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ICBs told to expand access to virtual wards

ICBs told to expand access to virtual wards
By Beth Gault
16 May 2024

ICBs have been told to expand access to virtual wards following a positive evaluation of their progress.

NHS England has called on ICBs to ‘maintain capacity and improve occupancy’ of virtual wards and expand access to provide an alternative to hospital admission.

In an update letter on the urgent and emergency care recovery plan, written to ICB chief executives and published today (16 May), NHS England said virtual wards have so far supported 240,000 people.

It said: ‘There is strong evidence that virtual wards are associated with reducing avoidable attendances and admissions to hospital, as well as supporting early discharge and reducing length of stay in acute beds.’

It referenced an evaluation of the South East region’s virtual wards, which showed over £10m of annual savings and 9,000 avoided hospital admissions.

In its set of action points for 2024/25, NHS England said systems should: ‘Maintain capacity and improve occupancy of virtual wards, expand access to step-up and step-down capacity, and improve length of stay by pathway, through implementing best practice as set out in the virtual ward framework.

‘Work together locally, including with social care providers, to increase access to virtual ward services that provide an alternative to hospital attendance or admission (‘step up’ virtual wards) including increasing the home referrals and directing patients from ED and SDEC following initial assessment where appropriate.

‘Consider specialty pathways and teams according to local demand, including paediatric virtual ward services and capacity.’

A new virtual wards operational framework will be published in spring/summer 2024, it added.

Earlier this year, Healthcare Leader looked at the cost effectiveness of virtual wards, following criticism that they cost more than double that of hospital beds.

The letter also called on systems to work towards having core operational integrated care coordination structures as a minimum by October 2024, with a single point of access integrated care coordination centre framework being published ‘shortly’.

ICBs were tasked with setting up a care coordination service that could include same day emergency care in the priorities and operational planning guidance published in March.

The update also called for ICBs to work with partners to increase the proportion of patients with direct access or direct referral from primary care, NHS 111 or 999 to same day emergency care (SDEC), and a reduction in the variation in those treated by SDEC services.

Incentivising performance improvement

Funding will be also provided to ICBs for improvements to ambulance response performance, and to trusts for reducing A&E waits, it added.

‘There will be up to £150 million of capital allocated within NHS operational capital budgets in 2025/26, to incentivise both highest performance and greatest improvement in performance since 2023/24,’ it said.

‘Capital will be allocated to the ICB for the Category 2 ambulance response performance and improvements, and to individual trusts and their nominated partners (which may include community and mental health trusts) for the A&E schemes.’

NHS national director for urgent and emergency care, Sarah-Jane Marsh, said: ‘Thanks to the hard work of NHS staff, last year saw considerable progress in the recovery of urgent and emergency care services with the first improvement in A&E performance outside of the pandemic in nine years, and Category 2 ambulance response times 17 minutes faster than the year before, all despite a record year of demand for A&E and ambulance call-outs.

‘However, it is clear there is still much further to go and with the rollout of ambitious new measures like more direct referrals to same day emergency care, more ‘step-up’ virtual wards, and targeted support for patients who regularly attend A&E, we are confident this plan can deliver further improvements for patients and continue to bring down the longest waits for care.’

Chief executive of NHS Providers, Sir Julian Hartley, said: ‘It is right that the next phase of the urgent and emergency care recovery plan focuses on rolling out successful initiatives to help reduce waits, improve care and ensure patients are seen in the right place, at the right time, according to clinical need.

‘From financial incentives across the whole system to help reduce the longest A&E waits, better data on total ED waiting times and targeted support for the trusts that need it, to greater use of same day emergency care and virtual wards, every avenue should be explored to enable trust leaders and their teams go further and faster in caring for their patients.’

Director of the NHS Confederation’s acute network, Rory Deighton, said: ‘We welcome the focus on 12-hour waits in the plan. We also welcome the subtle shift in focus away from hospital discharge to a greater focus on supporting people to stay healthy in their communities and avoiding hospital admission.’

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