We must bring digital home care to those who need it most

Tech-enabled support for those with the most complex needs could shift the dial on prevention and efficiency, writes Tara Donnelly, founder of Digital Care and former chief digital officer of NHSX

Fit for the Future places home at the heart of its 10-year strategy and describes an explicit change in the hierarchy: “At its core, the Neighbourhood Health Service will embody our new preventative principle that care should happen: as locally as it can, digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, in a hospital if necessary.”

The plan outlines a number of important developments for digital home care in the NHS, including further expansion of virtual wards over the next three years, neighbourhood health with a focus on personalisation through cohorting, the development of digital therapeutics and the Health Store, home monitoring for cardiovascular disease, integration of wearables, expansion of functionality within the NHS App and changes to funding flows.

Opportunities in Neighbourhood Health

One of the most immediate opportunities is within Neighbourhood Health Services – positioned as the cornerstone of personalised care.

The ambition is clear: deliver more joined-up, locally rooted, patient-centred support.

Neighbourhoods are starting to take shape and consider the first cohorts to wrap care round, with national guidance indicating that those with the most complex of needs should be the initial group to support.

Groups proposed include those living with multiple long-term health conditions; I think this is spot on.

To truly shift the dial on prevention and efficiency, we need to focus on patients with multiple, severe long-term conditions

To truly shift the dial on prevention and efficiency, we need to focus on those at the apex of need – patients with multiple, severe long-term conditions who repeatedly present in crisis.

By extending tech-enabled care to this group, we can not only improve individual lives but also ease the pressure on the wider system. The government’s  10 year health plan is a fantastic opportunity to do so, aligned to the three shifts (from hospital to community, analogue to digital, sickness to prevention).

Research from the Health Foundation highlights that the top 5% of NHS patients account for more spending than the remaining 95% combined.

Addressing this cohort differently would deliver outsized benefits: for these patients themselves, for staff who manage constant crises, and for the 95% of the population whose care is delayed by system strain.

From hospital to virtual wards

Five years ago, there were no tech-enabled virtual wards in the NHS in England.

Today, every integrated care system has provision in place, enabling more than 9,000 people to receive hospital-level care at home daily. This rapid scale-up shows that the NHS can adopt new care models that are tech enabled when it is made a clear imperative.

The technology that underpins virtual wards can be repurposed for proactive care

The same technology that underpins virtual wards – remote monitoring platforms, data-driven escalation, and 24/7 oversight – can be repurposed for proactive care. Instead of intervening once patients are acutely unwell, we can track deterioration earlier and step in before hospitalisation is required.

Patient perspective

Crucially, patients really value these new models. Satisfaction with virtual ward and proactive monitoring programmes routinely reaches the mid to high 90s.

As one patient from Hertfordshire living with chronic obstructive pulmonary disease (COPD) put it: “It has helped me so much. I packed in smoking, changed my diet and thanks to the nurses who came to see me I got counselling because I would not leave the house.

“Now I even think different, I have a life, and I went out for the first time to see my son and his wife.”

Such testimonies underline that proactive, digitally-enabled care restores confidence, independence and wellbeing in those living with long term and progressive disease.

Several NHS services already show what is possible:

• Leicester, Leicestershire and Rutland Integrated Care Board: The recent evaluation of their proactive frailty programme demonstrated that it reduced bed days by 61% in the cohort, GP appointments by 89%, and emergency admissions by 40%, with 81% of patients rating care five stars.
• Hertfordshire Community NHS Trust: Heart failure monitoring achieved a one-third reduction in emergency admissions, alongside better symptom control and greater patient confidence.
• Airedale NHS Foundation Trust: Currently the UK’s largest remote monitoring hub for COPD with more than 4,000 patients has reduced emergency admissions by 41%.

Closing the digital divide

One concern is whether digital care risks excluding those most in need.

Evidence suggests the opposite – if designed correctly. In Bristol’s Living Well with COPD hub, the most deprived patients were successfully recruited, thanks to thoughtful design choices:

• Devices and SIM cards provided at no cost
• Website translated into the six most popular local languages and simplified for low reading ages
• Animated explainers to support onboarding
• Staff making supportive introductory calls

The result was a third fewer emergency admissions, an 18% reduction in ambulance conveyances, and 77% of participants reporting improved self-management. The largest cohort on this digital programme was from the most deprived decile, IMD 1 with 19% of the group from this decile and 40% being in IMD 1-3 (twice the average of the ICB).

Implementing Fit for the Future, with an immediate focus on digital neighbourhoods, offers the NHS a chance to transform care for those most in need, reducing preventable crises, improving patient experience, and freeing capacity for the wider population.

By supporting those at the apex, we can improve flow through emergency and elective care, enhance independence in later life, and deliver on the promise of personalised, digitally- enabled, home-centred healthcare via the NHS.

I just hope this opportunity to deliver real change through tech enablement is seized.