Hospital at Home in Scotland evaluation: phase 1 findings report
The report presents findings from the first of two phases within a national evaluation of Hospital at Home services in Scotland. Phase 1 of the evaluation is a process evaluation.
Footnotes
1 NHS Scotland’s Operational Improvement Plan includes an additional £220 million investment, as contained within the 2025-26 Scottish Budget. A portion of this funding was used for the expansion of Hospital at Home services to 2,000 beds by December 2026.
2 Respondents who said that they were not aware of any H@H provision in their Health Board were routed directly to the end of the survey and were not asked any further questions. Those who said that they had ‘never’ referred into H@H were omitted from some, but not all, of the remaining questions - see the Workforce Survey Questionnaire in Appendix C.
3 Hospital at Home services in Scotland do not provide a 24-hour service. Whilst there are a wide range of delivery models, most services deliver care 5 or 7 days a week, for 10 to 12 hours a day (often 8am to 6pm or 8pm). In this context, Out-of-Hours refers to the periods outwith the working hours of the local service.
4 Remote monitoring involves the use of devices to monitor patients’ physiological parameters and detect any deterioration. In NHS England, ‘virtual wards’ and services that solely deliver remote monitoring can be referred to as Hospital at Home. However, this does not meet the NHS Scotland definition. Remote monitoring is in use in some areas in Scotland, but it is adjunctive to face-to-face care in the context of H@H.
5 In previous work by the Scottish Government, ‘Connect Me’ - with a focus on Covid remote health monitoring - was also included within Virtual Capacity, however, it is not included under the existing H@H definition.
6 There are 14 territorial Health Boards in Scotland which cover specific geographical regions (e.g. NHS Ayrshire and Arran, NHS Borders, etc.) and are responsible for the healthcare of their population (Organisations - Scotland's Health on the Web).
7 Please note, the H@H service in Dumfries and Galloway was suspended in December 2025.
9 For H@H, an alternative to admission outpatient service involves a patient attending a clinic for a short appointment, which may be a consultation with a specialist healthcare professional, a test, scan or procedure/treatment. This does not require an overnight stay.
10 It should be noted that the community-based referral routes (e.g. GP, Pharmacy, etc.) outlined in Figure 1 are an illustration of potential routes, but this should not be considered as an exhaustive list.
11 It should be noted, as set out by PHS in their March 2026 management information release on H@H activity, that accurately converting community-based activity into “bed equivalents” is complex because H@H capacity is flexible and does not operate like fixed inpatient beds in a hospital.
13 NHS Scotland’s Operational Improvement Plan includes an additional £220 million investment, as contained within the 2025-26 Scottish Budget. A portion of this funding was used for the expansion of Hospital at Home services to 2,000 beds by December 2026.
15 Those who said that they had ‘never’ referred into H@H were not asked: How would you describe the process of referring patients to a Hospital at Home service? (Almost always straightforward, Mostly straightforward, Sometimes straightforward and sometimes difficult, Mostly difficult, Almost always difficult).
16 Note that responses to open-ended questions suggest that some respondents who answered ‘never’, had previously referred to H@H, but no longer did so (often for reasons linked to perceived low levels of referral acceptance).
17 Only referrer respondents who did not answer ‘Never’ or ‘I’m not aware of any available Hospital at Home services in my Health Board’ were asked how easy or difficult they perceived the referral process to be. Had all respondents been asked, it may have impacted the findings around perceived ease of referral.
18 Hospital at Home services in Scotland do not provide a 24-hour service. Whilst there are a wide range of delivery models, most services deliver care 5 or 7 days a week, for 10 to 12 hours a day (often 8am to 6pm or 8pm). In this context, Out-of-Hours refers to the periods outwith the working hours of the local service.
19 Point of care testing allows certain diagnostic tests (such as blood or ultrasound tests) to be performed at the site of the patient without sample analysis in a hospital laboratory. This allows results to be received rapidly on site and, in Hospital at Home settings, means that routine tests could be performed in the patient’s home.
20 Remote monitoring involves the use of devices to monitor patients’ physiological parameters and detect any deterioration. In NHS England, ‘virtual wards’ and services that solely deliver remote monitoring can be referred to as Hospital at Home. However, this does not meet the NHS Scotland definition. Remote monitoring is in use in some areas in Scotland, but it is adjunctive to face-to-face care in the context of H@H.
21 A definition for ‘senior leadership’ was not provided to respondents, meaning interpretation of this term was based on the respondent’s perception.
22 Following the production of the logic model, sub-national planning structures have been introduced. It is anticipated that they will be key partners that the Scottish Government will work with in the future to support the design and development of services.
23 Please note that some outcomes were viewed to sit under more than one overarching objective. These have been demonstrated in Figure 6 via the corresponding colours in their border and have been mentioned in the text-only description of the logic model.
24 Non-territorial Health Boards refers to the National NHS Boards who support the territorial Health Boards by providing national and specialist level services. These include: Healthcare Improvement Scotland, Scottish Ambulance Service, NHS Public Health Scotland, NHS National Waiting Times Centre, NHS 24, The State Hospital Board for Scotland and Public Services Delivery Scotland (merger of NHS Education for Scotland (NES) and NHS National Services Scotland (NSS)).
25 To support the mitigation against risk of respondent disclosure, a number of survey response options have been amalgamated into the ‘Other’ category presented in Table A1. This includes response options: Advanced Clinical Practitioner, Clinical Fellow, Pharmacist, Resident Doctor, Specialty Doctor. As such, the total presented for ‘Other’ is a sum of responses to these response options, and the ‘Other’ response option.
26 It should be noted that the qualitative research reported here revealed that some individuals used the term ‘services’ instead of ‘pathways’ when referring to different H@H service elements, and this may have confounded responses to this question as provided in the survey, i.e. not everyone may have understood what was meant by multiple pathways.
27 To support the mitigation against risk of respondent disclosure, a number of survey response options have been amalgamated into the ‘Other’ category presented in Table A3. This includes response options: Advanced Clinical Practitioner, Pharmacist, Nurse and Manager. As such, the total presented for ‘Other’ is a sum of responses to these response options, and the ‘Other’ response option.
28 Please note that the individual statements in Questions 6, 7 and 14 were counted as individual questions meaning a total of 27 questions were included in the Workforce Survey. For most survey questions, respondents were able to select a single response from the options provided. The exceptions to this were questions which state “select all that apply” (whereby respondents could select multiple or all responses if they wished) and questions which state “Free-text question” (whereby respondents could type their response)
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