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  • Lloyd Price

Virtual Care - from hype to reality



The latest Digital Health Intelligence snapshot report uncovers how NHS trusts will prioritise virtual patient care based on the government's ambitious plans.


In the first of a new series of analysis for Digital Health Intelligence subscribers, Lloyd Price examines the virtual care market.


Download your copy for:

  • In-depth insights and expert analysis of the current virtual care market

  • Funding options available

  • Profiles of leading suppliers of virtual care solutions

  • What's next for trusts as NHS England abandons the HIMSS’ maturity model

  • Future plans for the virtual care market


Introduction


Virtual care has been presented as a promising new way to deliver healthcare services to patients, combining technical innovation with traditional clinic design and associated pathways. The reality, however, is more nuanced. NHS staff on the frontlines are tired: after a tough few years’ repurposing hospitals to deal with covid, designing and launching virtual wards is often seen as just another digital project.


‘Digital fatigue’ is starting to set in across many NHS trusts, with healthcare professionals questioning how to prioritise virtual care and virtual ward projects against a backdrop of staff shortages, a cost of living crisis, rising absence and sickness rates, the next winter pressures and ongoing covid planning.


Suppliers of virtual care and virtual ward products need to start thinking about a 360- degree solution: not just technical innovation but training and onboarding, supporting staff, reporting data, interoperability into clinical systems, and monitoring alerts to prevent false alarms.


Background


Virtual care has been adopted by ICBs and acute NHS trusts to keep patients out of hospital, at home under the direct supervision of healthcare professionals.


Often referred to as ‘hospital at home’, the aim is to deliver patient care in a safe and effective way at scale, utilising less staff resources and more technology, usually in the form of remote monitoring, remote video consultations, nurse-led telephone consultations and repeat prescriptions.


During the pandemic, virtual care was utilised as a key function in prioritising patients, resources, and staffing. Early on, patients identified as high risk with respiratory conditions were monitored at home, with more specialties added as the NHS managed unprecedented demand. Virtual care is now viewed as a key tool for elective care recovery.


Examples of virtual care


The NHS defines virtual care as "the use of digital technology to deliver healthcare services to patients remotely". NHS trusts are using a range of services, including:


1. Telephone consultations: Milton Keynes University Hospital NHS Trust

nurse-led prostate surveillance telephone clinic is run by urology-oncology nurse specialists and allows for regular monitoring of patients prostate conditions from their home.


2. Video consultations: face-to-face consultations using video conferencing software. St Helens and Knowsley Teaching Hospitals NHS Trust's six month stroke review service is delivered by Cinos Communication Services in partnership with Cisco enabling staff to see more patients in their home or care home


3. Online consultations: patients can fill out a questionnaire or chat with a healthcare professional through a secure online portal. Digital preoperative assessment (POA) at Guy’s and St Thomas’ NHS Foundation Trust identifies high-risk patients using the

‘MyPreOp at home’ patient questionnaire on any device connected to the internet.


4. Remote monitoring: patients can use wearable devices or sensors to transmit data about their health to their healthcare provider, who can then monitor their condition remotely.

Frimley Integrated Care System in partnership with Docobo has successfully delivered a range of remote monitoring projects leading to enhanced patient outcomes and a reduction in hospital and GP visits for patients.

Ambitious plans


In January this year, following the success of virtual care during the pandemic, the government announced plans to scale up virtual wards, with an ‘ambition’ to treat up to 50,000 people a month and expand their use for falls and frail patients. The plans represent a five-fold increase on current volumes of patients receiving virtual care.


Many virtual ward providers have commented that the level of funding supporting these plans is not realistic. To spread across all 42 English ICSs, delivery of virtual wards needs to be a priority. And this is not just about technology, it is about staff, training, cyber security, data interoperability, reporting and much more. Given the operational pressures facing frontline staff today, the government’s targets may be too ambitious.


With £250m of matched funding available in the 2023/2024 financial year, we are likely to see only pockets of innovation and success as a minority of NHS trusts prioritise the rollout of virtual wards. Most trusts will remain focused on significant other pressures such as staff shortages, growing waiting lists, and local ICB and ICS politics.


