Discharging patients to virtual ward led to near-doubling of costs, study finds

The study’s authors said the findings should raise concerns over a flagship NHS England policy, which has driven the establishment of 10,000 virtual ward beds.

Virtual wards, sometimes described as “hospital at home”, are cited as a safe way to reduce pressure on hospitals, by reducing length of stay and enabling quicker recovery.

The study at Wrightington Wigan and Leigh Teaching Hospitals, in Greater Manchester, said the trust’s virtual ward was for patients who could be discharged early from hospital.

They found average total length of stay was substantially higher for patients discharged to the virtual ward, as well as higher rates of readmission to hospital.

The authors said this led to additional costs, with the cost of avoiding a bed day in hospital by discharging a patient to the virtual ward averaging £935 per day. They said this compared to an average cost of £536 for keeping a patient in a general inpatient hospital bed. The study involved 318 virtual ward patients, with a wide range of conditions, over the course of 2022.

The paper, produced in partnership with Lancaster University, said: “The cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.

“Virtual wards must be cost effective if they are to replace traditional inpatient care, the costs must be comparable or lower than the costs of hospital stay to be economically sustainable in the medium to long terms.”

To break even, the paper said the virtual ward would need to double its throughput, but warned this would risk lowering the standard of care. The authors said the virtual ward had a nominal capacity of 40 beds, but this related to the software used, whereas the staffing model was roughly determined by the throughput achieved.

NHSE dismissed the findings, claiming the study was “misleading” because of its limited size and time span of just one year. But when invited to point to other research papers offering a more comprehensive analysis, it failed to do so. One example featured on its website involved fewer than 50 virtual ward patients, over a period of six months.

Martin Farrier, WWL director of digital medicine and the paper’s lead author, said NHSE’s response to the study was “odd”, adding: “This [is] the largest study that exists… and the first in the UK assessing their cost-effectiveness.

“It’s also worth noting that it would be very difficult to do the study across organisations [as] you can’t control variables. As such, the only way to increase the size of the study would be to do the work for multiple years.

“However, the longer the study runs for, the more it is likely to be influenced by uncontrolled variables, such as funding increasing or decreasing, or population changes.”

Dr Farrier hopes other trusts will conduct similar studies to assess their virtual ward costs before investing heavily in the move.

NHS Confederation, which represents leaders of local organisations, pointed to three previous studies or reviews which did link virtual wards to cost savings.

One involved 65 covid patients in Leicester over a three-month period at the end of 2020, while another covered 250 patient episodes in Croydon, mostly involving covid patients, in 2020-21. The Croydon example compared virtual ward care to receiving care from a rapid response team, as opposed to traditional inpatient care.

The third example, featured on NHSE’s website, involved 46 patients with COPD who were treated in a virtual ward over a six-month period in 2022.

NHS Confederation director of policy Layla McCay said: “It is clear that a much more in-depth review of the impact that virtual wards have had across the NHS is needed once more time has passed because examining one study based on one trust in isolation could lead to premature generalisations.

“However, so far our members have expressed a strong commitment to continue taking forward this new model of care, particularly following [a] reduction in physical beds over the last few decades.”

NHSE said: “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.”

A WWL spokeswoman said its virtual ward had expanded significantly since the study, adding: “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.”

Article has been updated to give a more precise description of the paper’s main finding and to clarify the capacity of the virtual ward.