At St James's Hospital in Dublin, a patient with suspected sleep apnoea now completes a questionnaire on an app, receives a home testing kit through the post and is seen by a specialist over video before ever setting foot in a clinic. The pathway shaved the average wait from referral to treatment from three years to five and a half months. It produced a specific number, roughly a thousand euros in savings per patient, and it has now been formally assessed for national rollout through Ireland's newly published Framework for Health Innovation rather than simply left to spread by word of mouth between hospitals.

That distinction, between an initiative that has been tested, costed and handed to a national structure for a scaling decision, and one that has merely proved popular locally, is where the real relevance to the NHS lies. England has its own equivalent activity in abundance. South East Coast Ambulance Service is drawing up a target operating model for virtual care. A pilot for older adults with complex mental health needs in Sussex is reporting positive early signs. University Hospitals Plymouth logged more than 182,500 virtual outpatient appointments last year, a figure it is proud enough of to publish in its quality account. None of this is trivial. NHS England's own virtual wards operational framework sets a national ambition of forty to fifty virtual ward places per hundred thousand population, and local evaluations, from north-west London to the Wessex Academic Health Science Network, have generated real savings figures of their own.

The weakness is not activity but architecture. Each of those NHS evaluations was produced independently, using different methodologies, different patient cohorts and different definitions of what counts as a saving. There is no equivalent to the mechanism Ireland has just built, a single national body that receives a locally proven pathway, tests its case for wider deployment and issues a considered verdict before money follows. NHS trusts continue to publish their own numbers in their own quality accounts, which read impressively in isolation and tell commissioners very little about which of them would actually work if lifted into another integrated care board with a different demographic and a different workforce base.

This gap matters more now than it would have a year ago. Yvette Cooper inherited a health department under instruction to demonstrate productivity gains ahead of Chancellor John Healey's Budget on 28 October, delivered against a fiscal backdrop that leaves little room for services to be funded on promise rather than proof. Sir Jim Mackey has spent much of his tenure at NHS England pressing trusts toward digital transformation as the route to meeting demand without matching capital, and virtual care sits near the centre of that pitch. But a productivity case built on a patchwork of self-reported local pilots is a fragile one to bring to a Treasury already sceptical of departmental spending claims, and it echoes a pattern that has already caused difficulty elsewhere in NHS digital policy, from the benefits recalculation on the Federated Data Platform to the safety concerns raised about the Advice and Guidance referral scheme, where enthusiasm for a digital fix outran the evidence base supporting its expansion.

Ireland's health service is a fraction of the NHS in scale and carries its own long record of delivery problems, and nobody in Whitehall is likely to look to the HSE as a model in any general sense. But the specific discipline on display in Dublin, testing a pathway, quantifying its return and then routing the decision to scale through a national assessment structure rather than leaving it to spread informally, is precisely the discipline that England's virtual care expansion still lacks. If ministers want virtual wards to carry real weight in the productivity argument this autumn, the case will need to rest on evidence built to a common standard, not on a collection of favourable numbers each trust has chosen to publish about itself.