Hospital at home: services to reduce hospital admissions lack enough trained staff

The Royal College of Physicians of Edinburgh (“the College”) is welcoming moves to expand Hospital at Home provision, but has warned that further investment in staffing to support these services is essential and that their impact on informal carers must also be fully assessed.

Hospital at Home is designed to offer short-term, targeted acute hospital care in an individual's own home - equivalent to that provided within a hospital.

On 10th May, The Scottish Government announced a further £3.6m to expand Hospital at Home.

Setting out its position on Hospital at Home ahead of a Holyrood debate on Tuesday 30th May, the College said that Scotland is experiencing a shortage of trained healthcare staff and warned that Hospital at Home services must be in addition to and not instead of current care provision.

Commenting Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

The Royal College of Physicians of Edinburgh welcomes the Scottish Government’s interest in alternatives to inpatient care or admission, especially for elderly people, and acknowledges its investment in Hospital at Home. We support efforts to prevent unnecessary hospital admissions and recognise that many older people risk experiencing deconditioning if they are admitted to hospital.

We are very clear, however, that Hospital at Home services must be developed and resourced in addition to existing services, not instead of existing services. In addition, they should not be resourced at the expense of existing services, particularly in the hospital sector which remains under such great pressure.

Hospital at Home services require the input of adequate numbers of well-trained staff across multidisciplinary teams including medical, nursing, rehabilitation therapy and care staff. We do not have sufficient numbers of such staff at present, either in hospitals or in the community, and we will need to see more recruited as our population continues to age and their care needs rise.

Informal carers, who are more frequently female and may be family or friends of the older person, already provide a massive amount of domiciliary support to older people. We must therefore also ensure that any additional impact on carers of managing the older person at home during intercurrent illness is adequately evaluated. The provision of respite care for informal carers in Scotland is already scant, and an expectation that such carers also take on care during periods of increased patient need, cannot pass unquestioned.

Finally, we would wish to emphasise that access to acute hospital care for older people has been hard won over many years and their right to access such care should not be eroded by the development of alternative domiciliary services, unless those services can fully meet each patient’s individual needs.