How do the public and NHS staff feel about virtual wards?

In January 2023, NHS England’s Delivery plan for recovering urgent and emergency services committed the health service to ease the growing pressure on hospitals by scaling up the use of ‘virtual wards’. Also known as ‘hospital at home’, virtual wards allow people to receive treatment and care where they live, rather than as a hospital inpatient, while still being in regular contact with health professionals. Virtual wards can be used to avoid a hospital admission or to support early discharge from hospital. In some cases, virtual wards are supported by technologies that help people monitor their health at home and send information back to health care professionals, such as devices to track pulse, blood pressure or oxygen levels.

NHS England is aiming for more than 10,000 virtual ward beds to be available in England by winter 2023. Current NHS England guidance is also driving the digitisation of virtual wards, with a view to soon have all virtual wards enhanced by the use of technologies, such as for remote monitoring. There are similar commitments in Scotland, Wales and Northern Ireland.

Understanding what people think about new ways of delivering care and new uses of technology is important for ensuring these new approaches command the confidence of patients and staff, for implementing them successfully and for maximising their benefits.Where the public and staff are less supportive, innovation and transformation can be significantly constrained.

So how do NHS staff and the UK general public feel about the use of virtual wards? To understand this, in March 2023 we commissioned a survey of 7,100 nationally representative members of the public (age 16 years and older) and 1,251 NHS staff members to find out how supportive they are of virtual wards and what they think is important for making sure they work well.

As shown in Table 1 below, disabled people, people with a carer and carers themselves are significantly more likely to support the use of virtual wards when compared with the population as a whole (50%, 58%, and 55% respectively, compared with 45% among the population as a whole).

Although the general public is on balance supportive, this support varies by socioeconomic group (determined by the occupation type of the primary income earner in a household). As shown in Figure 2 below, those in socioeconomic groups D and E, are more unsupportive than supportive (by 38% to 36%). As people in these socioeconomic groups may be more likely to face barriers both to accessing health care and using technology, it will be important for policymakers and providers to understand what lies behind the drop in support for virtual wards among this group, so that their concerns and any barriers they face can be addressed.                           

Support for virtual wards also varies with how much someone knows about how the NHS is using technology. As shown in Figure 3 below, there is a clear relationship between the level of self-assessed knowledge about how the NHS is using technologies and support for virtual wards. Those who know ‘a great deal’ or ‘some’ about how the NHS is using technology are significantly more likely to be supportive of virtual wards compared with those who know ‘very little’ or ‘nothing at all’ (70% and 53% compared with 36% and 24%). And as awareness reduces, the percentage of people choosing ‘don’t know’ increases. So the more people know, the more likely they are to support virtual wards.

This finding is consistent with previous Health Foundation research showing that confidence in technologies rises when people feel they have more knowledge of them. And while further research is needed to understand the relationship between support for health care technologies and self-reported knowledge, it suggests the importance of ensuring that the public is well informed about virtual wards and associated technologies.

Are people happy to use a virtual ward themselves?

We also asked members of the general public whether they would personally be happy to be treated through a virtual ward instead of hospital. The results are shown in Figure 4 below. Nearly three-quarters (71%) said they would personally be happy to be treated through a virtual ward, as long as their concerns and conditions were addressed (discussed in more detail below), while 1 in 4 (27%) said they would not.

Age is sometimes cited as a factor affecting attitudes to technology enabled care, with the assumption that those in older age groups will be less comfortable using technology and therefore less supportive than younger age groups. However, our analysis shows that the proportion saying they would not want to be treated through a virtual ward declines with age, as illustrated in Figure 5 below, with a corresponding rise in conditional support (‘It depends’) from a low of 32% among 25–34 year-olds to a high of 50% among those 65 years and older. This suggests that older age groups are potentially more open to using virtual wards under the right conditions.

What factors lie behind attitudes to virtual wards?

To delve deeper into the reasons why people selected ‘It depends’ or ‘No’ when asked if they would be happy to be treated through a virtual ward, relevant participants were given a list of reasons and asked to pick up to three.

For those who told us ‘It depends’ (42% of our sample), over three-quarters (77%) said whether they would be happy to be treated through a virtual ward would depend on what their illness or condition was (see Figure 6). To date, virtual wards have primarily been used in specific pathways such as acute respiratory infection and frailty, but with an ambition to expand the model to a greater range of conditions. In addition to considering which pathways are suitable for treatment through a virtual ward model, our survey findings suggest it will also be important to engage with the public to understand how they feel about using this model of care for different conditions.

As shown in Figure 7, nearly half (47%) of those who said they would not be happy to be treated through a virtual ward said it was because they would prefer being face to face with those taking care of them, and 43% said it was because they did not think the quality of care would be as good. Over a third (34%) said it was because they might not be able to access a health professional quickly if they needed it (a factor that was also important for those saying ‘It depends’, where it was the second most highly ranked reason).

