July 2, 2024

Understanding the capacity challenge in the NHS

Exploring how tech-enabled virtual wards can alleviate acute capacity challenges in the NHS, enhance patient care, and improve operational efficiency.

Table of contents

Unlocking NHS Capacity with Tech-Enabled Virtual Wards: Reducing Wait Times and Improving Patient Outcomes

Acute capacity issues in England are persistent and challenging. As of March, the waiting list stood at 7,538,800, with approximately 6,288,564 individual patients waiting for treatment. Around 3.23 million of these patients have been waiting for over 18 weeks, and over 309,000 of these patients have been waiting for over a year for treatment, statistics that haven’t improved from the months prior. 

The long wait times we're seeing are largely due to inadequate patient flow. Both general and acute bed occupancy has remained consistently over 90% since September 2021. Patients often stay admitted even after being fit for discharge due to issues like insufficient packages of care.

COVID-19 increased the burden on the health service, but even before February 2020, 4.43 million people were already on the waiting list for consultant-led care. Therefore, the acute capacity issues can't be blamed solely on the pandemic.

The ripple effect of acute capacity constraints

Acute capacity is a significant issue, highlighted by growing waiting times for planned procedures. This problem is exacerbated by the prioritisation of acute patients, which diverts resources from planned procedures. Let's consider cancer-related care as an example. Treatment rates are consistently dropping below operational standards. The average percentage of patients receiving their first cancer treatment within one month of a decision to treat is around 91%, not the target of 96%. The number of patients receiving treatment within 62 days sits around the mid-60% range, significantly lower than the operational standard of 85%.

Across the board, procedures are increasingly delayed due to resource constraints from tackling winter pressure. OPEL3 and OPEL4 alerts nationwide indicate severe bed shortages. Recent reports show that 150,000 patients waited over 24 hours last year to get a hospital bed in A&E, ten times the number seen in 2019. Most who waited were elderly or needed urgent medical care.

The struggle between bed allocation and limited social care availability further complicates the situation. On the one hand, patients who could be monitored at home often occupy beds needed for more critical patients. However, discharging patients is tricky as it’s critical to ensure that there is adequate monitoring at home.

Evaluating current NHS capacity solutions

There are two ways to impact capacity. Like trying to fill a bucket without overfilling it; you can turn off the tap or start putting holes in the bucket.

Turning off the tap means reducing the influx of patients who need acute care in the first place. Putting holes in the bucket refers to increasing the discharge rate by improving patient flow within hospitals. While optimising is beneficial to a point, to meet the additional 7.54 million cases on the waitlist, we'd need a substantial increase in hospital infrastructure and medical workforce that aren’t possible in the near future with current resources and budget constraints. This is where virtual wards have historically been introduced to expand our healthcare capabilities into patients' homes.

Stopping the overflow through virtual wards

Effective patient flow management involves diagnosing, treating, and discharging patients within the same day when possible. However, many patients require further observations or treatment. Delays and complications during their stay often extend admission time, leading to additional resource strains.

When further action is needed, patients progress up the hospital chain, where bottlenecks occur. Unexpected stays increase the risk of infection and deteriorating conditions beyond the initial reason for admission. Extended hospital stays are particularly detrimental to elderly and frail patients.

The best situation is to get patients well enough to continue their recovery at home. Over the years, many measures have been trialled to reduce the number of patients needing to come into the hospital and expedite their discharge. Traditional virtual wards and community care, such as home visits, have attempted to empower patients to manage their health. However, these methods have limitations due to the finite number of healthcare professionals available for home visits and patients' willingness to carry out tasks.

Community care issues like lack of compliance, engagement, and logistical challenges often keep patients in the hospital longer, causing further complications. Typically, a patient who is admitted to the hospital will leave with a lower functional status, especially among the frail population. For example, patients who were independent before may require increased social care support upon discharge.

Non-tech-enabled virtual wards need physical healthcare professionals to conduct periodic patient observations. While this option has made significant impacts by allowing more patients to be discharged, it's limited by the number of patients a single professional can monitor. 

Given the ever-increasing patient flow rate, simply putting more holes in the bucket—i.e., increasing discharge rates—won't be enough. Instead, the better solution is to restrict the flow in the first place. Turning the tap off means reducing the influx of patients needing support through improved community care and early intervention strategies, which prevent unnecessary hospital admissions. That's where tech-enabled virtual wards offer a more promising, scalable solution.

Turning off the tap through tech-enabled virtual wards

When integrated with technology, virtual wards significantly enhance capacity management by filling the gaps in traditional methods. They reduce the need for healthcare professionals in non-critical cases, allowing them to focus on more urgent care.

Looking at snapshots of data from our tech-enabled virtual wards across 10,729 onboard patients, a total of 2,184,454 minutes were saved in compliance, onboarding, and through observations. This led to NHS savings of £23,847,386. In total, this helped improve capacity through 64,111.6 total bed days reduced, averaging 5.98 bed days per patient. Improving primary care interactions and reducing clinical monitoring saw a positive knock-on effect, saving 11,097 GP appointments from being avoided and 366,400 monitoring minutes, averaging 131.23 per patient.

It's not about keeping everyone at home. By focusing on preventing non-essential admissions and enhancing community care by treating those at home who don't need to be in the hospital, the downstream impact enables beds to be used by the people who really need them.

Hybrid is the future of healthcare

Addressing the acute capacity issue needs a multi-faceted approach. While virtual wards play a crucial role, it's equally important to enhance community care to prevent unnecessary hospital admissions in the first place. By turning off the tap—reducing the influx of patients needing acute care—and improving the discharge process through tech-enabled solutions, the NHS can better manage its capacity challenges. There is still space for home visits, especially with elderly and frail patients, but having both as an option makes a substantial difference. By separating patients who can monitor their health at home from those who cannot, tech-enabled virtual wards facilitate better community care.

Technology isn’t a silver bullet solution to capacity issues, but it can drive substantial improvements. As part of our “Enhancing acute capacity in the NHS” series, next, we'll delve into how healthcare technology, particularly virtual wards and remote monitoring, can enhance capacity management. If you'd like to learn more about how tech-enabled virtual wards can help improve your operations, feel free to get in touch today.


Simao Saco

You might also like