At the end of March, NHS Shared Business Services (NHS SBS) announced a new £150M framework to develop new remote patient monitoring (RPM) initiatives across England’s health system.
The Technology Enabled Care Services 2 framework is arranged into six lots covering Remote Clinical Monitoring (allocated £36M in funding), Alarm Receiving Centre Platforms (£14M), Digital Alarm Solutions and Peripherals (£36M), Intelligent Activity Monitoring (£24M), Patient Controlled Personalised Healthcare Records ($14M) and One Stop Shop / Combined Solutions (£26M).
Overall, the Framework aims to free up hospital beds, reduce appointment backlogs, accelerate patient hospital discharge, and alleviate pressure on social care. An estimated 14,000 hospital beds are occupied by a patient who is clinically fit to leave, but has no appropriate care setting to be discharged to, and so creating new ‘virtual wards’ should go some way to relieving this costly bottleneck.
The Signify View
One of the most potentially impactful lots in Technology Enabled Care Services 2 is the £36M being allocated to Remote Clinical Monitoring solutions to expand England’s virtual ward capacity. These virtual wards had their origins during COVID, when transitioning patients out of hospital was a matter of crisis management rather than cost consideration. Even as the pandemic eased, hospital bed capacity in England remains under intense pressure, and staff shortages make care delivery more difficult than ever.
The Framework gives England’s 42 Integrated Care Systems (ICSs) the ability to rapidly procure RPM technologies from shortlisted vendors to build virtual ward capacities and support health and care professionals in delivering clinical care. The NHS intends for these virtual wards to care for people with chronic conditions such as diabetes, stroke and heart failure, as well as providing post-operative surveillance.
ICSs therefore have a central role to play in linking up health and care functions beyond the hospital. Whether they can deliver on the UK government’s goals to have 50,000 virtual beds in place in England by March 2024 (from 10,000 at present), is another matter, however.
Centralised Approach
NHS SBS is responsible for providing the funding and shortlisting vendors to carry out contracts in each of the six lots within Technology Enabled Care Services 2. It is then up to the individual provider organisation (e g the ICS) to select the vendor and manage the contract budget.
In terms of the Remote Clinical Monitoring lot, £36M won’t go far given that it must be spread across 42 ICSs in England. The fact that it is a one-off funding stream is also less than ideal, because it prevents RPM adoption from really scaling and delivering longer-term benefits. A consistent funding supply would nurture RPM technology adoption by giving providers the ability to develop long-term plans based on ‘guaranteed’ budgets.
Reimbursement Riddle
As Signify Research regularly reports in its Insights, the lack of reimbursement or ongoing funding structures in most countries, including England, also restricts progress in ‘hospital-at-home’ programmes, and RPM adoption, in a big way.
Even in the US, which is more advanced than in any other country in this respect, only around 200 hospitals have to date taken advantage of reimbursement for ‘hospital-at-home’ care (‘hospital-at-home’ being the US equivalent, to all intents and purposes, of England’s virtual wards), and only a small number of patients have actually been managed at home. Ongoing uncertainty over the renewal of specific ‘hospital-at-home’ reimbursement codes beyond May 2025 continues to play on the minds of providers in the US, and this is seriously dampening the RPM market potential.
A lack of clear long-term funding structures in England (and the UK), parts of Scandinavia and elsewhere means that the appetite to build virtual ward capacity and ‘hospital-at-home’ programmes depends almost entirely on more unpredictable, one-off funding streams. This funding, like Technology Enabled Care Services 2, is not tied to the number of patients being monitored at home (as would be the case in a reimbursement model). Instead, it is good for putting in place the service and workflow, but there is then no specific mechanism for providers to fund schemes on a long-term basis. It is no wonder that providers are reluctant to invest in RPM solutions.
Big Picture View
Despite the above, it is a positive that ICSs are responsible for how the £36M is spent on Remote Clinical Monitoring in England. The siloed nature of the healthcare system in England (as in many other countries) has traditionally meant different organisations in the system providing, for example, acute care and care at home, operate under siloed, individual budgets. It is not uncommon for a community healthcare organisation to invest in RPM technology but derive little real benefit from it because it’s the acute providers that benefit the most from them in terms of keeping patients out of hospital or being able to move patients out of acute settings quickly. For these community providers, RPM is largely just a cost burden.
So again, this stunts RPM adoption. While it will still be the hospitals, individual primary care networks, GP practices and social care systems who do the ‘legwork’ to expand virtual ward capacities, ICSs have the unique oversight of every different care setting. It is the ICS that can co-ordinate the various players in the system, and hopefully dismantle the silos that prevent RPM adoption from reaching its true potential.
In such a scenario, the shortlisted vendors competing for a slice of the £36M pie – Aseptika, Baywater, BT, Doccla, Docobo, Huma, Immedicare, InHealthCare, Prescribing Services, Solcom, Specialist Computer Centres, Spirit Healthcare and Vcare – will view this as one of many opportunities in this space going forward.
Of these vendors, Doccla, Docobo, Huma, InHealthCare and Vcare have already had success implementing virtual wards for the NHS on initiatives such as the COVID-led £65M NHS Spark Dynamic Purchasing System and COVID Oximetry at Home projects in 2020, and the NHS National Innovation Collaborative. They will be in pole position to benefit from the latest funding initiative.
Internationally, structures are also being put in place in France, Saudi Arabia, parts of the Nordics and Australia where big health systems (the equivalents of the ICSs) will also be in a better position to break down barriers and provide that big picture view on patient care management.
A Case of Myopia?
The Technology Enabled Care Services 2 framework nudges virtual care in England another step along the road. However, while undoubtedly helpful, the £36M one-off funding to expand virtual ward capacity in England is a short-term solution, when what is really needed is a long-term vision. Providers need a long-term spending commitment around which they can plan, deliver the number of virtual wards required in the future and enable RPM adoption to scale in the country.
While the desire for change is clear as hospitals and their staff creak under unrelenting pressure, joined up thinking and long-term strategy are essential to have a lasting impact.
