Virtual wards, which provide hospital level care in a patient's home, have rapidly shifted from a pandemic era trial to a central element of health policy. In 2023 alone, 4,311 patients were managed through NWL virtual ward pathways with an estimated 8,622 bed days saved and a £3,448,800 system saving, reflecting NHS England's investment and commitment to scaling delivery. While these wards often offer a more comfortable alternative to hospital stays for many patients, their rapid proliferation raises a critical question: is this expansion truly equitable, or is it quietly establishing a two tiered system of care?
Proven Results Undermined by a Growing Digital Divide
The Virtual Ward model offers compelling advantages, supported by robust evidence. Over 69 systematic reviews and NHS national evaluations confirm its success in reducing hospital admissions and shortening lengths of stay for specific patient groups, including those with frailty, COPD exacerbations, and certain post-operative requirements. Initiatives such as the Virtual Wards in West Hertfordshire and the South West London Monitoring Hub have demonstrated relative success and are viewed by many as a viable option for accelerating the often-lengthy NHS referral process.
Unequal access is increasingly highlighting the logic of hospital at home care. A major finding from The Virtual Wards Evaluation Report by the NHS Midlands and Lancashire Commissioning Support Unit is that digital exclusion is a significant issue: about one third of the population does not regularly access online health services. Crucially, the groups who often need coordinated care the most, including older adults, people with disabilities, and those with lower educational attainment, are frequently the very groups most likely to face digital exclusion.
Furthermore, eligibility for a virtual ward can be blocked by factors like inadequate housing, unreliable broadband access, or the lack of a private space for necessary monitoring. Charities such as the Red Cross and digital inclusion organisations are issuing warnings about the risk of "virtual inequality" unless deliberate and inclusive steps are taken to address these barriers.
Hidden Pressures and Unequal Access Threaten Safe Expansion
Virtual wards show promise, but they carry significant hidden costs and equity risks that threaten safe and inclusive scaling. Key challenges and risks exist. Many virtual ward models rely heavily on unpaid family members for essential tasks. These tasks include patient monitoring, medication management, and knowing when to escalate care. This responsibility, often taken on without adequate training or respite, causes considerable caregiver strain, which researchers repeatedly identify as a limiting factor in safe expansion. If clinicians do not formally integrate support into the model, virtual wards risk transferring resources and clinical risk onto families.
Implementation inequity and variation present another risk. The gap between models is widening. Some trusts such as the East Sussex Virtual War or the East Lancashire Intensive Home Support Service Team use general methods such as phone check ins and community nursing. Others deploy high tech solutions including wearable sensors, continuous oximetry, and integrated dashboards. High tech options disproportionately benefit digitally adept patients, creating a postcode lottery for outcomes. Workforce shortages, particularly in community nursing and rapid response teams, prevent many areas from offering virtual options at the necessary scale.
Virtual wards are a crucial element in modernising healthcare, yet their ultimate success will be measured by equitable access. To prevent these wards from becoming a source of deeper inequality masked as innovation, expansion must be paired with intentional investment in inclusivity, the workforce, and social support. By doing this, virtual wards can relieve pressure on hospitals without marginalising vulnerable patients.
