Hospital at Home evaluation

Evaluation summary

In 2023/24 Health Innovation Oxford and Thames Valley carried out an evaluation into the impact and implementation of ‘Hospital at Home’ services – also known as virtual wards – in the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS)*. Delivered by multi-disciplinary teams, Hospital at Home (HaH) services aim to prevent hospital admissions and support early discharge by providing hospital level support, care and treatment, either virtually or in person for up to 14 days in a patient’s home or care home. Across BOB ICS, six healthcare providers** deliver HaH services, providing 500 adult beds and 12 paediatric beds. Between September 2023 and January 2024, the HaH services provided care to 6,500 adults and 320 children, adding up to a total of 46,685 bed days for adults and 715 bed days for children. HaH services were primarily focused on avoiding hospital admission (60% of referrals). The majority of patients (88%) were treated at home rather than in care homes.

Patient profiles

The evaluation found that these services effectively managed a variety of acute illnesses and exacerbations of chronic conditions in adults, including chronic obstructive pulmonary disease (COPD), COVID-19, heart failure, pneumonia, and urinary tract infections, and provided palliative care for those with advanced or life-limiting illnesses. On average, adult patients had a HaH length of stay of seven days, were typically older (average age of 74), exhibited moderate frailty (average clinical frailty score of 6), and a notable proportion lived alone (35%). The children were very young with an average age below one year, and primarily treated for acute bronchiolitis (67%). They also had a shorter average length of stay of two days. Both adults and children had low readmission rates to HaH services within 28 days (below 10%).

System and workforce impact

The evaluation found that the intervention significantly reduced the need for emergency services within 28 days of discharge, particularly for older patients and those with longer HaH stays. Emergency admission rates fell by 73% for adults and 85% for children. There was also a reduction in ambulance journeys of 69% (83% for children) and a fall in calls to 111 of 58% (85% for children). Also, most patients (83% of adults and 97% of children) were discharged with no new or additional needs for support from health and social care. There was positive feedback from HaH staff – but some challenges and training needs were also identified. HaH services in BOB are one of several complementary services treating acutely unwell patients in the community.

Next steps

Further evaluation is needed to determine the longer term impact of these services and to understand how variations in service delivery affect patient outcomes.

 

* BOB ICS is a partnership of organisations covering three places: Buckinghamshire, Oxfordshire, and Berkshire West.

** The six healthcare providers delivering Hospital at Home (HaH) services across BOB ICS are:

• Royal Berkshire NHS Foundation Trust
• Berkshire Healthcare NHS Foundation Trust
• Oxford University Hospitals NHS Foundation Trust
• Oxford Health NHS Foundation Trust
• Buckinghamshire Healthcare NHS Trust
• Principal Medical Limited

This short video explains more about the HaH services in Oxfordshire.