Funding for virtual care


The NHS has made a range of funding available for virtual care, including:


Service Development Fund (SDF): a national fund that provides temporary funding for innovative healthcare projects. £200 million of funding was made available from the SDF in 2022/23, with an agreement that a further contribution of £250 million – on a match- funded basis – will be available in 2023/24. From 2024/25 systems will need to ensure virtual wards are built into their long-term strategy and financial plans.


NHS Long Term Plan: set out a number of commitments to virtual care, including the expansion of video consultations and the development of new virtual care services for patients with long-term conditions.


Better Care Fund: a £2.14 billion fund that was announced in 2023 to support the integration of health and social care services in England. Virtual care funding will be available in 2023/24 to meet the aims of the Better Care Fund, most notably improving discharge from hospital which includes providing support for patients to recover at home or in a community setting.


Future of virtual care


The national target for integrated care systems, combined with nationally available funding, is creating a large market opportunity for suppliers of virtual care services.


BT Health have developed a core platform and strategic partnerships to offer an ‘end to end virtual care’ solution to NHS organisations. Their newly enhanced platform offers smart device monitoring, remote monitoring, virtual ward rounds, patient captured data, personalised advice and guidance, and evidence-based digital interventions.


BT’s in-house healthcare team combines technical and product expertise, extensive frontline NHS experience, excellence in data, and AI and information governance, all supported by an external Clinical Advisory Board.


BT is well-placed to partner with NHS organisations to solve a wide range of virtual ward requirements balancing the complexities of patient pathways, interoperability, real time patient monitoring and chronic condition management.


Doccla have developed a ‘complete cloud hosted virtual ward service’ which is CQC registered, with in-house clinicians. The service has been deployed to great effect at NHS sites in both large complex acute and community settings, with proven benefits. Being CQC registered, Doccla are able to provide clinical monitoring support services to reduce NHS staffing pressures - a key advantage.


In addition, by employing their own clinical staff, Doccla are able to directly address one of the most common operational issues with virtual care: remote monitoring false alarms. For example, when a patient's NEWS2 score or other indicator is outside normal limits because of factors not directly related to their health, Doccla can filter out these signals by having their clinical staff contact the patient to check whether the alarm is genuine on their system before NHS staff need to respond to it.


Doccla’s market offering and value proposition is a promising new development in virtual care. Staffing is a major piece of the virtual care delivery jigsaw.

Leading suppliers of virtual care solutions


Some of the leading suppliers of virtual care solutions to the NHS include:


BT Health: video consultations, phone consultations, and remote monitoring.


Cisco: video conferencing, secure messaging, and remote patient monitoring.


Philips: video consultations, remote patient monitoring, and tele-surgery.


Other virtual care suppliers include Docobo, Current Health, Ortus iHealth, Doccla and Access.


One year from now


Fast forward 12 months and the virtual care market is likely to look very different, with less focus on tech and more emphasis on the staff who are (still) essential to the running of hospitals at home. The technology to deliver and run virtual wards is becoming fairly ubiquitous, with a lot of suppliers offering similar products with the promise of ‘unique features and benefits’. More staff will be needed to design, deliver and respond to virtual care day-to-day operations.


We can expect to see fewer ‘platforms’ and more focus on virtual care specialist nurses, prioritisation of patients by condition, training of carers and staff in care homes, and sharing key lessons in how to safely and effectively scale virtual wards.


Expect to see an NHS England set of ‘digital playbooks’ focused on maximising resources, with case studies from the successful projects on the frontlines, and real- world evidence of how to balance technical, operational, clinical and financial pressures.


A lot of hopes are riding on the delivery of 50,000 virtual care beds per month and NHSE needs quick wins. The likelihood of this may seem remote, but in the absence of other candidates we can expect the pressure to continue.



The latest Digital Health Intelligence snapshot report uncovers how NHS trusts will prioritise virtual patient care based on the government's ambitious plans.

In the first of a new series of analysis for Digital Health Intelligence subscribers, Lloyd Price examines the virtual care market.


Download your copy for:

  • In-depth insights and expert analysis of the current virtual care market

  • Funding options available

  • Profiles of leading suppliers of virtual care solutions

  • What's next for trusts as NHS England abandons the HIMSS’ maturity model

  • Future plans for the virtual care market


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