Commissioners' views and experiences of implementing virtual wards in Integrated Care Systems in England: a...

Virtual wards (VWs) have been rapidly adopted within the National Health Service (NHS) in England, showing promise for reducing hospital admissions and length of hospital stays. Additionally, VWs are reportedly highly acceptable to patients and may be preferable to physical wards (PWs) in some instances. However, little research exists on how to optimise the implementation of VWs from a strategic perspective. The current study aimed to investigate commissioners' perceptions and experiences of implementing VWs in integrated care systems (ICSs) in England, with a particular focus on changes and continuities in implementation influences over time.

A longitudinal qualitative design was adopted. Semi-structured interviews were conducted via Teams with commissioners involved in the implementation of VWs at two timepoints (TP) six months apart; TP1 (n = 20) and TP2 (n = 14). Interviews focused on perceptions and opinions of the VWs programme, including barriers and facilitators to successful implementation. Data were analysed using the Consolidated Framework for Implementation Research (CFIR) in line with the Framework Method. The CFIR comprises five domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process.

Implementation progress diverged across sites at follow-up, with some scaling back due to challenges while others expanded their VW programs. On a domain level, Inner Setting (ICS) constructs appeared most influential on implementation over time, with constructs in the Individuals domain seemingly becoming less important. The main barriers to implementation included: limited staff capacity, recruitment issues, and inefficient communication and interoperability of systems (Inner Setting); uncertainty around long-term funding (Outer Setting); inequalities in patients' home circumstances and lack of buy-in from clinicians (Individuals); and lack of detailed implementation planning (Implementation processes). Key facilitators included: building on existing similar services (Innovation); collaborative working (Inner Setting); and national guidance (Outer Setting) with flexibility to adapt to local contexts (Implementation Process). Commissioners perceived patient acceptability to be generally high, with a reported preference for receiving care at home.

Buy-in from clinicians, collaboration, detailed advanced planning on an ICS level, and sustainable funding are particularly important for implementation of VWs. To avoid generating inequalities, tailored additional support should be provided to disadvantaged patients. Directions for future research includes exploring the perspectives of clinicians.