When the electricity system operator gained the power this week to order rotating blackouts at eight hours' notice, the announcement came with a reassurance aimed squarely at hospitals. Sites of national importance, including hospitals and water treatment works, would sit on a protected list, exempt from the rolling three hour cuts that could otherwise sweep across the country during a supply squeeze. It was the kind of detail designed to close down concern quickly. It also revealed, by omission, where the concern should actually sit.
For close to a decade, NHS policy has worked to get patients out of hospital buildings and into their own homes. Virtual wards, now running in well over three hundred programmes across England with thousands of beds and rising, deliver what the service calls hospital level care outside hospital walls: intravenous fluids, remote monitoring, oxygen therapy, dialysis. The current ten year plan for the NHS treats this shift as settled doctrine, aiming to roughly double virtual ward capacity and framing home as the default setting for care that used to require a ward. None of that ambition appears anywhere in the new blackout protocol, because none of it counts, in regulatory terms, as critical health infrastructure.
The gap this exposes is not abstract. Kidney patients on home haemodialysis rely on machines with battery backup lasting around half an hour before treatment must be interrupted. Being registered on an energy supplier's priority services list, the mechanism most people assume offers protection, does nothing to shield a household from a nationally coordinated planned outage; kidney charities have already had to say so plainly to worried patients. Oxygen concentrator users fare slightly better, since most keep a static cylinder as backup, but that too is a stopgap measured in hours, not the days that Neso itself concedes a worst case restoration could take. A policy built to prevent the kind of uncontrolled collapse seen in Spain and Portugal last summer has, in protecting the institutions, left the individuals those institutions were told to discharge largely to work it out themselves.
There is a second layer to this, less visible but arguably more structural. The same period that produced virtual wards also produced the NHS's growing dependence on centralised digital infrastructure, from the Federated Data Platform to ambient voice technology now spreading through consultations. Virtual ward data itself increasingly flows through FDP tenants. None of that architecture runs on goodwill; it runs on servers, and servers run on power that is not guaranteed to be theirs by right, only by the accident of which substation happens to sit in a protected block. A system that has spent several years building itself around always on data has been handed a clear signal that the grid underneath it is no longer assumed to be always on.
What makes this a genuine policy failure rather than an unfortunate coincidence is the mismatch in planning horizons. The blackout code was developed and approved with attention to industrial users, protected sites and household demand reduction. It was not developed with reference to NHS England's own hospital at home strategy, even though that strategy has spent years actively increasing the number of clinically fragile people whose care now depends on a domestic socket. Two arms of the state built policy in parallel without checking whether the other had accounted for it.
Fixing this does not require reversing the shift toward home based care, which remains clinically sound and operationally necessary given the pressure on beds. It requires NHS England and integrated care boards to treat virtual ward and home dialysis patients as a defined vulnerable cohort for outage planning, in the same way protected sites are defined, with local trusts and network operators sharing data on who actually depends on power for treatment rather than convenience. Until that happens, the comforting line about hospitals being protected will keep obscuring the fact that a meaningful share of NHS care no longer happens inside a hospital at all.
