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NHS England guidance for integrated care system (ICS) leads shares enablers for success when implementing NHS virtual wards and hospital at home services.

Published on 25 April 2022, ‘Supporting information for ICS leads – Enablers for success: virtual wards including hospital at home’ is a key document for ICS leads in England as virtual wards continue to be implemented.

The guide defines virtual wards as: “A virtual ward is a safe and efficient alternative to NHS bedded care that is enabled by technology. Virtual wards support patients who would otherwise be in hospital to receive the acute care, monitoring and treatment they need in their own home. This includes either preventing avoidable admissions into hospital or supporting early discharge out of hospital.”

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Below, AT Today will cover some of the key points from the guidance, as well as NHS England’s vision for virtual wards.

Background information

NHS England is asking all ICSs to extend or introduce for the first time the virtual ward model.

By December 2023, ICSs are expected to deliver virtual ward capacity equivalent to 40 to 50 virtual ward ‘beds’ per 100,000 population. This builds on ambitions detailed in NHS England’s document on priorities and operational planning guidance for 2022/23.

The idea is for ICSs to more effectively and productively manage the treatment of patients through better use of resources.

ICSs are expected to develop virtual ward models for acute respiratory infection and frailty but can develop other pathways in addition.

Virtual wards should be developed across systems and provider collaboratives, rather than individual institutions. Services can be based on partnership between secondary, community, primary, social care and mental health services and in many cases partnerships with the independent sector, the document says.

NHS England stresses that virtual wards should be technology-enabled, meaning that patients are managed remotely by a clinical team via a digital platform.

Who the guide is for

NHS England’s latest guidance supports ICSs with their strategic and financial decisions on virtual ward planning and implementation. The content is positioned at ICS leadership teams but will be helpful for provider organisations as they plan together to implement this model.

Available funding

To help ICSs set up virtual wards, £200 million of funding is available from the Service Development Fund (SDF) in 2022/23. A further contribution of £250 million, on a match-funded basis, will be available in 2023/24. However, no ringfenced recurrent funding will be made available from 2024/25.

This funding is intended to help NHS virtual wards start up but is not intended to cover the ongoing cost of the service. ICSs are therefore required to ensure virtual wards are built into long-term strategies and expenditure plans.

In addition to SDF monies, there is a separate allocation of Regional Scale Programme (RSP) funding from NHSX, with up to £6.3 million available nationally. This additional funding is designated for ICS technology implementation support, which includes, but is not exclusive to, the technology enablement of virtual wards.

ICS funding plans

NHS England explicitly states that ICSs will need to develop and submit two-year comprehensive rollout and delivery plans up until April 2024. As part of this, they are expected to create detailed financial plans that include projected workforce staffing and expenditure.

Additionally, ICSs must share their understanding of expected ‘bed’ capacity benefits. This is the net comparative ‘bed’ benefit of using workforce in a virtual ward compared to using workforce in a secondary care bed setting. To support with this analysis, a Bed Benefit Tool has been made available on FutureNHS.

Although ICSs will have local determination over their funding allocations, NHS England expects them to spend most of the money on workforce pay costs (including clinical, operational, administrative and programme delivery resource) to fund the staffing models required for virtual wards.

Integrated care boards (ICBs) – statutory organisations that each ICS has that bring together the NHS and councils locally to improve population health and commission services – are expected to use the virtual ward funding to pay for enabling technology.

Financial reporting

From the second half of 2022/23, there is an expectation that ICSs will commit to quarterly financial updates as part of their regular assurance meetings, the document underlines. For example, ICS leads might be asked to share data on year-to-date spend and forecast out-turn on workforce pay costs, as well as year-to-date spend and forecast out-turn on technology non-pay costs.

Workforce recommendations

The guide stresses that virtual wards present a unique opportunity to develop multidisciplinary teams and flexible ways of working, which could help attract new staff, retain existing staff, and improve employee satisfaction.

NHS England highlights that workforce models should be determined by local need, joint health and social care system planning, clinical need (including admission and discharge criteria), robust clinical and professional judgement, and aligned to the National Quality Board and Developing Workforce Safeguards recommendations.

The guide details five good practice recommendations for virtual ward workforce models, which are:

  1. Appropriate clinical leadership and governance in place (mandatory requirement) – Virtual wards should be clinically led by a named registered consultant practitioner. Wards should offer support 24 hours a day to patients.
  2. A competency-based approach, avoiding assumptions about professional boundaries and early investment in workforce development and training – A multi-professional team will ensure virtual wards have the skills necessary to support patients.
  3. Integrated working across health and social care – This might include joint working across urgent care response teams, primary care, community nursing teams, rehabilitation and enablement teams and trusted assessors for care homes.
  4. Appropriate use of technology with training and supervision – Technology should provide flexibility for staff in terms of blended roles of face-to-face and virtual care.
  5. An incremental approach to improvement and growth – Monitor areas of virtual wards like capacity, flexible working opportunities, and optimal care models to expand and improve where necessary.

Engaging with carers

To ensure the success of virtual wards, NHS England underlines, ICSs should engage with carers early on in the development process. Carers know the patient the best, so their input is “vital”. ICSs need to engage with carers and carers groups to help shape virtual wards to ensure they fully consider the needs of carers, as well as the person with care and support needs.

Working with the independent sector

The guide says that as independent providers already play a key role in health and social care partnerships, involving them in virtual ward development presents an opportunity to strengthen current relationships.

Partnering with independent sector organisations could help expand capacity and enhance capabilities, especially as there are many technology innovators from the independent sector.

These independent sector collaborations will support designing technology-enabled pathways that improve care experience, provide clinical teams with the technology to work efficiently, and improve clinical decision making by having the right data available for their patient at the point they are delivering care.

Improving health

At the heart of virtual wards should be a focus on improving the healthcare of patients and ensuring equal access to care by enabling individuals to manage their health in their own homes.

However, the guide notes that if wards are implemented without a real focus on improving health outcomes, they are likely to increase inequalities. There is a risk, NHS England outlines, that the use of digital technologies will disproportionately exclude people from certain groups, including older people, individuals on lower incomes, disabled people, and rural populations.

To ensure people are not digitally excluded from using virtual wards, the document says that ICSs should consider the following:

  • Provision of necessary equipment (including adaptations to overcome barriers): this could be in the patient’s home or in another location that is readily accessible
  • Support and training: this should be designed with and driven by the needs of users; based in spaces that are easy to access; involving peer support and VCSE organisations
  • Support for ongoing use including mobile data/access to WiFi
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