Community nurse and her car

Surrey Downs Health & Care Virtual Ward Service

Provided by a Multi professional Team of clinical specialists providing safe and effective hospital care to patients in their own homes.

Service overview and benefits to patients

The Virtual Ward allows patients who meet a set of criteria to get hospital level care in their own home. This may prevent an admission to hospital or support a patient to leave hospital earlier.

Patients accepted on the virtual ward will receive the care and treatment they need which may include monitoring via telephone call or home visits by a member of the Multi-Professional Virtual Ward team.

The Virtual Ward team will support the detection of any changes or potential complications early on, allowing for timely intervention. By identifying issues before they escalate, appropriate care can be provided, preventing emergency situations and minimising the need for hospital admissions.

Being on a virtual ward can offer numerous benefits for physical health, mental well-being, and overall recovery;

  • Easy Access: Access healthcare services from the comfort of your home, regardless of your location or mobility.
  • Convenience and Comfort: Receive medical attention without needing to be admitted to hospital.
  • Reduced Risks of Hospital Associated Harm: Minimise exposure to hospital associated harm by staying in the safety of your own surroundings.
  • Personalised Care: Enjoy individualized care plans tailored to your specific needs for better outcomes and satisfaction.
  • Close Monitoring: Stay closely monitored enabling early detection of any health changes or complications.
  • Enhanced Communication: As well as home visits, connect with healthcare professionals via telephone where care, support and guidance can be provided.

Virtual Wards: an animation to describe how they work in the NHS

Find out more about Virtual Wards service by watching this animation video.

Virtual Ward team

The virtual ward team is led by consultants who are responsible for the care of the patients admitted to the virtual ward.

Pictured below are Dr Malin Farnsworth and Dr Christopher Sin Chan, Joint Clinical Director HomeFirst Services.

Dr Malin Farnsworth and Dr Christopher Sin Chan, Joint Clinical Director HomeFirst Services Surrey Downs Health Care Partnership

The virtual ward team comprises of a multi professional team of clinicians including;

  • Advance Care Practitioners
  • Doctors
  • Nurses
  • Paramedics
  • Pharmacists
  • Therapists

What is a Virtual Ward?

Virtual wards allow patients to get the care they need at home safely and conveniently, rather than being in hospital. The NHS is increasingly introducing virtual wards to support people at the place they call home, including care homes.

A virtual ward is a healthcare service that allows patients to receive medical attention, support, and monitoring from the comfort of their own homes, rather than being physically admitted to a traditional hospital ward.

The virtual ward model aims to provide personalised care plans, close monitoring, and timely interventions, similar to those received in a hospital setting. However, the virtual approach offers convenience, reduced exposure to hospital-acquired infections, and the ability to receive care from a distance. It can be particularly beneficial for patients with chronic conditions, post-operative recovery, or those who require ongoing monitoring and support.

The establishment of virtual wards within the NHS reflects a commitment to improve access to healthcare, optimise resource utilisation, and enhance patient outcomes while maintaining patient safety and comfort.

What can I expect if I am on a Virtual Ward?

When admitted to a virtual ward, patients can expect a range of services and support. Here is an overview of what a patient can typically expect:

Initial Assessment: Upon admission to the virtual ward, a healthcare professional will conduct an initial assessment, which may involve a home visit, video consultation or a phone call. They will gather information about your medical history, current symptoms, and any specific needs or concerns you may have.

  • Personalised Care Plan: Based on the assessment, a personalised care plan will be developed specifically for you. This plan outlines the treatments, medications, and interventions that are needed for your condition. It will also include any necessary monitoring or follow-up appointments.
  • Monitoring: Depending on your condition, you may be provided with monitoring devices to track your vital signs, such as blood pressure, heart rate, oxygen saturation, or glucose levels. These devices are easy to use and allow healthcare professionals to monitor your health more closely.
  • Regular Check-ins: The healthcare team will maintain regular communication with you through home visits, video consultations or phone calls. They will check on your progress, answer your questions, and provide medical attention, care, guidance or support as needed. These check-ins ensure that you receive continuous care and that any changes or concerns are addressed promptly.
  • Medication Management: If you require medications, the healthcare team will provide instructions on how to take them and may arrange for home delivery or prescription refills. They will monitor your medication regimen and adjust it if necessary, ensuring you receive the appropriate treatment.
  • Rehabilitation and Therapy: If you require rehabilitation or therapy, the virtual ward may provide guidance and resources for exercises or therapy sessions that can be done at home. They may also arrange virtual consultations with therapists or provide instructional videos to support your recovery process.
  • Ongoing Care and Follow-up: As your condition progresses, the healthcare team will adjust your care plan accordingly. They will schedule follow-up appointments to monitor your progress and ensure that you continue to receive appropriate care until you are ready to be discharged out of the virtual ward back to the care of your GP.

It's important to note that the specific services and medical procedures may vary depending on your individual medical needs. The healthcare team will provide detailed instructions and guidance specific to your situation to ensure you receive the best possible care.

How long will I be on the Virtual Ward

Patients can remain on our virtual ward for up to 14 days where required. However, most patients stay between 3 to 5 days.

What are the benefits of being on the virtual ward?

Physical Health Benefits

  • Reduced Hospital Associated Harm: Patients on a virtual ward lower their risk of any hospital associated harm e.g. exposure to infectious diseases commonly found in healthcare settings, promoting better physical health.
  • Close Monitoring: closely monitoring patients' vital signs and health status allows for early detection of any changes or complications, enabling timely intervention and promoting better physical outcomes.
  • Timely Interventions: With close monitoring, healthcare providers can identify potential issues promptly and take necessary actions. Early interventions can prevent the worsening of conditions, reduce the need for emergency hospital admissions, and facilitate a smoother recovery process.

