Virtual ward challenges and how to overcome them

The workforce 

Virtual wards make more efficient use of clinical expertise through a properly coordinated tasking of healthcare professional to patient, but the problem is the amount of staff available and the amount required.

Dr Noel O'Kelly, Clinical Director for Spirit Health, has highlighted the risk that staff shortages pose for virtual wards. A Freedom of Information request by Spirit Health found that 40% of NHS trusts in England would require new staff to be able to deliver virtual wards - a finding that remains relevant given the NHS workforce pressures that have continued into 2025/26.

New healthcare ventures often need new staff, so that’s not too problematic, but the NHS has a staff shortage already. As this Lowdown article points out, the complication is that there is little consensus of how many staff members virtual wards may need; it depends on the care required and staff availability. How many clinicians? What hours? How many days a week? Can we borrow from other departments? The risk then is that this “borrowing” may deprive staff resources elsewhere.

NHS England's own operational guidance has acknowledged coverage gaps in early virtual ward implementations. At Frimley Health NHS Foundation Trust, out-of-hours patients were managed by existing healthcare pathways rather than a dedicated virtual ward team - illustrating that a day-time virtual ward service does not automatically translate into round-the-clock coverage. 

Chair of Healthcare and Workforce Modelling at London South Bank University, Professor Alison Leary summed up the problem nicely in an interview with Nursing Times.

We’ve already got an overstretched community workforce, and we don’t need any more [staff] leaving.

If you’re going to give people more work, you need to see how it’s going to affect the work they already do.

There is hope though. Health Innovation Network did point out that, while the virtual ward service had recruitment issues at first, “positive word of mouth has helped generate interest, especially among internal candidates”.

Statistics from Norfolk and Norwich University Hospitals NHS Foundation Trust also showed that the flexibility of such work resulted in zero sick days. This isn’t to say that staff didn’t get ill, but during the trial period those who did were minorly afflicted and could safely perform lighter tasks from the comfort of home – such as patient monitoring and video calls.

In addition, the flexibility and lower intensity of these tasks, perhaps alongside a longstanding sense of duty, is even starting to attract nurses and clinicians out of retirement.

All of this can quickly turn into a snowball effect too. Success breeds success through proper practices, but also the appeal to staff to apply knowing there’s flexibility and positivity. Nobody wants to join a sinking ship or tarnish their reputation, but by properly establishing virtual wards the recruitment problems will disappear quite rapidly.

The NHS Confederation's research into virtual ward implementation found that workforce shortages remain one of the most consistently cited barriers to scaling virtual wards, with commissioners describing the challenge as "pinching from Paul to pay Peter." The 10 Year Health Plan acknowledges this directly, setting out new workforce models to support the shift from hospital to community care. Until those models are in place, trusts and ICSs will need to plan virtual ward staffing carefully against existing community workforce capacity.

Cost

It might seem odd to think cost is a challenge, given virtual wards cost approximately one third (1/3) of the cost of a physical ward, but it’s not so much the operating costs that are an issue as the initial setup costs and the available funds to support this.

NHS England provided £200 million through the Service Development Fund for 2022/23 and £250 million for 2023/24 to support virtual ward setup. Beyond that, ringfenced national funding has not continued. For 2025/26, NHS England has devolved greater financial autonomy to local systems, with ICSs and trusts expected to fund virtual ward expansion within their existing resource envelopes.

This shift makes the costing model more important than ever. Virtual wards operate at roughly one third of the cost of a physical ward bed, but the upfront investment in equipment, infrastructure and staffing remains significant. Organisations should model both short-term setup costs and long-term savings before committing to a particular scale of rollout.

NHSE airs concerns that its own earmarked funding might not be enough to cover the equipment required and the setup of a base of operations, let alone recruitment and staffing costs.

Health Innovation Network points out a rough estimate of £3,000 to £4,500 worth of savings per patient in a virtual ward, which seems like an obvious win, but this figure doesn’t take into account the aforementioned costs and raises an obvious omission: virtual wards need a costing model.

All organisations should work from a costing model to ensure they are financially viable, and the NHS is no different. NHSE must invest in virtual wards, and plan both short-term for their establishment and long-term for the savings made.

Clinical buy-in

This is arguably the most difficult challenge of all: getting clinicians to “buy in” to the idea of virtual wards and to change well established working practices.

