JMIR Publications

ABSTRACT

Background:

The National Health Service in England is facing unprecedented demand on hospital services with virtual wards being a central tenet of the strategy to manage these ongoing pressures on capacity. Virtual wards combine digital and analogue tools, monitoring systems, and teams of multi-disciplinary care providers to support patients in their place of residence who might otherwise be cared for in hospital. Despite virtual ward programmes continuing to proliferate in the UK and across the globe, the models of care which support them are still evolving, and best practice in their design and implementation is yet to be fully established. It is therefore necessary to continue to gather evidence about the influences that shape their design and support their successful and sustained introduction.

Objective:

To explore the experience of staff involved in designing, developing and delivering virtual wards as part of the national programme, in order to understand the factors that influence its implementation and sustainability.

Methods:

Qualitative data were collected through semi-structured interviews with staff and senior stakeholders involved in developing, leading, and delivering the virtual ward programme within one of the largest integrated care systems in England. Data were analysed using directed content analysis, informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework.

Results:

We interviewed 20 participants from clinical and non-clinical roles including service transformation leads, programme leads, physiotherapists, nurses and consultants. Using the NASSS framework, we identified several key findings. Patient context was as important as clinical criteria in determining referral suitability (Condition). Stand-alone digital monitoring solutions with offline capability improved accessibility (Technology). While benefits to patient rehabilitation and hospital capacity were widely understood, concerns over the lack of evidence remained (Value proposition). Clearer messaging about the nature and benefits of virtual wards was needed for patients and carers and staff described challenges with remote care and shared responsibility across settings (Adopters). Pre-existing collaborative arrangements helped but varied by speciality (Organisations). NHSE targets and metrics of success were considered unrealistic (Wider system). Finally, participants recommended more coherent regional planning that involved consultation with patients (Embedding over time).

Conclusions:

If the UK’s virtual wards programme is expected to move forward, it requires patients, their family and carers, and staff receive coherent messaging of their responsibilities and benefits. Targeted training and ring-fenced time for staff would help, as would the provision of purposely designed patient-facing technologies. Finally, extended planning and funding cycles are needed to gather robust evidence and refine virtual wards, ensuring better integration with existing services that incorporates patient preferences and needs from various socio-cultural backgrounds.