Executive Chair of InnoScot Health, Graham Watson looks at how the service can develop

The rise of the Hospital at Home service across Scotland is undeniable, and already a success, but is it set to be the future cornerstone of community-first healthcare?

In essence, Hospital at Home provides short-term, acute hospital-level care directly in a patient’s own home instead of a traditional hospital ward, providing comfort and familiarity to them whilst lowering pressure on acute services and reducing risk of hospital-acquired infections.

A report from Health Improvement Scotland (HIS) for the period April 2025-March 2026 concluded that the service had saved more than £60m, including an estimated £18.8 million in healthcare costs as well as a further £44.3 million saved on projected post-discharge treatments across six months.

If accurate and sustainable, these are impressive figures by any yardstick with unnecessary expenditure on hundreds of physical hospital beds reportedly also avoided and over 500 residential care home admissions prevented, according to HIS.

The Scottish Government said in late 2024 that it aimed to make Hospital at Home the “biggest hospital in the country”—and that goal was achieved between October and December last year when the amount of care provided by the programme became higher than any other setting in Scotland.

As part of that attainment, it is thought that the service reached more than 17,000 people over the age of 65 in the 2025-26 financial year.

Indeed, while the service predominantly helps frail, older adults avoid hospital stays, its clinical scope continues to broaden—from respiratory and intravenous outpatient parenteral antimicrobial therapy (OPAT) to paediatric and neonatal care for children, with hundreds already receiving specialised care.

NHS Forth Valley has recently announced its own Hospital at Home expansion, including development of a new 10-bed respiratory virtual ward for patients with acute respiratory conditions, creation of five new OPAT Hospital at Home beds, and extending Hospital at Home capacity for older people from 25 to 30 beds.

Professor Jann Gardner, Chief Executive at NHS Greater Glasgow and Clyde, has spoken publicly about the opportunities which the entire spectrum of community-first innovation is capable of offering to help support patients.

She has said: “In structural reform, we need to harness opportunities as they begin to unfold, to be able to work differently, to come together more cohesively, and certainly in the world of virtual, there is greater opportunity.

“It’s not one continuum, it’s not a virtual hospital, it’s not a wearable device, it’s not a hospital at home. I think it is us thinking about the physicality of a hospital and care setting, and then how do we use all elements of a virtual space from right across the spectrum, from wearing technology, right up to that much more significantly supported hospital at home model.

“So, we want to see these elements, we want to see people remaining in the community, we want to see the reduction in our waiting times, we want people to be able to get to the right place at the right time. We want to move to a more digital way of being.”

So, does the Hospital at Home service represent the central tenet of community-first Scottish healthcare in future? Arguably, it already is.

With Hospital at Home admissions in most cases costing less than hospital admissions and all figures pointing in the same positive direction, the service is evidently here to stay, underlined by an £85 million investment announced by the First Minister John Swinney to extend capacity to 2,000 equivalent beds by December this year.

The success of the service also goes beyond figures and efficiencies – clinical data and direct feedback highlight high patient satisfaction with older or vulnerable patients reporting that they are able to maintain normal sleep and daily routines.

While there are challenges in delivering a consistent service right across the country – including a fluctuating clinical scope, funding constraints having an occasionally unpredictable effect, and recruitment issues/staff shortages in achieving the right multidisciplinary balance – all other indications so far point to it fundamentally working well.

Hospital at Home is undoubtedly innovative and has already proved to be transformative, but the learning must continue, with gaps closed, inconsistencies ironed out, and further analysis undertaken to ensure it can reach its maximum potential.

If such research can challenge the service and rigorously evidence its value to Scottish healthcare, then we stand on the brink of something truly special.

How that new evidence aligns with previous findings, and if the service can be further scaled with growing efficiencies while ensuring equitable access right across the system, is perhaps the real question.