JMIR Publications

ABSTRACT

Background:

Virtual wards (VWs) are being introduced in England as a new way of delivering care to patients who would otherwise be hospitalised. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their own homes. Integrated Care System commissioners have an important role in the adoption and implementation of VWs in clinical practice.

Objective:

This study aimed to explore commissioners’ perspectives of implementing VWs in England.

Methods:

Qualitative semi-structured interviews were conducted with 20 commissioners employed by the NHS in various geographic regions of England. Thematic analysis was conducted, structured using the Framework approach and informed by the Consolidated Framework for Implementation Research.

Results:

Commissioners expressed a strong desire for system-level change in care provision within the NHS. Enthusiasm for VWs was driven by a strong desire for patient-centred care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also question over the need for VWs to be tech-enabled. Differing interpretations of the NHS England instruction between different healthcare sectors, and lack of clarity in definitions and use of hospital-centric language within national guidance, was considered a hindrance to convening a systems-approach. Other perceived challenges included: narrow parameters of success; unrealistic timescales; lack of interoperability of tech and time-consuming procurement procedures; liability concerns; and patient suitability issues. Motivated and passionate clinical leads were considered key to successful implementation.

Conclusions:

VWs have the potential to reform patient-centred care in England. However, there should be more clarity over definitions and specifications for tech-enablement, use of less hospital-centric language, and a greater focus on patient-centred measures of success. Further, ICSs need more time allowance to ensure development and implementation of VW services that meet the needs of patients and staff.