Integrated care systems (ICSs) were set up with the goals of improving health outcomes and driving efficiencies for the population by creating a coordinated network of healthcare services, built on a foundation of interconnectedness.
Yet these partnerships of commissioners, providers and care planners can often find themselves constrained by funding that unfortunately prioritises siloed short-term fixes over the broader ambition of transformative change.
Last year, the government announced a £30 million fund for Integrated Care Systems (ICSs).
This funding was allocated to assist NHS organisations in deploying new digital tools to address winter pressures, including the expansion of virtual wards.
However, the timing of this funding posed challenges for ICSs in implementing projects that could significantly alleviate demand during the winter season.
High costs, and not enough time
Deep in the winter season, it’s evident that funding allocated to care providers, intended for addressing seasonal pressures, may not be used as efficiently as hoped, with many having to opt for hastily developed stopgap solutions, reflecting their current manual processes, in order to obtain the funding and meet NHS England’s virtual ward targets.
In contrast, a longer-term, integrated approach underpinned by digital technologies and standards, could offer a more affordable and effective solution.
By taking this approach, healthcare providers can reduce logistical friction and improve system efficiency, ultimately leading to more sustainable healthcare practices.
Virtual wards as digital islands
That said, as of 2024, NHS England has achieved the significant milestone of providing 10,000 virtual beds.
This is a welcome accomplishment, especially during a period when NHS performance data indicates that waiting lists exceed 7.6 million.
However, this figure should be scrutinised, as these beds do not necessarily equate to increased operational efficiency, nor do they necessarily constitute a virtual ward.
They must be integrated with existing systems, addressing logistical friction to be of real value.
The broader challenge, then, is the lack of integration of these virtual wards.
Despite the potential for virtual wards to streamline processes like automated discharge and patient care planning, the limited scope of funding means that trusts and ICSs have been constrained to small, isolated projects, such as remote monitoring.
At the same time, the manner in which these solutions are procured (often hastily due to external factors such as funding deadlines and targets) means virtual wards end up as standalone digital entities, reflecting current practices and that are not integrated with other systems.
As a result, patient information remains siloed and inaccessible for continuous care management, adding to fragmentation within the broader healthcare system and working against the overall goal of integrated care.
The impact of fragmentation
The lack of interoperability of legacy systems can also be a roadblock to care coordination.
This highlights the need for funding structures that firstly encourage, but also mandate the adoption of interoperable standards and solutions.
According to data from NHS England there was an average of nearly 12,500 people waiting in hospital who were medically fit to be discharged on every day of October 2023.
Imagine what a difference it would make if care teams had the visibility to decide whether these patients could be safely discharged to a virtual ward.
Likewise, think how much better it would be for patients if they were allowed to return home and recover in a familiar, comfortable setting, under the close digital observation of care teams, as opposed to being caught in limbo between the hospital and their home.
There is already technology available that can help solve these challenges.
Digital brokerage systems, for instance, show hospital teams what support is available for a patient being considered for discharge into a virtual ward, ensuring their safe recovery and reducing the likelihood of them being readmitted to hospital.
Likewise, shared care records provide community health and social care teams with real-time visibility into a person’s medical and care in the community, helping them make more informed decisions about their care and tailor treatment accordingly.
All of this supports the broader vision of ICSs to facilitate seamless transition between different care settings, improve patient outcomes and support the best allocation of resources across the care continuum.
Short-term challenges vs. long-term change
There will always be a need to balance immediate healthcare demands with longer-term healthcare transformation.
But prioritising quick fixes will only land us back in this same situation next winter. By addressing the logistical friction in the system, we can deliver sustainable improvements.
Part of this means rethinking how money is allocated and distributed, which can only be achieved if all stakeholders are involved in the discussion.
This will lead to a more comprehensive picture of the health and care landscape, which will in turn lead to deeper insights into the design of virtual wards by factoring in social determinants like housing.
A drop in the ocean
Despite some of the recent controversy around the efficiency of virtual wards, when integrated with other digital solutions such as EPRs, they hold great potential to release hospital capacity and save money.
It’s why it’s encouraging to see recent strategy and funding announcements that favour the scale-up of technology across ICSs.
But while the £30 million funding is a positive step, the timing and scope of these types of funds – combined with complex systemic challenges around integration – means they’re unlikely to have much of an impact for healthcare teams this winter.
To truly deliver the benefits of virtual wards at scale, there needs to be a rethink of how, when, and where money is made available, with a focus on programmes of work that support the broader goal of care coordination.
This means ensuring ICSs have the time and resources they need to do the job they were set up to do: implementing cohesive solutions that integrate seamlessly across the health and care spectrum, and building a resilient, patient-centred system that’s fit for the future.
