Memorandum of understanding

This page outlines the working arrangements between Healthcare Improvement Scotland and services applying to join the Hospital at Home (H@H) Expansion Programme.

The programme, including support from us and any associated funding, is open to services in Scotland who are either expanding their current service or developing a new one. H@H services for the programme are as defined in the 'Hospital at Home guiding principles':

  • a hospital specialist acts as senior decision maker and responsible medical officer
  • the service treats short, time-limited acute episodes of care
  • under the care of a H@H service, patients have urgent access to hospital-level diagnostics
  • the service provides a different level of intervention compared to other community based services, such as access to IV fluids and oxygen, and
  • care is delivered by multidisciplinary teams.

The role of NHS boards/HSCPs when applying

During the application process, you will be expected to:

  • Obtain strategic support from your NHS board/HSCP to implement H@H developments.
  • Consider local funding options to sustain successful changes beyond the duration of the programme.
  • Agree to attend in-person national learning sessions on Tuesday 27 June and Wednesday 27 September.

The role of participating services during the programme

During the programme, you will be expected to:

  • Develop a H@H service that meets the four key elements of the national definition for Scotland.
  • Submit monthly data reports to Healthcare Improvement Scotland.
  • Submit quarterly progress reports to Healthcare Improvement Scotland.
  • Attend national learning sessions on Tuesday 27 June and Wednesday 27 September.
  • participate and share information about your service at project surgeries, coaching sessions and national learning sessions
  • Communicate transparently throughout the work about successes and challenges so that other services can learn from your experience.
  • Agree to work with us to use quality improvement (QI) methodology to:
    • develop a new H@H service
    • expand an existing service, or
    • maximise use of current capacity.
  • Work with us to submit a funding bid at access Scottish Government funding to test local improvements.
  • Provide any changes to the funding bid in writing to Healthcare Improvement Scotland.
  • If required, create a business case to access local funding/staff to sustain improvements.

The role of Healthcare Improvement Scotland

We will deliver a national programme to support NHS boards/HSCPs to expand H@H services throughout Scotland. This will include:

  • A learning system based on:
    • national learning sessions
    • QI project surgeries
    • a Scotland-wide H@H online community
    • tools and templates to support service improvement/development
    • an implementation toolkit that brings the learning and resources together, and 
    • protocols, procedures, policies and other resources.
  • Templates for monthly and quarterly submissions.
  • Advice and recommendations to support participating services to progress, including:
    • Practical quality improvement support to identify where funding can have the biggest impact on the number of patients managed by your service.
    • Quality improvement support to implement changes and set-up new services.
  • Advice on the development of local business cases to NHS boards/HSCPs for sustainable funding.
  • A national measurement plan and system for capturing and interpreting data.
  • Templates to support participating services to plan and monitor their improvements, for example, project charter, measurement templates.
  • Supporting delivery of local webinar sessions based on key issues, topics or recurring themes from across participating services.
  • A network for key national stakeholders to share learning and publicise the work nationally.
  • Providing a Healthcare Improvement Scotland lead contact for the duration of the work. If the lead changes, a handover should be undertaken to ensure the new lead has the knowledge and skills to support the service.
  • Facilitating a bidding process to access Scottish Government funding.


If your application is accepted, we will work with you to understand how and where funding will best support your aim. You will then be expected to submit a funding bid based on the outcome of the exploratory work. Details about this process, and how we will support you, will be provided to successful services.

You are required to submit a bid detailing how the money will be used and plans to secure local long-term funding. Any changes to the details provided by NHS board/HSCPs in the funding bid should be notified in writing to us.

Funding will be provided to NHS boards/HSCPs to increase the pace and scale of H@H development across Scotland. The funding provided by Scottish Government must be used for the purposes of H@H development.

Funding will be paid to NHS boards/HSCPs directly from Scottish Government.

What happens if it's not working?

If any party is unable to meet the expectations detailed here, those involved are committed to identifying this at the earliest possible stage and will attempt to resolve issues amicably and at working level.

If a situation arises where an escalation of an issue is required, the following process will be undertaken:

  1. Formal discussion between Healthcare Improvement Scotland and NHS board/HSCP Hospital at Home service lead.
  2. If not resolved, referred to the Healthcare Improvement Scotland sponsor and NHS board/HSCP sponsor.
  3. If not resolved, referred to the Scottish Government.
  4. If not resolved, referred to Healthcare Improvement Scotland Chief Executive and NHS board Chief Executive/HSCP Chief Officer.


Ownership of information

Publication of materials relating to this work will be submitted to the other party for approval in advance and should acknowledge and reference participating services and Healthcare Improvement Scotland.

Data submitted to Healthcare Improvement Scotland can be published on the national Hospital at Home MS Teams Community, website shared with Scottish Government and in event presentations; on the basis that this does not include patient level data. 

Intelligence captured from NHS boards/HSCPs through the H@H programme will be shared with national agencies when appropriate.

Equality and diversity statement

When undertaking shared work, we will:

  • Assess the implications for equality and diversity including the impact on protected characteristic groups.
  • Consider the potential effect our work will have on factors that contribute to health inequalities.
  • Consider the potential impact of our work on an individual’s human rights.