Welcome to reality: the actual cost of virtual care

With the significant risk of over seven million people on waiting lists for treatment, the NHS has rightly been examining more efficient and innovative ways to operate to clear the backlogs while also offering better patient outcomes. One of the solutions that’s been prominent has been the use of virtual care, with many trials underway.

Recently however, the concept has come under scrutiny. Indeed, two interesting comments have been injected into the innovation and virtual wards debate this week, with Pritesh Mistry (Kings Fund) commenting that “it’s not a lack of innovation, but a lack of scaling of meaningful solutions”. Additionally, a study reported in HSJ shed light on the financial burden of virtual wards, revealing that they were also double the cost compared of traditional inpatient care.

In the face of worsening deficits and resource shortages, real system constraints present real barriers to scale. For virtual care the situation is potentially worse. We know of at least one Integrated Care Board (ICB) that is actively considering dropping its virtual ward programme due to cost considerations. Despite this, virtual models of care have real potential. They facilitate home care first, improve acute demand and flow and provide a pathway to remote monitoring and the reduction of waiting list risks.

The issue is not with the concept of virtual care; it lies in the current deployment model. Based on our work with NHS organisations, we estimate 70 -80% of the activities involved in the delivery of virtual care or remote monitoring does not need to be performed by a clinician. The challenge is enabling the clinical community to focus on clinical tasks. Conversations with multiple Integrated Care Boards and providers have led us to believe that the predominant deployment model heavily emphasises technology, laid over a largely clinician-centric operating model, often delivered as a series of small pilots. Such an approach enables progress and innovation to be demonstrated quickly against bed targets, but it is harder to scale and sustain, both in terms of resourcing and economics. Such a model is beneficial for technology vendors who view virtual wards primarily as a technology licensing opportunity, rather than a service transformation challenge.

At Capita, when we developed our virtual care hub solution, we took a step back and started with two principles:

1. How do you make ‘virtual’ (including remote monitoring) sustainable in NHS terms?
2. How do you work within the NHS context as a true partner, enabling NHS resources and experiences to flourish while empowering them to do more?

In practical terms, this also involves considering investment and financial risk – true partnership working.

As part of this, we believe suppliers must stop positioning technology as a simplified route to solutioning complex systemic problems. You only need to look at the level of narrative around how GenAI is “transforming” healthcare. Does a Chief Executive or Finance Director facing a worsening deficit or an under resourced clinical team on the edge of burnout feel that “transformation”? As suppliers and partners of the NHS, we must enable innovation, including digital, but deliver solutions that make a real difference - today. This means providing solutions which are sustainable, effective for patients and clinicians and can address the current scale of challenges facing the NHS.

The NHS does not have to accept that virtual is twice as expensive. Equally it should not be compelled to consider abandoning or curtailing virtual services or remote monitoring, along with accepting the operational and risk implications such a move would bring.

We believe there is a different approach which embraces NHS innovation and clinical services, while enabling scalability and economic sustainability.

 If you’d like to know more, get in touch and let’s have a conversation.