Inpatient care and treatment - virtual capacity: interview findings

Executive Summary

Virtual Capacity (VC) enables traditional inpatient care and treatment to be provided in alternative settings, often in people’s homes. This report aims to provide an understanding of how Virtual Capacity is operating in Scotland.

In part one, qualitative semi-structured interviews with pathway representatives were utilised to describe the development and scale of VC services, alongside barriers and facilitators to implementation. In part two, findings from a rapid evidence review examining the effectiveness of VC in alleviating pressure on hospitals are described as well findings related to how services are experienced by patients.

This report only focuses on evidence published between 2017 and 2022 and does not include evidence on safety or cost-effectiveness. The report also restricts its focus to the use of pulse oximeters for covid remote monitoring, and omits wider work being progressed through Connect Me and therefore only provides a partial view of how VC is operating in Scotland.

The interviews highlight the important role committed clinicians have played in VC, who have been central to driving change through local innovation. Other findings highlight the variable nature of implementation which has resulted in pathways being at various stages of development across Scotland. A national focus in the advent of COVID-19 has helped to accelerate change and has been accompanied by central funding, although sustainable funding was identified as being required as well as further expansion to address a lack of geographical equity with regards to access.

The effects of workforce issues on delivery were discussed by interviewees, including difficulties in recruiting adequately skilled staff. This was perceived as being impacted by wider funding structures. Participants also highlighted that changing embedded ways of working can be challenging and securing buy-in amongst strategic decision-makers is pertinent for successful implementation.

The rapid evidence review highlighted that people were satisfied with VC services and liked being in the comfort and familiarity of their own home. The reduced disruption to their everyday lives was valued, though some were less satisfied when travel was required for treatment, and concerns around safety were also noted (Echevarria et al., 2018; Gardner et al, 2019; Minton et al, 2017; Tonna et al, 2019).

The evidence review identified that VC services help to save hospital bed days by providing an alternative to an inpatient stay (Durojaiye et al, 2018; HIS, 2020; SAPG, 2022). The ability of VC to reduce hospital readmissions from hospital level care is however variable (Edmond et al, 2017; Pickstone and Lee, 2019; Tierney et al, 2021), though is often explained by wider contextual factors (e.g. the acuity of the population and availability of overnight care) (Shepperd et al, 2021).

Randomised Control Trial (RCT) evidence shows that VC services can reduce hospital length of stay (Singh et al, 2022; Echevarria et al, 2018). Length of treatment (e.g. on a VC service vs inpatient stay) varies depending on the study however. Shepperd et al’s (2021) RCT found a slight increased length of treatment for people receiving Hospital at Home, though it is unclear if this was statistically significant. Service evaluations (which are less robust than RCT’s) do however report reduced length of treatment (Tierney et al, 2021).