We look at whether an increased reliance on virtual wards, as outlined in the government's newly-launched Urgent and Emergency Care Plan, will ease pressure within the NHS and prevent another winter crisis for 2023.

The 2022/23 winter period was the worst in the 75-year history of the NHS.

Strikes, low staffing levels, record waiting times for an ambulance or in A&E, patients with conditions exacerbated by the pandemic, high levels of bed blocking on the wards, and the worst flu season in a decade has seen the NHS reach breaking point.

This has impacted the level of care patients have received. But particularly the vulnerable, elderly and disabled who disproportionately rely on the NHS more often than others, especially in an emergency.

Demand on the NHS is unprecedented, driven by an ageing population with increasingly complex needs or multiple morbidities. Hospitals are trying their hardest to accommodate everyone with limited resources, but it is clearly taking its toll on both patients and staff.

The Department of Health and Social Care has realised it needs to reform the NHS to adapt to these changing needs, provide better experiences and outcomes for patients, and prevent a repeat of the winter crisis next year. It has launched a major new strategy, the Urgent and Emergency Care Plan, to scale up community services. The government has set aside up to £14.1bn for health and care services over the next two years and plans to make healthcare more accessible for all.

The new plans focus on providing more support at home on ‘virtual wards’ for the most vulnerable in society. By doing so, they believe this will curb unnecessary hospital visits, help at-risk patients receive faster treatment, improve ambulance response times, and free up staff times to ease pressure within emergency departments.

What are virtual wards?

Virtual wards have been increasingly used as an alternative to hospital care. This is where patients who have been treated in hospital can recover at home aided by technology. Wearable and other medical devices and apps take readings (e.g. temperature, blood pressure, blood oxygen levels) which are remotely monitored and reviewed by a clinical team. Patients are contacted daily by phone or video call.

The team is alerted when any patient moves outside agreed parameters, allowing them to take appropriate action. Home visits by community nurses are available where necessary.

Virtual wards are mainly used for patients who are frail, have acute respiratory infections, or cardiac conditions. Their prevalence has increased by 50 percent over the last year (7,000) with a view to creating 3,000 more ‘hospital at home’ beds by the end of 2023.

This ‘at-home’ care model will also extend to same day emergency care units, rehabilitation, physiotherapy, and even an increased access to medical technology such as home dialysis machines for patients with chronic kidney disease.

Up to 50,000 patients a month are set to benefit from virtual healthcare by the end of 2023.

Are virtual wards the answer to the NHS crisis?

The government sees virtual wards as a solution to bed blocking in hospitals. This winter there were 14,000 beds occupied by medically fit patients who could have been discharged but, due to issues with social care or the discharge process, had to remain in hospital unnecessarily.

Many of these patients could have avoided a hospital stay if the right care was in place initially. Falls are increasingly common, with frail patients less able to recover as quickly, requiring more time in hospital or respite care.

A smooth transition is needed to ease pressure on hospital capacity, reduce re-admission and a long-term reliance on social care.

In theory, patients might agree that an earlier discharge and recovering at home in familiar surroundings sounds like a much more comfortable option than a stay in hospital. But data alone cannot paint the clearest picture of a patient’s recovery. Remote monitoring cannot detect those subtle changes to a patient’s appearance or responsiveness that would be apparent to a doctor or nurse checking a patient in hospital

From a patient’s perspective, being home alone may in fact hinder their recovery by omitting the motivation from healthcare teams to get up out of bed and regain some normality. Patients need more time and attention in their aftercare, not less.

Virtual wards can ease bed blocking. But it doesn’t address the issue of staffing levels. Virtual wards require extra community nurses and nursing shortages are already at record levels of 47,000 vacancies. The NHS is chronically understaffed, so it is unsure how the government plans to recruit (and retain) extra nurses to join these enhanced community teams.

Caring for people in their homes can be a positive step. But it needs to be done right to be effective. It requires dedicated staff available 24 hours and close cooperation between hospitals and community care. Patients need to be selected carefully.

What are the legal implications of remote technology in healthcare?

As technology becomes more embedded in healthcare, extra precautions must be considered to avoid any future legal claims.

In medical negligence claims, we use the Bolam test to define the appropriate standard of reasonable care that a healthcare provider should have given to a patient. While these principles are traditionally there to guide doctors, new technologies such as AI in diagnostic imaging systems can muddy the waters in terms of what a reasonable doctor would do, because the technology itself may not be used widely enough to make that call.

The increased use of technology means there may be less chance of human error. Such technology means clinicians have more information, and perhaps more importantly, more accurate information, about a patients’ condition. This should mean clinicians can respond more appropriately to what they are seeing, with the potential to improve patient care, whilst reducing the burden on clinicians by removing the need for unnecessary face to face appointments.

But technology is not infallible. Would an over-reliance on technology mean staff become complacent?

It is also imperative that patients make an informed choice about the treatment options they are given. Trusts who actively promote virtual wards should consider the risk of patients’ total reliance on digital tools and offer alternatives should patients lack the ability to fully use the technology.

NHS Resolution has confirmed that provision of NHS care within a virtual ward commissioned to be provided by an NHS organisation will be covered by one of its clinical negligence schemes.

However, when negligence does occur, it may become tricky to isolate the key problem within each individual situation. This can mean that patients have no clear pathway for blame, which may complicate matters of law.

Why Choose Us?

We’ve handled many different types of medical negligence cases and provided expert advice for over 30 years.

  • We offer FREE, no obligation legal advice all throughout
  • Our processes are hassle free & we handle all the paperwork
  • We won't charge you a penny until your case has been settled

Our surgery claims expert:

Caroline Moore

Managing Director/Head of Sheffield Office