Penny Shepherd analyses “Hospital at Home for frailty: Current situation and future potential” (British Geriatrics Society / UK Hospital at Home Society, August 2025)…
“Hospital at Home” services provide hospital-level clinical care in their own homes for patients who are sufficiently unwell to otherwise be admitted to acute hospitals. Shifting care from acute hospitals into community-based services is one of the three key priorities in the new NHS Ten Year Plan. Today’s “Hospital at Home” services are demonstrating how this will work in practice for frail older people, including those without access to informal care.
These services are popular and, according to analysis referenced in a recent report, may deliver better health outcomes than hospital admission. However, they are sometimes designed without access to support for activities routinely provided in acute hospitals such as food preparation and help with washing and dressing, the report says. This introduces a dependence on “family and friends” being available to help and may result in patients who could otherwise clinically benefit from hospital at home having to be admitted to hospital instead.
AWOC East Kent highlighted in its earlier submission to the NHS Ten Year Plan the risk of health inequalities for those without informal care if these hospital services were not included in “hospital at home” support. We hope that this more recent report by these two prestigious health societies – the British Geriatrics Society and the UK Hospital at Home Society – will act as a wake-up call to the NHS and to the Independent Commission on Adult Social Care (Casey Commission) to ensure that no-one’s access to the best clinical care is impacted by whether or not they have sufficient personal support.
The report “Hospital at Home for frailty: Current situation and future potential” describes current services providing hospital-level clinical care for frail older people who would otherwise be admitted to acute hospitals. The foreword by Dr Shelagh O’Riordan, UK Hospital at Home Society President Elect, Consultant Geriatrician in Kent, and Professional Adviser to NHS England, highlights the popularity of the schemes with patients. “I can’t tell you how often I am hugged by a patient .. as I leave!”, she says.
The report highlights that “a meta-analysis and systematic review published in Age and Ageing shows that people cared for in Hospital at Home may have improved cognitive and functional outcomes when compared to hospital admission”. (Section 4: What is the evidence base?)
However, according to the report, AWOCs in some parts of the country may be deemed “unsuitable” if they have no informal care. The report says “It is important to note that people receiving care from a Hospital at Home team must be able to manage at home without support or have family or friends around who can help them to carry out daily activities such as preparing food, washing and dressing. Some Hospital at Home services have access to urgent personal care services that can support people who cannot manage on their own and do not have family to help them. If this support is not available through the Hospital at Home team or through the individual’s own family or friends, Hospital at Home may not be suitable for this individual and they may need to be admitted to hospital.” (Section 5: Patient Experience)
The report says also that unacceptable strain may sometimes be placed on family carers suggesting that the need for personal support goes beyond patients with no informal care.
Shifting care from acute hospitals into community-based services should be a positive step towards addressing some of the challenges that AWOCs experience with in-patient care, but unless the NHS learns from this report and recognises that we are a significant and vulnerable group needing inclusive service design, it could be an alarming development for those of us without family or friends to provide additional care.
Penny Shepherd
Penny Shepherd is an AWOC trustee and a steering committee member of AWOC East Kent.
