Scotland's largest health board has dropped its Hospital at Home service in Glasgow on the cusp of winter despite evidence that it has helped to prevent hundreds of patient admissions over the past two years.

The initiative, which has operated in the south of the city since 2022, closed to new admissions on October 31 and was discontinued on November 8.

Papers show that members of Glasgow's integrated joint board (IJB) - which oversees the delivery of health and social care in the city - signed off on plans to close the service back in August on the basis that it would be replaced by an improved, Glasgow-wide service which would cost around £659,000 less to run per year.

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The plans originally envisaged that this revised model would "go live" immediately, on November 8, but an update on NHS Greater Glasgow and Clyde's website now states that the successor service "is currently being planned with the aim of commencing in 2025".

According to NHSGGC, the existing service - which was open to care home residents and people over 65 with long-term conditions - had cared for more than 1000 patients to date, including 235 between November 2023 and February 2024.

Dr Iain Kenndy, chair of BMA Scotland, said the loss of Glasgow's Hospital at Home service immediately before winter was 'extremely concerning' (Image: BMA)

It helps to avoid admissions by enabling patients to receive hospital-level interventions such as ECGs, bladder scans, rapid blood testing, oxygen, intravenous fluids and antibiotics, X-rays, and ultrasound in their own home.

On average, patients would receive eight home visits over a typical four-day "stay" in the service, with a hospital-based multidisciplinary team receiving daily updates on their condition.

Since the initiative was first piloted by NHS Lanarkshire in 2011, versions of Hospital at Home have been adopted in every health board region except Orkney with the Scottish Government investing £15m since 2020 to help expand it and free up acute capacity.

Nationally, in 2023/24, Hospital at Home is estimated to have saved £36.3m through avoided hospital admissions, outpatient activity and care home support.

Renfrewshire - which falls within the NHSGGC footprint - is in the process of introducing its own Hospital at Home service, but Dr Iain Kennedy, chair of BMA Scotland, said it was "extremely concerning" that Glasgow was now entering winter without one.

He added: “The Scottish Government has highlighted the Hospital at Home service as a key part of measures to tackle winter pressures, helping to reduce delayed discharges and free up beds within hospitals."

Glasgow lauched its Hospital at Home in February 2022. Last winter, from November to February, around 235 patients were managed through the service (Image: HealthcareImprovementScotland (HIS)) Lanarkshire was the first to pilot Hospital at Home, in 2011. Last winter, between November and February, the service managed around 1,600 patients (Image: HealthcareImprovementScotland (HIS)) According to the plans outlined by Glasgow's IJB, the revamped Hospital at Home will go from covering only Glasgow South and some parts of the North-West to incorporating the whole city, including all 61 care homes under the banner of Call Before You Convey (CBYC) - whereby care home residents at risk of being admitted to hospital can be "preventatively assessed" in the home instead.

Initially it will provide 11 virtual beds which can support up to 1000 patients per year, but annual running costs are expected to fall from £1.78m to £1.121m as consultant input is removed.

Whereas nurses working in the existing service had the option to contact an on-call consultant geriatrician, the new model will be wholly community-based with clinical decision-making support from an appointed GP or lead Advanced Nurse Practitioner (ANP).

The bulk of the new service's cost - around £764,000 - is also expected to come from diverting cash from the district nurse budget, with another £257,000 earmarked from Scottish Government cash and £100,000 from Primary Care funding.

Glasgow IJB papers note that while current occupancy levels in the Hospital at Home service have "oscillated between 50 and 70%", this is expected to increase as it expands to accept referrals from the whole of the city.

It estimates that it will save "between 8,000-12,000 bed days per year" in avoided acute admissions.

Dr John Montgomery, a GP at the David Elder Medical Practice in Govan - one of Scotland 'Deep End' GP sites - and the chair of South Glasgow's GP committee said the existing service had not been well designed but that he did not expect the revamped to 'make much difference' either (Image: Nick Ponty/Newsquest) However, Dr John Montgomery, a Deep End GP and current chair of the South Glasgow GP committee, said that in his experience the existing Hospital at Home model in Glasgow "didn't make an awful lot of difference" in terms of keeping people out of hospital.

He said: "It's not like the initial Lanarkshire pilot where they actually had consultant geriatricians going into the patients homes and assessing them. That didn't happen in Glasgow.

"The way they had it set up, they used ANPs with a GP as a point of contact and guidance from a geriatrician.

"We [GPs] could refer into it, and then the nurses would go in and do an assessment, but it was pretty limited in its scope.

"For example, they had to have a family member who was willing to stay with the patient because they didn't have any kind of overnight service. So that was a big restriction.

"Secondly, they had the age restriction, so they had to be at least 65.

"For the majority of Deep End practices [which serve Scotland's most deprived communities] it wasn't much use because most of our patients were too young.

"Then with the ANPs, they took them out of their attachment to the local authority nursing home where they were really, really useful for us because they would deal with things like [urinary tract infections].

"They were pulled out of the nursing homes to go and work in this service, so it was a bit of a robbing Peter to pay Paul.

"The change that's being made is basically to take the consultant geriatricians - who had limited involvement - completely out of it so that everything else basically stays the same, but they would have GPs as the main point of medical contact.

"It's probably not going to make an awful lot of difference apart from, maybe, saving a bit of money."

Scottish Labour's health spokeswoman, Dame Jackie Baillie, said the existing service had been axed 'without a clear plan' for what happens next (Image: PA) Jackie Baillie, Scottish Labour's health spokeswoman, said the service's closure "just as we enter winter is an ominous reminder of how much our NHS needs a change in direction"

She added: "While there is always room to improve services, to axe this without a clear plan in place is yet more evidence of chaos under the SNP."

A Scottish Government spokesman said it was "aware" that Glasgow has closed its Hospital at Home service. 

He added: “We provided additional funding to maintain the existing Hospital at Home service until this decision was taken and Glasgow City now plan to operate a GP-led ‘Community hospital in the home’ service.

“Glasgow City have offered assurances that existing staff will be redeployed and that this decision will not have any impact on the newly-established Hospital at Home for Older People service in Renfrewshire."

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In a statement NHS GGC said the service "is transitioning to an alternative enhanced care model which will build on the experience of Hospital at Home".

It added: "The successor service will be community-led, and will have capacity to support up to 1,000 patients per year while also incorporating a Call Before You Convey service to support care home residents.

"A consultation process with staff and trade unions on the transition to this service is currently under way and is expected to conclude by the end of November.

"As the original Hospital at Home model was a test of change, it was always intended that learnings would arise.

"Patients prefer where possible to be supported in their own home.

"The Hospital at Home service enabled a shorter length of stay compared to an acute hospital, whilst still providing a high level of care.

"Over the last two years, the service cared for over 1000 patients and saved more than 4700 hospital bed days.

"We would like to thank all members of NHSGGC staff and our HSCP partners for their work in achieving these positive results.

"Renfrewshire Health and Social Care partnership is currently in the implementation phase of introducing a Hospital at Home service, which is expected to begin supporting patients over the winter period."