What is hospital at home?

In Scotland, Hospital at Home aims to reduce hospital admissions for elderly patients by enabling them to receive treatments at home that would otherwise require them to be admitted to hospital.

This can include an intravenous drip or oxygen supply. It also provides access to hospital tests under the care of a consultant in their own home.

Where did it start?

The idea of Hospital at Home originated in the mid-1990s, following a pilot study into geriatric care led by US researchers and involving 17 patients which concluded that it was "feasible, safe and cost effective".

A larger evaluation, from 2000-2002, found that Hospital at Home "met disease-specific quality standards at rates similar to the acute hospital" and that the "average patient length of stay was shorter, and overall costs were a third lower than an inpatient stay".

In addition, patients treated at home were less likely to develop delirium or require sedatives, and family members reported feeling less stressed and "more satisfied with care compared to those treated in the hospital".

Patients also regained their ability to do usual tasks more quickly.

Hospital at Home models have now been widely adopted around the world, including by the NHS, with investment accelerated during the pandemic.

What's happening in Scotland?

Since 2020, the Scottish Government has allocated £8 million to support the development of Hospital at Home.

There are now 312 so-called "virtual beds" run by 21 health and social care partnerships, including in the Highlands and Western Isles.

A total of 7,369 patients were managed via Hospital at Home beds between April and November 2022.

The Scottish Government recently announced £3.6m will fund the creation of an extra 156 virtual beds.

What's the problem?

The Royal College of Physicians Edinburgh has welcomed the expansion of Hospital at Home, but also warned that there is a risk that staff shortages in the NHS could lead to more pressure falling on unpaid carers.

RCPE president, Professor Andrew Elder, cautioned that Hospital at Home "should not be resourced at the expense of existing services" and that "any additional impact on carers of managing the older person at home" must be "adequately evaluated".

However, researchers in child health from Aberdeen University have also flagged a lack of paediatric Hospital at Home provision as a problem for Scotland amid an "unsustainable" increase in hospital admissions for under-16s - particularly short-stays and infant admissions.

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What happens in England for children?

Several NHS trusts in England have established children's hospital at home services, including in parts of London, Liverpool and Southampton.

The services are designed to get children home from hospital earlier and to prevent admissions among children with complex or long-term conditions, including children with a terminal illness.

This includes home nursing care, such as babies requiring oxygen therapy or provision of intravenous antibiotics, as well as access to specialists in childhood diseases, asthma, or epilepsy remotely or via community hubs.

Service users have said the model enables them to continue a normal life with minimal disruption.