Treating patients in ‘virtual wards’ costs twice as much as in hospitals, Wigan study reveals

The NHS is increasingly introducing virtual wards to support people at home and away from hospital, including in care homes.

According to NHS England, virtual wards allow patients to get hospital-level care at home safely and in familiar surroundings, helping speed up their recovery while freeing up in-demand hospital beds for patients who need them most.

A team monitors the patient at home using technology and can provide a range of tests and treatments, with a daily review carried out via video-link or in person.

There are more than 340 virtual ward programmes across England – 58 opened in January alone – including a total of 7,653 virtual beds.

Now, a new study carried out in Wigan, which the authors say is the biggest of its kind, has found the cost of providing the beds is double that of a traditional stay in hospital and leads to more patients being readmitted to hospital.

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) compared 318 patients in virtual wards with 350 patients in hospital with similar characteristics.

The results showed that virtual ward patients had a shorter stay in hospital before being admitted to the virtual ward (2.89 days) and had slightly improved survival, although when readmitted their survival deteriorated rapidly.

Those on virtual wards were also more likely to be readmitted to hospital than those kept for longer as inpatients.

The cost of a 24-hour period in a general hospital bed was £536, but the cost of delivering the same care using a virtual ward was £1,077.

The researchers said the 40 virtual-bedded ward freed up three hospital beds per day “however, their cost was almost double”.

They added: “This is the largest virtual wards study, in terms of virtual wards patients, and the first in the UK assessing their cost-effectiveness.

“In order for the virtual wards to be cost-effective they need to halve their costs without affecting patients’ clinical outcomes.

“However, the higher rate of readmission to hospital from virtual wards patients, compared to hospital patients, can hamper any gain from reduction in costs, highlighting the necessity of appropriate plans and procedure for the selection, design and management of the virtual wards and their patients.

“This evidence should be taken into consideration by NHS in planning the next large deployment of virtual wards within the UK.”

Last month, the Wigan Observer reported that 1,620 patients with a range of health issues have been treated on the borough’s virtual wards since they opened in January 2022.

They were developed from a scheme where patients were supported at home during the coronavirus pandemic.

Currently the virtual wards can cater for 110 patients, with the trust on target to reach 150 virtual beds by March.

A WWL spokesman said: “At WWL we are really proud to have led the way in the development and implementation of a virtual ward service and have received positive feedback from both our staff and the patients who have used the service.

“We are now in our second year of providing a virtual ward service, which has brought significant benefits to treatment and recovery for our patients, as well as freeing up hospital beds for those patients who need them most.

“At WWL, we constantly review all new services to ensure they provide value for money and deliver benefits, including ensuring access to healthcare in the most appropriate location.

“We thank the authors from WWL and Lancaster University who undertook this review.”

They said the current capacity on the virtual ward is 110 beds, with over 90 per cent occupancy in January.

Since October, they have seen more than 230 patients per month. In December, 263 patients were admitted to the virtual ward, with 1,278 bed days saved.

An NHS spokeswoman said: “This limited study – which covers just one NHS trust – is misleading as it looks at a small number of patients during the programme’s first year, and the virtual ward is now able to do four times as much activity than then.

“While globally recognised research shows people who are treated at home recover at the same rate or faster than those in hospital, and that patients prefer to be treated and recover from the comfort of their own homes closer to family, friends and carers, while freeing up hospital beds for patients that need them most.”

One study published in Age and Ageing found “low to moderate certainty evidence that clinical outcomes including mortality were probably equivalent or better for hospital at home”.

Admissions to care homes are “probably reduced” but researchers found uncertain results over cost-effectiveness and how carers felt about people being at home.

Another study published in Annals of Internal Medicine from nine hospital and community sites in the UK looked at 1,055 older people who were medically unwell but stable and had been referred for a hospital admission.

At the six-month follow-up, 528 of 672 people in a “hospital at home” group versus 247 of 328 in a hospital group were living at home.

The researchers concluded that treating people in hospitals at home “led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at six months”.

A further study published in BMJ Open concluded that “for suitable patients, hospital at home generally results in similar or improved clinical outcomes compared with inpatient treatment, and warrants greater attention in health systems facing capacity constraints and rising costs.”