NIHR-funded research confirmed that caring for a select group of older, frail patients in their homes - rather than admitting them to hospital - can deliver better and less expensive care. The evidence from this research informed a new policy on a hospital at home model with NHS England, resulting in over 10,000 virtual ward beds being created.
Published: 21 August 2024
When is hospital not the best option?
Nearly two thirds of people admitted to hospital are over 65. Many are frail or have dementia and are admitted after a fall or illness. Although they need treatment, hospital admission can be linked to a loss of physical ability, confusion and an increased risk of delirium. All of these effects can hasten the move from independent living to a care home.
In addition to this, demand for hospital beds continues to rise. The NHS must therefore look for ways to manage hospital admissions while providing the best patient care.
One option is the hospital at home scheme. Also known as virtual wards, this approach brings specialist teams to the patient’s home instead of taking the patient to hospital.
This approach became more common during the Covid-19 pandemic in 2020, but as Sasha Shepperd, Professor of Health Services Research at Oxford Population Health, University of Oxford explained: “Up until now, nobody has known whether to fully invest in hospital at home nationwide, or to focus on hospital care.”
Funded by an NIHR award of £2.2 million, Professor Shepperd and her team investigated whether hospital at home could improve healthcare for older people. Their evidence would inform policymakers’ decisions about whether to expand the services nationwide.
Hospital at home is a safe alternative to inpatient care
The research team recruited more than 1,000 older people (over 65 years) from across the UK and randomly assigned them to either hospital or hospital at home care. The patients had all been referred for urgent hospital admission because of a sudden change in health.
After 6 months, around three quarters of patients from both groups still lived at home. Those who received hospital care were slightly more likely to have moved into residential care. Their findings were published in Annals of Internal Medicine.
The number of patients who had died in either group at 6 months was very similar (around 17%). After 1 month, patients who were treated at home were less likely to experience extreme confusion.
Overall, patients preferred hospital at home care and said that communication with their care staff was better.
When the team compared the cost of care, they found that hospital at home was less expensive overall than inpatient treatment. Savings made through staff time, medicines, transport and residential care totalled around £2,265 per patient. The savings increased to £2,840 when informal care costs were also included. These results were published in the journal Age and Ageing.
Policy changes to cut costs and improve care
The team’s findings gave policy makers and healthcare providers timely answers. In 2021, their evidence informed a new policy on a hospital at home model with NHS England. By September 2023, the NHS had rolled out 10,000 virtual ward beds.
As a result, more than 240,000 patients have benefited from being treated and monitored by virtual wards in their own home. This service is credited with freeing hospital beds and saving NHS resources.
According to Rowan Harwood, Professor of palliative and end-of-life care at the University of Nottingham: “Hospital at home is one of the most important developments of recent decades. Large-scale trials to evaluate cost-effectiveness allow us to prioritise innovations like this against other services.”
The study was funded by the NIHR Health and Social Care Delivery Research Programme and published in Health and Social Care Delivery Research.
More information about the study is available on the NIHR’s Funding & Awards website.