It Right First Time (GIRFT) guidelines and national clinical standards, and supported by remote monitoring technology and rapid access to diagnostics (including point of care testing).
Relevant services and partners are asked to work closely together to increase the proportion of virtual ward beds accessed from home (step up virtual wards) and maximise the impact on system flow. This includes directing patients to a virtual ward from emergency departments and same day emergency care (SDEC) following initial assessment where appropriate
How are technology providers being selected to support virtual wards?
NHS organisations are commissioning approved technology suppliers via the Crown Commercial Service’s procurement system to provide digital platforms and technology to support virtual wards. Members of this framework must demonstrate that they meet required standards across clinical safety, data protection, cybersecurity, interoperability and accessibility.
