Real patients and virtual wards

The human factor

Sir, – The sentiment of the headline to Muiris Houston’s article “Virtual care is not an alternative to additional hospital beds” (Health, December 4th) is one with which I agree.

Careful nomenclature is required in this field of clinical practice in order to establish a lingua franca. Policymakers, often without clinical expertise or knowledge, can readily muddle the definitions of services, ultimately resulting in more muddling through meddling.

Virtual wards require additional human resources as existing staff cannot bolt this on to existing work. Hospital at home is not time efficient for the clinicians to deliver: moving two metres between beds expends less time (and carbon) than driving 20km between residences. Better for the individual patient but perhaps not the most equitable for all patients. The cost-effectiveness is also up for debate, as one trial in an NHS setting has shown.

Muiris Houston identifies hospital at home services in UK and US as longstanding but it must be remembered that these exist in very different health and social care systems with different reimbursement systems and indeed goals. Israel, Spain and France have longstanding hospital at home services, all with different reimbursement systems and structures. France has had hospital at home enshrined in statute since the 1950s, offering everything from paediatric oncology to chronic leg wound dressings to intravenous antimicrobial therapy for acute illness, activity often undertaken by already established services.


My grave concern is the risk of infringing the right of the older person to access acute hospital care when they need it. Older people are the bulk of service use in secondary and primary care and will increasingly do so. Too often older people are maligned by the managerial class for taking too long to recover. A policy to push older people, over other groups, into virtual ward and hospital at home services also risks inverse ageism, ie, the younger, usually less frail patient, cannot to avail of these services due to commissioning constraints.

Hospitals are a 19th-century concept, the walls of which are being broken down, and arguably this is the correct path for the 21st century. However, don’t tear down the walls and dig up the foundations when you’re at it. – Yours, etc,


Consultant Geriatrician,


Sir, – I am a cancer patient and on medication for the rest of my life.

No longer do I have go into hospital for quarterly blood tests and monthly injections. Instead my tests are taken in my local surgery and sent in to the hospital. The monthly injection is also administered in the surgery. Then every four months I get a call from a doctor to discuss results or issues.

Simple, effective and beneficial to all concerned. – Yours, etc,



Co Wicklow.