Although fewer of these respondents chose the reasons that they ‘wouldn’t be able to care for themselves at home’ (17%), that their ‘home wouldn’t be suitable’ (16%) or that they ‘don’t have reliable phone or internet access’ (9%), this nevertheless suggests that a small yet significant number of people may lack the infrastructure or support needed to take advantage of virtual wards. These factors raise questions over equity of access and underscore the importance of considering the barriers some households will face, when deciding if this model of care will be suitable.

Given our findings show that support for virtual wards can vary by socioeconomic group and age (see Figure 9 and Figure 10), we sought to understand if the reasons people gave for saying that they would not want to be treated through a virtual ward also varied by these characteristics. As shown in Figure 9 below, the top three reasons given by those saying they would not want to be treated through a virtual ward remained consistent across socioeconomic groups.

However, the number of people selecting ‘Because my home wouldn’t be suitable for a virtual ward’ rises consistently, from 13% of households in socioeconomic groups A and B, to 19% in socioeconomic groups D and E – once again, raising questions about equity of access to this model of care.

If we look at the reasons given by those who would not want to be treated through a virtual ward and how this varies with age, shown in Figure 9, the order of the top three reasons does not change. But the preference for face-to-face care rises steeply, cited by 38% of 16–34 year olds, but 59% of those age 55 years and older. So while older people as a whole are more supportive of virtual wards than younger people (see Figure 5), those older people who say they would not want to be treated through a virtual ward are much more likely to cite a preference for face-to-face care as the reason.

Another factor that may affect how people feel about virtual wards is the terminology used. This could be because of a lack of understanding of the concept, a general dislike of the idea of hospital wards, or negative views of related concepts such as ‘virtual consultations’.

Our survey also included a question asking people whether they would or would not ‘be happy to monitor, with help if you needed it, your own health at home, using technologies like a blood pressure monitor, instead of in a hospital’. This describes a typical scenario in a virtual ward service, but avoids the term ‘virtual ward’. As shown in Figure 10, 78% of the public told us they would be happy to do this, whereas only 13% would not; a more positive picture than when asked specifically about virtual wards.

These results, alongside those discussed earlier, indicating that support for virtual wards is higher for those with more awareness of how the NHS is using technology, suggest that the term ‘virtual ward’ may need rethinking, or at least further explanation and clarification. For example, it may be failing to convey that virtual wards can include face-to-face care delivered outside of hospital – something that may provide reassurance to a significant number of those who said they would not want to be treated through a virtual ward.

What do NHS staff think is needed for virtual wards to be successful?

We asked NHS staff what they think the most important factors are for making sure virtual wards work well. As shown in Figure 11, the highest ranked factor was ‘People can get admitted quickly to hospital if their condition changes’, chosen by 40% of NHS staff. This was closely followed by ‘People can still talk to a health professional if they need help’, chosen by 36% of staff. Interestingly, this echoes one of the main concerns of those members of the public who only expressed conditional support for the idea of using a virtual ward – namely, that they would want to know they could get help quickly if they needed it (see Figure 6).

Implications for policymakers and those overseeing the development of virtual wards

Our findings suggest that there is an existing base of support for virtual wards among the public on which to build as this model of care is developed and spread, but also that there is further to go to secure buy-in across the population as a whole. The finding that those who know more about how the NHS is using technology are more supportive of the model suggests that awareness raising could play an important role in building support. There may also be a need to consider the terminology of ‘virtual wards’ and explore whether using alternative descriptions or providing supporting information could strengthen support for this model of care.

But steps to build awareness and offer reassurance are only one part of what is needed. It will also be critical to continue to monitor and evaluate virtual wards as they are rolled out, ensuring they deliver high-quality and safe care in practice. For example, the Health Foundation’s Improvement Analytics Unit will be working closely with NHS England and a number of frailty virtual wards to explore how frailty virtual wards are operating, and assess equity, safety and effectiveness.

Proponents of virtual wards will be encouraged to see support is stronger among certain groups with greater care needs, including older people, disabled people and those with a carer. These groups might be expected to be more intensive users of virtual wards, as well as among carers themselves, who will play an important role in making virtual wards work well in practice. Nevertheless, it is notable that those in socioeconomic groups D and E are less supportive of virtual wards. It will therefore be important to understand the issues here and address concerns, including the suitability of people’s homes for virtual wards and whether or not they have the necessary support available. In seeking to expand the virtual wards model, providers will need to work closely with other services and agencies, such as social care and local authority housing teams, to ensure people have the support they need.

Our findings suggest that support for virtual wards depends for many people on the specific condition or illness for which they are being used. As the NHS seeks to expand this care model to more conditions, it will therefore be important to consider not just which conditions are amenable to treatment through virtual wards, but also whether patients are comfortable with the model in these situations.

Finally, our NHS staff survey contains useful intelligence about what staff think will be important for making virtual wards work well, including ensuring people can be admitted to hospital quickly if their condition changes, and that they can still talk to a health professional if they need help. Our public survey also suggests that getting these factors right will play an important role in offering greater reassurance about virtual wards to those who are not already convinced.