Virtual Wards & Discharge Pressures

Last month’s NHSE Board reports confirmed that virtual ward capacity in England has surpassed 10,000 beds. That milestone reflects years of innovation and investment, but behind the figures lie persistent tensions: long discharge delays, acute bed pressures, and deep workforce strain in both acute and community care.

As urgent care demand remains stubbornly high and more patients are treated in non-traditional settings, the question isn’t just whether virtual wards work, but whether the system around them is strong enough to make them work well.

 

 

Virtual Wards: Innovation Built on Necessity

Virtual wards are not new, but the scale and centrality of their current role is unprecedented. They were rapidly expanded during the pandemic and then formalised in NHSE’s urgent and emergency care (UEC) strategy, with the target of 10,000 virtual ward beds by late 2023, now achieved.

The concept is simple: hospital-level care at home, supported by remote monitoring, wraparound clinical input, and escalation protocols. But implementation is complex, requiring:

• Community nursing capacity
• GP and consultant oversight
• Rapid-response pathways
• Digital infrastructure
• Patient trust and inclusion

And yet, despite these demands, they’ve become a cornerstone of NHS flow strategy.

Discharge Blockages: Still the Elephant in the Corridor

While virtual wards are relieving some pressure, the problem they aim to solve persists:

• The number of patients in hospital deemed “medically fit for discharge” remains high.
• Discharges delayed by social care gaps or capacity mismatches are still widespread.
• In some Trusts, corridor care continues, despite record virtual ward use.

May’s NHSE performance report noted that bed capacity had increased, but also stressed the ongoing challenge of maintaining flow, particularly when community-based step-down options are unavailable or inconsistent.

The effectiveness of virtual wards, therefore, depends not only on digital tools or monitoring kits, but on integrated workforce coordination across settings.

Workforce: The Missing Piece in Virtual Care Success

Virtual wards have technology, but they still rely on people. The very success of home-based models hinges on:

• Community nurses who can manage complex care
• Rapid-response teams available 24/7
• Discharge coordinators navigating a stretched system
• Digital confidence among staff and patients

Yet staffing in these areas remains fragile. Community teams are often under-resourced, facing rising complexity without proportional investment. This raises a key concern: Are we building care pathways faster than we are staffing them?

Risk of Inequality and Patient Safety Gaps

There’s also the issue of who benefits. Virtual wards may unintentionally widen access gaps:

• Patients without digital literacy or home support may be excluded
• Those with unstable housing or language barriers may not be suitable
• End-of-life care needs are rising, but may not align with virtual ward criteria

Clinical leaders have warned that virtual wards must be part of broader care redesign, not a substitute for in-person care or system-level transformation.

What Now: Beyond Bed Numbers to System Readiness

NHSE rightly celebrates the 10,000-bed achievement, but it’s clear that numbers alone don’t solve the discharge puzzle.

To unlock their full value, virtual wards must be integrated with:

• Workforce planning across acute, community, and social care
• Safe Digital maturity that extends beyond pilot projects
• Real-time discharge coordination
• Patient engagement from design to delivery

There’s also a need for local flexibility, recognising that what works in one ICS may not scale in another.

Tech Must Be Safe to Be Scalable

As the NHS expands digital-first models like virtual wards, recent cyber incidents are a stark reminder: innovation must be safe.

All virtual ward technologies are now required to meet the Digital Technology Assessment Criteria (DTAC), a national standard covering clinical safety, cyber risk, interoperability, and usability. Local systems must demonstrate compliance, backed by clinical safety cases, procurement governance, and operational assurance.

With ransomware attacks on health providers growing, cybersecurity is now a patient safety issue. Trusts, ICSs, and suppliers must work together to ensure that virtual care remains secure, clinically sound, and trusted by patients and professionals alike.

A Final Word from Altin Biba, MBA,  Chief Executive of ProMedical

Virtual wards are a promising innovation, but they cannot stand alone. Without the right people, processes, and community capacity behind them, they risk becoming a system pressure valve, not a solution.

At ProMedical, we believe in enabling care closer to home, but never at the cost of safety, equity, or sustainability. That’s why we focus on supporting integrated workforce solutions that complement digital transformation, not compete with it. If your system is exploring ways to strengthen flow, capacity, and continuity, we’d welcome a conversation, grounded in evidence and partnership.

References

• NHS England – Digital Technology Assessment Criteria (DTAC) https://www.england.nhs.uk/digitaltechnology/dtac/
• What Good Looks Like (WGLL) Framework https://www.england.nhs.uk/digitaltechnology/what-good-looks-like/
• NHS England Virtual Ward Guidance https://www.england.nhs.uk/virtual-wards/
• Data Security and Protection Toolkit (DSPT) https://www.dsptoolkit.nhs.uk/
• Cyber Security Strategy for Health and Social Care https://www.gov.uk/government/publications/2023-cyber-security-strategy-for-health-and-social-care
• (Department of Health and Social Care’s latest plan to strengthen cyber resilience in the NHS and wider sector)
• The Synnovis Cyber Attack – June 2024 https://www.bbc.co.uk/news/uk-england-london-69032190
• NHS Transformation Directorate – Interoperability & Federated Data Platform https://transform.england.nhs.uk/key-tools-and-info/interoperability/