The layman argument is “if it isn’t broken, don’t fix it” but the NHS is provably broken and in need of support. Virtual wards, and supporting software solutions, can provide this support and a much needed win.

There are three arguments that keep being brought up in opposition to virtual wards:

• A lack of guarantees
• Confusion over the duration for virtual ward care
• ‘Too good to be true’ sentiment

The Lowdown NHS article focuses heavily on guarantees; first criticising the lack of ringfenced funding beyond the financial year 2023/24 but then moving on to circumstances. Nobody is yet to argue against the premise of virtual wards, but in Lowdown’s words, they couldn’t find anything via NHS England about flexibility with care in a virtual ward depending on a patient’s home circumstances.

This then leads into the time limit issue. Early NHSE guidance suggested virtual ward care should be short duration - typically up to 14 days. The 10 Year Health Plan signals a broader ambition, with virtual wards positioned as part of proactive, planned care for people with long-term conditions, not just short-term step-down from hospital. This shift should help address the concern that virtual wards are a temporary measure rather than a sustainable care model. Does the patient then return to the physical ward if they time out of virtual ward care? Even if it’s one day extra needed to be observed remotely?

This is the frustration from patients and clinicians. The lack of clarification on the matter heavily impacts confidence, which could suggest a bigger issue at the heart of NHS England whereby the push for virtual wards isn’t being supported by an overarching plan. Thus we lead in to the final complaint: virtual wards are too good to be true.

On top of this you can then raise issues about deteriorating health and the chronic delays with ambulance arrival, issues with improper use of kit not informing clinicians of deteriorating health, patient deterioration at the same time and who gets priority… the list goes on.

Hospital Times argues about how the virtual care kits, with the tablet devices and other wearables, are meant to operate at home. What if they lack phone signal? What if they lack internet access? These are key questions, and while some digital telecare providers account for this in their solutions, do we know that NHSE is using just those providers? Once again we return to the issue of clarification and transparency. NHS England needs to be far more open if it is to win over the sceptics.

Consultants are understandably cautious about handing over patients to a virtual ward - it is their GMC number on the line if something goes wrong. This is where technology makes a genuine difference. A well-integrated set of clinical tools can provide greater oversight and visibility of a patient's condition than a physical ward, where a clinician may only review a patient once or twice a day. Connected software means patients are never lost in the system.

Integration

Integration is a challenge affecting not just the whole NHS, but the entire health and social care system. For virtual wards to succeed they must be able to share data, and quickly. This means that a software solution – whether in conjunction with digital telecare equipment – must be onboarded with the core goal of ensuring this interoperability between existing and new software so that departments can properly cooperate and coordinate.

For integration across health and care services to work, information needs to be securely shared and accessible between every service involved in a patient's care. This is achievable, but only through digitisation of records in each service and through systems that can share data, either directly or through a connecting technology. Put simply, an integrated approach requires technology that is integrated.

Beyond this, the ability to talk to other virtual wards that have already established themselves in previous trials would be a huge bonus for a nationwide rollout. Everyone’s starting from scratch, but what if they had support from those who had already made mistakes and adapted? What advice could they give to smooth the setup process and avoid any delay in patient care?

The 10 Year Health Plan addresses this directly. The government has committed to a national procurement for a proactive, planned care platform, with data flowing through the NHS App and the Single Patient Record. NHS England is also expected to publish a digital and data blueprint in 2026 covering technology infrastructure and operating standards. For organisations implementing virtual wards now, adherence to the Digital Technology Assessment Criteria (DTAC) for clinical safety, cyber security and data exchange provides the clearest framework for ensuring your systems will be compatible with the national direction of travel.

Inclusivity

Digital literacy remains one of the most significant equity challenges in virtual ward delivery. The Government's Digital Inclusion Action Plan (2025) reinforces that digital inclusion is a shared responsibility across health, social care and wider public services. For virtual wards, this means NHS organisations cannot assume patients have the connectivity, devices or confidence to engage with remote monitoring technology.

NHSE’s own research says “There is a risk that the use of digital technologies will disproportionately exclude people from certain groups, including older people, those in social housing, those on lower incomes, the unemployed, those with disabilities, rural populations, traveller communities, homeless people, those with no recourse to public funds, and young people not in employment, education or training (NEETs).”

Virtual ward staff need to be fully trained in the digital telecare equipment, such as wearables and tablet devices, to ensure that they can explain to patients in a clear and understandable way how to use them without aid.

