Over two blogs, Diarmaid Crean, Ethical Expert and Thomas Webb, CEO, at Ethical Healthcare share the reasons for their love/hate relationship with the 10 Year Health Plan. From a ‘hate’ perspective – they explain why the Virtual Hospital Vision will not be achieved by buying “a product,” but by enabling a virtual system: adaptive, people-powered, and embedded in the places where care happens. 

Virtual Wards (or more accurately the need for ICS level Virtual Hospitals) is not a product choice – it’s a system redesign. Brilliantly, the 10-Year Health Plan sets out a compelling vision for the future of care – one that shifts from reactive, hospital-based treatment to proactive, personalised support delivered where people live.  

Inside the Plan is this very important announcement: 

 We will undertake national procurement for a new platform … including the ability to remotely monitor patients, with data flowing through to the NHS App and Single Patient Record.

Apart from the category mistake this announcement contains – we think the spirit of this is fantastic as it directly addresses the key asks of the national programmes to support the growing Virtual Hospital Vision. 

The mistake would be to select a single NHS supplier. The NHS already knows from history that this will never be a good idea – unless you’re talking about a nationalised commodity/utility where there is no need for innovation or a full acceptance that it is unlikely to happen at any pace.  

Virtual wards are a new and volatile space where the best solutions today won’t be the best in a few years.  

In the last few weeks alone the Virtual Ward community has been sharing and liaising on Trial Without Catheter (TWOC) Pathways, VIP scores for canula IVs, prescribing direct from local pharmacy, direct ambulance referrals and the most effective use of medical consultants for moving patients from ED to VW.  

Current suppliers must respond to this as the active community is learning who is able to do what, where and with who. 

So, in this situation the NHS should want to actively encourage as many entrants to the market as possible to drive innovation. We are concerned that the 10-Year Health Plan shows a complete lack of understanding of how markets need to work for the NHS, especially now as it urgently needs to reshape itself.  

On top of this error, it is important to understand Virtual Wards are not just about buying a product. It’s a complex service design challenge – and the NHS success depends on learning from the experience of 100s of virtual teams across the country. We need to mobilise the full ecosystem of capabilities. 

Care at Home – Not a Shortcut, but a Shift

The 10-Year Health Plan makes explicit commitments to increase care delivered in people’s homes, supporting recovery and monitoring of long-term conditions without needing hospital admission. This is more than just convenience – it’s a population health imperative. 

But home-based care doesn’t run on apps alone. It requires coordination between specialists, community nurses, allied health professionals, social care, and carers – and all underpinned by robust remote monitoring infrastructure and rapid response capacity. 

Care Homes – Missed Opportunity or Central Pillar?

Care homes are referenced in the 10-Year Plan as part of the wider ecosystem for frailty care. They must be central to Virtual Hospital delivery. 

To fully realise the benefits of virtual, we must treat care homes not as passive recipients of care but as active partners in its delivery – with integrated data access, clinical escalation pathways, and wraparound support from community teams. 

Wearables – Valuable but not sufficient

Wearables are important enablers of remote monitoring. But their impact depends on what happens after the data is captured. 

Without clinical triage, shared decision-making, and workforce alignment, wearables risk becoming expensive step counters. The 10-Year Health Plan gestures to innovation but stops short of articulating the full chain of action that gives wearables clinical value. 

Virtual Care using wearables is just one aspect of the design challenge for a total Virtual Hospital. 

Workforce Gaps – The Reality We Must Design For

The NHS is clear about the challenge: we do not have enough clinicians. Virtual care cannot succeed by adding more tasks to already stretched staff. 

Instead, we need system-wide workforce allocation: rotational roles across providers, flexible staffing pools, and the intelligent use of technology to triage, escalate, and inform – not replace – clinical judgment. 

Clinical Expertise at a Neighbourhood Level

The Plan highlights the need for neighbourhood teams – integrated, agile, and close to the patient. This is essential. 

Virtual care should strengthen, not centralise, clinical expertise. That means equipping local clinicians with tools to intervene early, access specialist advice, and work in partnership across organisations. Virtual platforms must flex to local needs, not override them. 

Integrated Neighbourhood Teams – The Front Door

The future of the NHS lies in integrated neighbourhood teams – supported by data, equipment, skills, and shared ways of working. 

Virtual care must be embedded into INTs.  

Virtual Hospitals: Not Just Tech, But Transformation 

The Virtual Hospital model is not a digital tool. It is a reimagining of how we deliver care—combining: 

– Remote monitoring 

– Shared data infrastructure 

– Systems thinking 

– Workforce coordination 

– Clinical escalation pathways 

– Equipment delivery and retrieval 

This requires not just software, but human-centred design, logistics, training, and cultural change. 

Virtual care is growing because clinicians, patients, and teams are building what works. A centralised solution risks undoing that momentum. 

We must support the vision in the 10-Year Health Plan not by buying “a product,” but by enabling a virtual system: adaptive, people-powered, and embedded in the places where care happens.