Virtual ward platform technologies to support transition of patients to the home setting or to avoid hospital admission
Scottish Health Technologies Group (SHTG)
Recommendations for NHSScotland
The current evidence base for virtual ward models of service delivery is limited and heterogeneous. Evidence on the added value of virtual ward platform technologies is inconclusive, and therefore their use should be accompanied by ongoing and systematic data collection.
When NHS boards implement virtual wards supported by virtual ward platform technologies, they should be offered as an optional alternative to either hospital admission or in support of earlier discharge. Virtual wards should be used only for patients who require ongoing monitoring and are clinically suitable for remote monitoring. Participation should be based on informed patient choice and consideration of patients’ circumstances, including the potential burden on carers. This should be supported by clear and comprehensive discussions between clinicians and patients about risks, benefits and available alternatives.
In delivering virtual ward services, NHS boards should assess the suitability of a patient’s home environment for this purpose, the availability of informal support, digital access and literacy, and any assistance required to use the technology. This is necessary to ensure the intervention is appropriate and that resources are used effectively.
Virtual ward platform technologies should not be expected to deliver benefit in isolation and should be implemented as an integral element of service delivery.
Remote monitoring devices used must be validated for use across diverse populations, including people with a range of skin tones. Clinical decision making should be informed by multiple measures rather than relying on a single data point.
The introduction of virtual wards should be supported by a structured evaluation framework to enable consistent and meaningful data collection. These data will be critical for assessing clinical and cost effectiveness and for informing future decisions on the scale and scope of national implementation.
NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) recommendations.
How the Council reached the recommendation
1. The Council recognised the complexity of the topic and the associated evidence base. In particular, the substantial variation in virtual ward delivery models was recognised as limiting the interpretability of the evidence and complicating the formulation of clear, generalisable recommendations.
2. The Council heard expert input from two clinical topic experts from NHS England and a representative of the Roy Castle Lung Cancer Foundation.
3. A clinical expert described how remote monitoring can take many different forms depending on the clinical context, the condition being monitored and the technologies used. Monitoring may be continuous or intermittent. The expert highlighted that the term ‘virtual ward’ is not consistently understood and may be confusing for patients in terms of what the model involves in practice.
4. Clinical experts questioned the suitability of the NHSScotland virtual ward model for widespread application across patient groups. They noted that hospital admissions are rarely for monitoring alone and more commonly reflect multiple clinical needs. From this perspective, experts advised that remote monitoring may be better framed as one of several enabling approaches supporting a broader shift away from hospital‑centred care towards care delivered in community settings.
5. The Council noted expert advice on the importance of the type of technology used for remote monitoring, particularly the distinction between active and passive approaches. Active technologies require patients or their carers to take physiological measurements (such as blood pressure or oxygen saturation) and to enter or transmit the data themselves. This can place additional demands on patients and carers, relies on correct technique, and may increase the risk of missing or inaccurate data, especially for people with limited digital confidence, cognitive impairment or fluctuating health status. In contrast, passive technologies such as wearable electrocardiogram (ECG) or physiological monitoring patches, require minimal active input from patients. These technologies may therefore be more acceptable and accessible for some patients and carers, reduce the burden of self management and lower the risk of errors in data collection or reporting.
6. The representative from the Roy Castle Lung Cancer Foundation highlighted the vulnerability and anxiety experienced by many patients following discharge after lung cancer surgery. Virtual ward monitoring was described as having the potential to provide reassurance, reduce feelings of isolation and support patients, many of whom will have co‑existing chronic conditions, through the remote monitoring of vital signs. Technologies enabling early identification of complications and timely intervention were valued by patients and carers and may help reduce avoidable readmissions.
7. The Council noted that informal carers often play an important role in supporting people who use virtual ward platform technologies. Carers may assist with monitoring signs and symptoms, as well as facilitating communication with healthcare teams. The Council recognised that this support may increase caregiver burden and requires appropriate consideration, training and support within service design.
8. The Council agreed that the value of virtual ward platform technologies is likely to depend on how effectively they are implemented and integrated into service delivery. The Council drew on insights from the evaluation of the NHS Borders respiratory virtual ward pilot, noting that technologies should not be expected to deliver benefits in isolation and must be:
a. aligned with service needs
b. embedded within clearly defined care pathways
c. supported by appropriate clinical oversight, sufficient workforce capacity and robust operational processes.
9. The Council acknowledged that the term ‘virtual ward’ is used inconsistently and has the potential to cause confusion, particularly for patients and the public. It was also recognised that virtual ward platform technologies are already in use in NHSScotland, including within hospital at home pathways, adding complexity to decision making in this area.
10. The Council discussed sustainability considerations and sought the views of the clinical experts. Experts advised that some remote monitoring devices can be reused following appropriate decontamination, depending on device type. They also noted that virtual ward models may contribute to reduced carbon dioxide emissions, primarily through reduced patient travel and fewer emissions associated with inpatient hospital stays.
11. The Council discussed the findings of the Citizen’s Panel survey and highlighted the value it added to this work. The demographics of respondents were considered, with the Council acknowledging that the use of an electronic survey may have led to an over‑representation of individuals who are already comfortable using digital technology. This limitation was recognised by the authors of the Citizen’s Panel report. The Council also noted the under‑representation of respondents aged under 45, and of those living in social or private rented accommodation, while recognising that survey responses were weighted by age and housing tenure to mitigate this imbalance.
12. The Council acknowledged the lack of robust economic evidence to inform its considerations. This was viewed in the context of the heterogeneity of service models and the difficulty of defining discrete models from which costs and cost effectiveness can be reliably estimated. The Council highlighted the importance of further evidence generation to support future decision making in this area.
Date of publication: 30 June 2026