£100M Hospital at Home Plan to Ease Delays and Boost Patient Care
The Scottish Government has announced a £100 million funding package as part of its 2025-26 Budget to expand the Hospital at Home initiative, positioning it to become the "biggest hospital in the country." By December 2026, the programme aims to offer 2,000 virtual beds, providing a home-based alternative to acute hospital stays. This move is seen as a response to the ongoing challenge of delayed discharges in hospitals, which has contributed to overcrowded wards and extended wait times for new patients. While the Hospital at Home initiative offers significant potential benefits, it also raises important questions about patient experience, staffing, and long-term feasibility.
The concept of Hospital at Home allows patients to receive acute care at home rather than in a traditional hospital ward. Using remote monitoring, video consultations, and visits from healthcare professionals, patients are provided with medical care similar to what they would receive in a hospital. It’s designed primarily for older patients and those with chronic or long-term conditions.
The model has been in use across Scotland for some time but will now be scaled up. The government argues that it will not only free up hospital beds but also provide patients with a more comfortable and dignified care experience in their own homes.
The Benefits of Hospital at Home
Reduced Pressure on Hospitals
With 2,000 new virtual beds created by 2026, Scotland's hospitals will have additional capacity to reduce overcrowding and cut waiting times.
This could ease the burden on A&E departments, which have been under severe strain in recent years. It could also address the problem of patients being "stuck" in hospital despite being fit for discharge, often due to delays in social care arrangements.
Improved Patient Experience
Patients generally recover faster and feel more comfortable in their own homes. For many, being at home reduces the risk of hospital-acquired infections and psychological stress.
The policy supports a shift towards person-centred care, giving patients more control over their environment.
Focus on Dignity and Autonomy
According to Social Care Minister Maree Todd, once a person has been assessed as ready for discharge, their best place is often at home, not a hospital. The scheme supports the idea that hospital stays should be a last resort, not the default option.
Economic Efficiency
Traditional hospital stays are costly, involving food, cleaning, and 24-hour staffing. By moving care into people's homes, hospitals can save money on these operational costs.
The expansion of the service may help Scotland reduce its reliance on costly emergency care and hospital admissions.
Personalised Care Plans
Patients in the Hospital at Home programme will have bespoke care packages tailored to their specific needs, offering a more holistic approach to treatment. This approach has been shown to improve patient satisfaction.
Investment in Frailty Units
The plan includes funding for frailty units in all A&E departments, directly linked to community care services. This will ensure that older patients, in particular, are assessed and supported more quickly.
The Drawbacks and Challenges
Impact on Patient Safety
While receiving care at home may be beneficial for some, others may require the 24/7 support that only hospitals can offer.
There are concerns that patients at home may be at higher risk of falls, dehydration, or missed medical complications, especially if staffing levels are not sufficient.
Staffing and Workforce Pressure
The policy raises questions about how existing NHS staff will be stretched to support both traditional hospital care and home-based care.
More healthcare workers will be needed to visit patients at home, which could lead to increased pressure on already understaffed nursing teams. Recruitment and retention will be critical to success.
Technology and Accessibility
Remote monitoring and virtual consultations rely on digital infrastructure and stable internet access. Patients in rural or remote areas may face technical barriers that limit their access to this service.
Older patients unfamiliar with technology may struggle to navigate apps and devices used for remote health monitoring.
Equity and Fairness
Some patients will have the privilege of space, privacy, and support at home, but others may not. Those living in overcrowded, unsuitable housing may face significant barriers to receiving adequate care.
It is essential that the service accounts for socioeconomic inequality, ensuring the system does not unfairly favour wealthier households.
Sustainability and Long-Term Viability
Scaling up Hospital at Home to provide 2,000 beds requires a substantial financial and logistical commitment.
Critics may question whether the policy is a short-term fix or part of a long-term healthcare reform. If funding cuts or changes in government policy occur, the system could be at risk.
From a patient’s perspective, the Hospital at Home model has clear advantages. For many, the opportunity to recover at home, rather than in a shared hospital ward, will be a welcome change. Patients often experience lower stress levels, reduced exposure to infections, and a greater sense of autonomy.
Not all patients will feel comfortable with this change. Some may feel that they are being sent home too early or that they lack the resources to care for themselves properly. Patients with mobility issues, those living alone, or those with limited family support may feel vulnerable.
The plan makes sense from an economic perspective, as it is more cost-effective to support care at home than to maintain traditional hospital beds. It also allows hospitals to focus on patients with the most urgent needs. Frailty units in A&E will ensure older patients are assessed and supported before being moved into home-based care.
However, it is essential that the government addresses potential inequality and access issues. Not all homes are suitable for at-home care, and vulnerable patients may face higher risks. Ensuring proper staffing, accessible technology, and emergency support will be critical.
If implemented properly, Hospital at Home could be a game-changer for Scotland's NHS. It won’t work for everyone, but for many, it will mean the difference between a stressful hospital stay and a comfortable recovery at home. Whether this becomes the “biggest hospital in Scotland”, as the government hopes, remains to be seen, but the ambition is clear.