Mental Well-being Benefits

  • Comfortable Environment: patients often prefer to be at home close to family, friends and pets. Remaining in the familiar and comforting environment of one's own home can positively impact mental well-being. Patients may experience reduced stress and anxiety associated with hospital stays, contributing to improved overall mental health.
  • Reduced Disruption to Routine: By avoiding hospital, patients can maintain their daily routines and stay connected with their support systems. This stability can help reduce stress and promote a sense of normalcy, which is beneficial for mental well-being.
  • Increased Autonomy and Control: Being on a virtual ward allows patients to actively participate in their own care. They have more control over their treatment process, leading to a greater sense of empowerment, autonomy, and improved mental well-being.

Overall Recovery Benefits

  • Personalised Care Plans: Virtual wards offer individualised care plans tailored to each patient's specific needs. This customised approach can enhance treatment effectiveness and improve overall recovery outcomes.
  • Enhanced Communication and Support: Regular communication with healthcare providers through virtual platforms, video consultations or telephone ensures that patients receive necessary care, guidance, support. This ongoing support fosters a sense of being cared for, contributing to overall recovery.
  • Convenient Access to Resources: Virtual wards provide easy access to educational resources, rehabilitation exercises, and post-treatment instructions. Patients can conveniently access and utilise these resources from home, facilitating their recovery process.

What to do If I am unwell? (In hours and out of hours)

​​​​​​If you are feeling more unwell, have new or worsening symptoms;

Monday to Sunday, 8am to 8pm, call 020 8296 4488 for;

  • New symptoms or changes that you were not expecting or feeling more unwell
  • Breathless when standing or moving 
  • Severe muscle aches
  • Shakes or shivers
  • New agitation/confusion
  • A sense that something is wrong

If out of Virtual Ward opening hours (8pm to 8am) call NHS 111 for;

  • New symptoms or changes that you were not expecting or feeling more unwell
  • Breathless when standing or moving 
  • Severe muscle aches
  • Shakes or shivers
  • New agitation/confusion
  • A sense that something is wrong

In an emegency call 999 or go to your nearest Accident and Emergency Department for;

  • Sudden onset chest pain 
  • Severe breathlessness (even when talking)
  • Coughing up blood 
  • Cold and sweaty with pale/blotchy skin
  • A rash that doesn’t fade when you apply pressure
  • Collapse/faint

This list is NOT exhaustive - if you feel you are experiencing an emergency, please call 999 immediately.

Virtual ward carers guide

As a carer, you already provide essential help, which is unpaid, to someone who could not manage without your support. 

You will be a vital team member if your loved one is admitted to a virtual ward. Supported by a team of clinical staff , you can expect full communication about all aspects of the care the person you look after will receive while they are on the ward. You should expect to receive help with things that are new to you or equipment provided to monitor how your loved one is doing on the ward and to have the chance to join in discussions about what will support and help their discharge from the virtual ward. You will be key, as their carer, to their progress as they recover and you should be asked for your consent to help care for them during the timme they are a patient.

This guide has been developed to support patients and carers (paid, unpaid, family/friends) with any information you may require while on the virtual ward.

Virtual Ward Carers Guide [pdf] 330KB

Information for referrers, GP’s and other care providers

Referrals to the service will be accepted from GPs, the ambulance service, NHS 111 and other health and social care professionals.

Patients already known to community services can self-refer. All referrals to virtual ward should be made via our Urgent Community Response (UCR) service.

To make a referral please call the Single Point of Access (SPA) telephone number 0208 296 4488 (Option 3) to ensure your call is logged centrally, and patients are triaged as soon as possible. 

Referrers from Secondary Care

Referrals are accepted between the hours of 8am to 7pm. Patients referred after 6pm will be followed up at home the following day.

The referring clinician should carry out a patient assessment to ensure patient meets the inclusion criteria.

The referring clinician should then call Surrey Downs Single Point of Access (0208 296 4488, option 3), request Virtual Ward Follow Up and provide patients details.

The SPA Administrator will confirm patient's identity & transfer the call to the Virtual Ward duty clinician. The person referring will be expected to outline the clinical plan and discuss the needs of the patient prior to acceptance onto the Virtual Ward.

Inclusion Criteria

  • Patient is over 18 years of age
  • Patient is registered to a GP within Surrey Downs
  • Consent by patient or deemed to be in their best interest
  • Step down patient's condition is on improving trajectory or NEWS2 scores known and acceptable to admitting Virtual Ward clinician

Exclusion Criteria

  • Requires immediate medical attention to stabilise their condition for assessment
  • Needs acute / complex diagnostics and clinical intervention in hospital
  • Is experiencing a mental health crisis (as primary concern) and requires referral and assessment by a specialist mental health team
  • Patient unable to take medication independently or with help of relative/carer
  • Patient is pregnant

GP’s and other Care providers

GP’s and other care providers with Access to community systems can access information and updates about their patients.

If you have an urgent query about a specific patient admitted to the virtual ward please call Surrey Downs Single Point of Access (0208 296 4488, option 3)

When a patient is clinically fit for discharge from the virtual ward a discharge summary, advice on medications and liaison with community care will be communicated as effectively as if the patients was discharged from hospital.