Treating patients in ‘virtual wards’ costs twice as much as in hospitals – study finds

By Jane Kirby, Reporter25th January 20245th February 2024News EnglandHome Care, Hospitals, Integrated Care, News England, NHS, NICE

Treating patients in “virtual wards” at home – a key NHS policy – costs twice as much as treating them in hospital, a study has found.

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 hospital beds for patients who need them most.

A team monitors the patient at home 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 – including a total of 7,653 virtual beds.

Now, a new study, 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 in the North West 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 £935.

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.”

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 global 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.”

The National Institute for Health and Care Excellence (Nice) reviewed costs in 15 studies and found that in 13 virtual wards and hospital at home models of care “are usually reported as cost saving”, including by cutting days in hospital.

However, it warned: “Most of the included studies, however, have been assessed as having potentially serious limitation in relation to their methodological quality.”

It said it is “therefore possible that the savings attributed to virtual wards within these studies may be overestimated”.