Picture a world where you can recover from major surgery without ever returning to hospital; doctors track your progress remotely while you rest at home. This isn’t a distant concept, but a reality within reach.
It is a transformational concept worthy of the NHS’s revolutionary roots – a universal, publicly funded health service, redefining how we deliver care and setting an example for the world. But a system built for 1940s Britain cannot meet the demands of 2025.
In the immediate term, hospitals are grappling with rising costs, worsening value for money, declining productivity and access, and deteriorating patient experience. In the longer term, they face shifting clinical demand: an ageing population, more conditions that are incurable but survivable, and relentlessly increasing costs of care.
All of this points to one hard truth: if the NHS were to be designed from scratch in 2025, it would look nothing like the system we have today. If you took our current hospital model and placed it in 1948, the underlying model – patient in, treatment, patient out – supported by the familiar wards, clinics and A&E departments, would look basically the same. Yet healthcare demand looks profoundly different.
As the NHS faces a considerable generational test, it desperately needs to rediscover the reforming spirit that once made it a model for the world. For decades, politicians have promised to modernise the NHS. Now, this government has sought to turn slogans into substance, launching the UK’s first entirely virtual hospital.
It is hard to overstate the sheer operational complexity of a hospital. Hospitals are unusual in combining constant emergency demand with a single site that houses multiple – and expensive – specialist departments. Subject to complex and ever-changing demand, it is a unique economic unit.
Redesigning the NHS today would yield a very different model. Technology would form the foundation of care delivery rather than being an add-on. Patients would be able to be inpatients from the comfort of their own home and receive hospital-level monitoring while going about their daily lives.
The hospital would be a service, not just a building, accessible anywhere at any time without undermining the quality of care. Only those who need to be in the physical hospital building would be there – reserved for the most risky, complex care and little else.
This is what makes the Prime Minister’s recent announcement to create an entirely virtual hospital – NHS Online – such a crucial innovation. Virtual secondary care has existed for many years in fragments, but never at scale. Much like the NHS was a world-first, so too is the shift to virtual secondary care.
What once seemed futuristic is now a growing reality – and essential for the hospital of the future. NHS Online does not, of course, have the same suite of services that a traditional hospital does and should not attempt to. But within its scope – providing faster, more convenient treatment across a range of specialisms – it can help to address several of the challenges that typically accompany efforts to expand NHS capacity.
Historically, increasing health system capacity has been complicated and prohibitively expensive. Up until now, “more capacity” meant hiring more people, buying more equipment and constructing more buildings. It essentially requires funnelling more money – billions of it – into a system we know is not working effectively.
Just one large hospital trust could cost as much as £1bn a year in running costs. This is roughly equivalent to the funding required by 130 comprehensive schools or an astonishing 600 GP practices. But a virtual hospital can be developed and scaled extremely quickly, with minimal overhead costs in comparison to a physical hospital.
Compare the New Hospitals Programme, costing a gargantuan £45bn over 15 years, and with the construction of one hospital alone taking 3.5 to seven years. From inception to delivery, it can take as long as 11. Then look to Moorfields Eye Hospital’s virtual A&E: 32 different virtual waiting areas, with two of their large services seeing
40 to 50 patients a day, all set up within a month. Drop-in video consultations were launched less than 48 hours after the first UK Covid-19 lockdown was announced.
Since it would provide fewer services than a traditional bricks-and-mortar hospital, could move through appointments faster and have lower fixed costs, NHS Online can serve a much larger group at less expense. It will not be bound by physical capacity or local geography. Staff can work from home at times convenient to them.
Critics may argue that the NHS is about more than fiscal sustainability, that it exists first and foremost to provide critical healthcare to patients. Of course, this is true. But fiscal sustainability and efficiency are generally what make good care possible. And, irrespective, evidence from previous virtual initiatives suggests that the value patients get out of the speed and efficiency of the service counterbalances any reservations they may have had around virtual care. Indeed, many appreciate the convenience and comfort of being treated in their living room rather than a sterile hospital ward.
The shift to a virtual hospital marks the first decisive step towards a health system built for modern society, not the post-war era. As the Secretary of State put it, the NHS faces a choice: reform or die. This move reflects a clear commitment to pursuing the former.
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