Integrated care systems (ICSs) were set up with the goals of improving health outcomes and driving efficiencies for the population by creating a coordinated network of healthcare services, built on a foundation of digital integration.
Yet these partnerships of care planners, commissioners and providers can often find themselves constrained by funding that unfortunately prioritises short-term fixes over the broader ambition of transformative change.
A recent example is the £30 million government funding for ICSs announced in October, which has been released to help NHS organisations roll out new digital tools to help them with this year’s winter pressures, including the expansion of virtual wards. The timing of the funding unfortunately hampers the ability of ICSs to implement projects that will have a material impact on alleviating demand this winter.
It’s a familiar scenario, whereby funding is made available to care providers as seasonal demands are already creeping up. This all but eliminates the prospect of funding being put towards strategic, medium/long-term planning, with organisations instead having to focus on short-terms solutions that address immediate concerns, typically unsustainable and increase friction in the system.
The short timeframe to respond to the funding no doubt also means missed opportunities for ICSs to embark on exciting, innovative projects with the potential to integrate health, social and community care. We can see this with the implementation of virtual wards, which NHS England signposts as a key initiative for improving patient care and reducing pressure on wider services.
Virtual wards as digital islands
NHS England recently announced that it had achieved its milestone of delivering 10,000 virtual beds. It’s an impressive achievement, and particularly welcome at a time when NHS performance data puts waiting lists at more than 7.6 million.
The broader challenge, however, is the lack of integration of these virtual wards. Despite the potential for virtual wards to streamline processes like automated discharge and patient care planning, the limited scope of funding means that trusts and ICSs are likely to be constrained to small, isolated projects, such as remote monitoring.
At the same time, the manner in which these solutions are procured (often hastily due to external factors) means virtual wards end up as standalone digital entities with distinct systems. As a result, patient information remains siloed and inaccessible for continuous care management, adding to fragmentation and logistical friction within the broader healthcare system and working counter to the overall goal of integrated care.
The impact of fragmentation
Interoperability of legacy systems can also be a roadblock in care coordination, underscoring the need for funding structures that not only encourage, but mandate the adoption of interoperable standards and solutions.
According to recent data from NHS England there was an average of nearly 12,500 people waiting in hospital who were medically fit to be discharged on every day in October 2023.
Imagine what a difference it would make if care teams had the visibility to decide whether these patients could be safely discharged to a virtual ward. Likewise, think how much better it would be for patients if they were allowed to return home and recover in a familiar, comfortable setting, under the close digital observation of care teams, as opposed to being caught in limbo between the hospital and their home.
There is already technology available that can help solve these challenges. Digital brokerage systems, for instance, show hospital teams what support is available for a patient being considered for discharge into a virtual ward, ensuring their safe recovery and reducing the likelihood of them being readmitted to hospital.
Likewise, shared care records provide community health and social care teams with real-time visibility into a person’s medical and care in the community history, helping them make more informed decisions about their care and tailor treatment accordingly. All of this supports the broader vision of ICSs to facilitate seamless transition between different care settings, improve patient outcomes and support the best allocation of resources across the healthcare continuum.
Short-term challenges vs. long-term change
There will always be a need to balance immediate healthcare demands with the broader goal of healthcare transformation. But instead of prioritising piecemeal services for instant relief, we should be championing coordinated systems that connect the dots and deliver sustainable improvements.
Part of this means rethinking how money is allocated and distributed, which can only be achieved if all stakeholders are involved in the discussion. This will lead to a more comprehensive picture of the healthcare landscape, which will in turn lead to deeper insights into the design of a virtual ward by factoring in social determinates like housing.
A drop in the ocean
Virtual wards (integrated with other digital solutions) are of huge strategic significance to health and care services in England, and there are myriad reasons to be optimistic about their success.
It’s why it’s encouraging to see recent strategy and funding announcements that favour the scale-up of technology across ICSs. But while the £30 million funding is a positive step, the timing and scope of these types of funds – combined with complex systemic challenges around integration – means they’re unlikely to have much of an impact for healthcare teams this winter.
To truly deliver the benefits of the virtual ward at scale, there needs to be a rethink of how, when, and where money is made available, with a focus on programmes of work that support the broader goal of care coordination. This means ensuring ICSs have the time and resources they need to do the job they were set up to do: implementing cohesive solutions that integrate seamlessly across the health and care spectrum, and building a resilient, patient-centred system that’s fit for the future.
By Alan Payne, Group Director, The Access Group and Honorary Professor in Intelligent Systems, University College London