Although the older population is rising, a third fewer acute hospital beds exist today than 25 years ago (4). Despite this, hospital emergency admissions in England continue to rise at 2-3% per year (5). Hospitals have historically coped with this increase by reducing the average length of stay for patients, however this fall in length of stay has flattened and in the past few years in England, and it has started to rise for the over 85 population (6). Nearly two-thirds of people admitted to hospital are over 65 and an increasing number are frail or have a diagnosis of dementia (7). Clinicians freely admit that they are not well equipped to cope with patients who have multiple complex needs, including dementia (7).

These issues do not only cause issues for older people, however, as younger adults and children & young people are also at risk of iatrogenic harms from hospital admission. In addition, hospital admission can be distressing and stressful for both patients and their loved ones, at any age.

Hospitalisation is a major issue and decision makers across the NHS are attempting to reconfigure services to respond to rising needs, often with an inadequate evidence base. Of concern is the tendency for different service models to evolve within the NHS without supporting evidence or adequate evaluation. The risk is that some of these service models are short lived, modest in scope, and have the potential to divert resources from other parts of the health system or duplicate services.

The need for new, evidence-based models of care is critical.

Admission-avoidance Hospital at Home (HaH) care, potentially with CGA (if appropriate), provides co-ordinated, multi-disciplinary, and integrated care in the home for people who would otherwise be admitted to hospital. This level of care requires additional training for community staff, to equip them with the expertise to look after higher acuity patients than has been the normal for community services. Evidence for admission-avoidance HaH comes from a Cochrane Review (N=16 RCTs, recruiting 1814 patients) (8).

This update of the review found “little or no difference” to mortality at 6 months as a result of admission-avoidance HaH (RR 0.77, 95%CI 0.60 to 0.99, 912 participants). There is a suggestion that it may increase satisfaction, and reduce both likelihood of requiring residential care at 6 months and costs, but these outcomes remain uncertain at present.

DID YOU KNOW....

• Patients and families often prefer the comfort of Hospital at Home to Acute Care hospitals

• General Practitioners value Hospital at Home for continuity of care

• Acute Hospitals appreciate implementing early, safe discharges to Hospital at Home

• Administrators can prefer Hospital at Home for value-based services

• Preferred by health care professionals who prefer to take care of patients in the patient’s home environment

• Health Care providers develop strong patient/family provider partnerships

• NHS recognises positive health care outcomes from Hospital at Home

References:

• Edgar K, Iliffe S, Doll HA, Clarke MJ, Gonçalves-Bradley DC, Wong E, Shepperd S. Admission avoidance hospital at home. Cochrane database of Systematic Reviews 2024, Issue 3

• NHS Long Term Plan: Chapter 1 - A New Service Model for the 21st Century. London: NHS, 2024

   

• Department of Health, Policy & Strategy Directorate 2008 Delivering care closer to home: meeting the challenge

   

• Imison C, Poteliakhoff E, Thompson J. Older people and emergency bed use. Exploring variation. London: King’s Fund, 2012.

   

• Hospital Episode Statistics. http://www.hscic.gov.uk/hes

   

• Royal College of Physicians. Hospitals on the Edge? The time for action. London: RCP London

   

There are more references on our Research and Resources page - covering topics such as patient and carer outcomes and satisfaction, service models and reviews.