Capturing honest patient feedback on digital care experiences is essential. Anonymised feedback mechanisms built into virtual ward software give patients a way to flag difficulties without feeling they are letting their care team down. The answer isn’t definitive, but the hope is that software providers can incorporate a feedback mechanism into the equipment provided – or the NHS, during home visits, asks these questions up front. An honest answer may not be as easy to come by in that case though, so anonymity is a big advantage for true feedback that can lead to proper improvement longer term. 

Fortunately, existing virtual wards have already addressed these challenges. They have included patients’ digital capabilities as part of their initial assessment. If it is felt a person would be less able to use certain technology, or would prefer not to, they can simply call to give their readings, or a carer can enter their readings into the system for them

Keeping clinical skills up

Virtual wards are meant to be a weighted mix of virtual, remote care and the occasional in-person clinical visit to check up on the patient. The concern at present is that, with the lack of clear guidelines on establishing virtual wards, that a default position will be taken of purely remote support.

This is problematic. Not just from a patient care point of view, where your home comfort may begin to feel like medical isolation, but it also risks degradation of clinical skills. It is important for healthcare professionals to continue to engage with patients in person, to ensure their skillset remains strong, and to ensure the rapport and trust between patient and clinician. 

NHS trusts must offer both thorough training and guaranteed in-person patient visits - even if rotated across the team - to ensure clinical skills are maintained alongside remote working.

Disadvantages of virtual wards

All new ideas and launches have problems, and we’ve showcased plenty, but now we turn to the disadvantages. Virtual wards as a whole are a very popular idea with strong statistics and data showcasing how beneficial they can be, but they aren’t flawless.

The Guardian newspaper interviewed Brian Bostock, Head of Sustainability and Transformation at NHS Cambridge and Peterborough. Mr Bostock’s take, as an NHS insider, was that the “end of the bed assessment” is gone when using a virtual ward; that the core part of healthcare is attention to detail and those small, passing moments where a patient is looked in on and maybe even just one detail has changed – but that could be the key clue to a change in condition and the difference between prevention and deteriorating health.

Bostok, like others, also critiques the staffing shortfall and recruitment issues and the risk that these delays and concerns could undermine the larger picture project.

Overcoming virtual ward challenges

Lord Darzi's 2024 independent review of the NHS set out the challenge of virtual wards clearly. He noted that they, "have the potential to reduce hospital admissions and reduce the length of stay for those admitted" but that realising this potential requires "the right professionals with the right skills, and the modern facilities, digital infrastructure, and diagnostics to support them." That framing holds in 2026. The barriers are real but they are not insurmountable, and the organisations making the most progress share a common approach: they treat virtual wards as a whole-system change, not a technology project.

Fortunately, the challenges of delivering virtual wards are not insurmountable and many of them have already been overcome in different ways, by different organisations.

For those aware of the benefits virtual wards can have, these challenges also seem minor in comparison and certainly worth the effort to overcome. As Stephanie Somerville, Director of Community Health Services Transformation and Virtual Wards, NHS England has said:

We have a moral imperative to treat people at home where we can

The most immediate opportunity for progress is software. NHS clinical systems have historically been fragmented, and the lack of interoperability between them has been one of the biggest practical barriers to virtual ward delivery. That is changing. The NHS Shared Business Services health and care digital framework - now in its second iteration - has doubled the number of accredited suppliers, including The Access Group, giving trusts and ICSs a clearer, more competitive route to procuring the technology they need.

The goal is to rebuild confidence between NHS organisations and technology partners, and to give clinical teams the tools to deliver virtual ward care safely and consistently.

Electronic patient record software can centralise records for accuracy and clear usage. Other tools can then communicate with this EPR, particularly remote wearable tech such as that used in virtual wards. The tablets, the arm devices… they can report back to a log within their own central patient record so that clinicians have the most up to date information on a patient at any given time.

The right software connects patient record keeping, data recording, multi-professional input and cross-organisation communication in one place. Virtual wards work best when every team involved - acute, community, social care, voluntary - has a consistent view of the patient. That is what integrated software makes possible.

At The Access Group we provide the full spectrum of software to support successful virtual wards, including (but not limited to) electronic patient records, advanced digital telecare and patient administration systems.

Find out more about what virtual wards are, the virtual ward technology or, for an impartial and no-obligation discussion of our work in developing and implementing virtual wards with our partners in healthcare provision, simply contact us today and we will contact you at a convenient time.