Virtual Wards

A virtual ward is a cadre for providing support in the community to people with the most complex medical and social needs. The concept was developed in Croydon Primary Care Trust (South London) – and virtual wards are now being introduced in several parts of the UK (including Croydon, Dorset, Dudley, Brent, Hillingdon, Bracknell and Nottinghamshire PCTs). Virtual wards use the systems and staffing of a hospital ward, but without the physical building: they provide preventative care for people in their own homes. The project won in four categories of the 2006 Health Service Journal Awards (the "UK's Biggest Awards in Healthcare") namely Primary Care Innovation, Patient-Centred Care, Information-Based Decision Making, and Clinical Service Redesign. This was the first time in the 25-year history of the HSJ awards that a project won in four categories. In 2007 it won the Transformation category of the Public Service Awards run by The Guardian and was judged overall winner of those awards.

The key aims of virtual wards are to:

Using risk stratification, patients can be identified by their likelihood to require admission into a hospital within the next year. The group of patients examined in this way can be based on a practice, a group of practices, or by a number of long-term conditions. The most commonly used risk stratification tool is the PARR++ Algorithm, which is available to NHS institutions free of charge – the tool takes data available from hospital admissions for the last four years and generates a percentage risk score. A more thorough tool is in development called the BUPA Health Dialogue risk stratification tool, which also accesses hospital data, but adds in data from the patients' practice to generate a risk score – the higher the score, the greater the risk of admission. This tool is available to NHS organisations for a moderate annual subscription. Other tools include the Milliman Advanced Risk Adjuster Tool provided by GPC Solutions Ltd in the UK that also indicates risk drivers and likely impact on areas of service.

Like a hospital ward, the capacity of the ward is set – usually between 0.5% and 1% of the number of patients grouped together. Also, like a hospital ward, patients are admitted and discharged from those beds. The ward is termed virtual as these beds are not real, and care takes place in the most appropriate setting for the patient, usually at home. Initially, the patients at highest risk of admission to hospital are considered for admission to the ward and for intensive case management. When one of these "beds" becomes vacant as the patient stabilises then the predictive algorithm is looked to for a replacement.

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