Hospital at Home Programme - virtual capacity: equality impact assessment

Background

Pressures on acute hospital services has been increasing for some time against a background of rising attendances and increasing complexity and acuity (which have been exacerbated by, but were evident pre-pandemic) that reflect changes in the capacity and demand profiles of the Health and Social Care system across Scotland.

Virtual services, specifically Hospital at Home has been operating in Scotland since 2011. Since the beginning of 2022 the Scottish Government has been focused on rapidly expanding our virtual capacity pathways in the healthcare system, to ensure people are being treated in the most appropriate setting for their healthcare needs. As well as managing ongoing pressures on acute care and supporting recovery towards a sustainable future. By ensuring there is enough capacity within the community to provide care closer to home, we can provide treatment for conditions that would traditionally require patients to experience a hospital stay. We recognise that there are many occasions where a hospital admission is not necessary and in these instances, delivering care at home or in a community setting, is to the benefit of patients.

There is significant evidence that initiatives that reduce hospital activity, such as admissions avoidance pathways and supporting people to manage their own care, have the potential to improve patient experience, overall health outcomes and maintain vital independence. Keeping care close to home and in a preferred place can increase an individual’s choices over their care. For example, Hospital at Home has consistently delivered improved levels of patient satisfaction compared to in hospital care, and remote monitoring has reduced mortality for heart failure patients. Care is structured around the person’s needs provided by multi-disciplinary teams. Qualitative evidence demonstrates that patients valued being in the comfort and familiarity of their own home, and reduced disruption to daily routines.

This work focuses on five priority pathways:

• Hospital at Home: General Adult and Older People
• Respiratory Services
• Outpatient parenteral antimicrobial therapy (OPAT)
• Heart Failure
• Paediatrics

The Virtual Capacity Programme is led by the Scottish Government in collaboration with Healthcare Improvement Scotland and the Centre for Sustainable Delivery.