Hospital at Home

Guiding principles for service development

Published January 2020

This publication brings together and reviews the published evidence on the effectiveness and safety of hospital at home initiatives for older people with frailty and shared learning from existing services across Scotland. It is intended to assist in local and regional planning for acute and specialist services to support people, who would ordinarily require admission to acute hospital, to receive treatment at their home.

Key points

  • Hospital at Home has been in existence in a number of countries across the world for 25 years. The first hospital at home service was introduced in Scotland in 2011.
  • Older people with frailty are at particular risk of being affected by institutionalisation and delirium. Some 30 to 56% have been shown to experience a reduction in their functional ability between admission to hospital and discharge.
  • Hospital at Home is a short-term, targeted intervention that provides a level of acute hospital care in an individual’s own home that is equivalent to that provided within a hospital.
  • Hospital at Home works best when it is part of an integrated acute and community-based service model to meet local population need.
  • Creating the environment to support Integration Authorities, NHS Boards and Local Authorities to effect transformation and introduce services such as hospital at home will require close collaboration and robust strategic planning and commissioning across sectors.