Greater Manchester's Hospital@Home programme grew from innovations in remote monitoring developed during Covid.

‘When the first wave of Covid happened we learnt quite quickly that remote monitoring had benefits for healthcare,' Dr Alam explained.

‘We were monitoring people with oxygen saturations at home and then escalating their care into a hospital setting when they deteriorated.'

In 2022, NHSE and NHS Improvement asked all ICSs to extend or introduce the virtual ward model as part of a two-year transformation programme. ICSs were set the target of serving 40-50 beds per 100,000 population.

The GM Virtual Wards programme was renamed Hospital@Home in the same year as it evolved from delivering just virtual care to providing hospital level care in patients' homes.

Since Covid, the programme has expanded significantly with six trusts and 11 hospitals offering services (see box).

Greater Manchester has the highest Hospital@Home bed capacity (883) and registered population (3.2m) in England.

Hospital@Home in numbers
Services	Step-up patients (referrals from GPs, community services, A&E attendance and hospital setting, step-down patients (hospital discharge)
Provider trusts	Bolton Foundation Trust, Manchester Foundation Trust, Northern Care Alliance Foundation Trust, Stockport Foundation Trust, Trafford Healthcare NHS Trust, WWL NHS Foundation Trust
Hospital@Home hubs	11

 

The Hospital@Home service offers four care pathways: acute respiratory; heart failure; frailty; and general medicine.

‘Every provider offers step up and step down pathways across the four care services but some of our providers are now trying to extend their capability by expanding their relationship with surgical teams,' Dr Alam said.

Patients, who are looked after for a nationally recommended period of up to 14 days, can be referred by primary care, community providers or from hospital.

‘Not everyone needs the full 14 days,' Dr Alam noted.

As of February 2025, average length of care in Greater Manchester was 7.52 days.

‘Virtual wards offer a middle layer where patients would otherwise end up in being in hospital but now can be managed in a hospital at home,' Dr Alam explained.

‘Likewise, for patients who can be discharged from hospital that middle transition allows that transitional care to happen.'

The Greater Manchester service cared for over 19,000 patients during the first eight months of 2025.

Personalised care

As part of the personalised care offering, team members may visit patients twice a day.

‘It may be that the patient just requires a phone call every day to check in on them,' Dr Alam explained.

‘It may be that the patient just requires remote monitoring. We have kits that a patient can use to check their blood pressure, observations and saturations, and upload them onto a system. We can passively monitor that and if there's any change in their condition, we can contact them and intervene.

‘We have different levels of intervention and these are personalised to the patient depending on what they need.'

Workforce

Teams consist of dedicated Hospital@Home staff and community health workers and include consultants, advanced nurse practitioners, admin team members, heart failure and COPD nurse specialists, frailty consultants and specialists.

GM ICB has created an assurance framework setting out what the service is expected to deliver, including clear admission and discharge criteria, how patients should be onboarded, monitored and reviewed, and how further specialist inputs can be accessed if required.

Hospital@Home is aligned to existing community services and urgent mutual response and is working with diagnostic hubs so that urgent investigations can be accessed outside hospital.

The virtual wards operate seven days a week until 10pm along with an out of hours call service.

A new direction

As demand for healthcare continues to rise exponentially, Dr Alam said community solutions such as virtual wards will only be more vital.

‘We have to do something different,' she stressed.

‘If we don't, we have limited options on how we're going to meet increasing demand.

‘We will have an growing number of people in a Hospital@Home setting and a mixture of people from different specialities that are amenable to that kind of care, which will help us reduce our length of stay in hospital, lower readmissions and also reduce the number of people seeking help in the first instance.'

With a long-term decision still to be made on funding, Dr Alam stressed the importance that significant progress is not lost.

‘I'd like to see ICBs continue to develop Hospital@Home services,' she said. ‘It's not some intervention that I would like to see come and go.

‘ICBs have invested in this significantly. We can't go backwards as that will mean we are not be able to realise the benefits of our investment.'