Aberdeen researchers say expanding Hospital at Home services to unwell children could work to slow the “unsustainable” tide of paediatric hospital admissions – but a royal college warns that any further extension will need more staff.

Research suggests urgent short-stay admissions of children to Scottish hospitals are rising rapidly, partly as a result of a lack of capacity in community care and earlier discharge.

The University of Aberdeen’s Dr Smita Dick and Professor Stephen Turner say Hospital at Home – which allows people to receive acute care outwith hospital wards – could slow and potentially reverse this trend.

Dr Dick says similar programmes have shown promise down south:

“In Scotland today there are 15 Hospital at Home beds per 100,000 adults, with an ambition to rise to 40-50 beds. Currently there are no Hospital at Home beds for children in Scotland.   

“However, we know that Hospital at Home for children is a success since it has been rolled out in many English towns and cities, it would be great for children and parents if Hospital at Home could be rolled out in Scotland.”   

The Hospital at Home programme has been in operation in Scotland for more than a decade, with services now available in nearly every health board area.

These consultant-led teams have this month been bolstered by a further £3.6m, which Health Secretary Michael Matheson told parliament earlier this week will increase capacity by 50% by the end of this financial year.

However, the Royal College of Physicians of Edinburgh has raised concerns Hospital at Home services lack enough trained staff.

Ahead of a Holyrood debate on Hospital at Home held on Tuesday, RCPE President Professor Andrew Elder said the college welcomed the government’s interests in alternatives to inpatient care – especially for older people – but that this must not come at the expense of existing services:

“We support efforts to prevent unnecessary hospital admissions and recognise that many older people risk experiencing deconditioning if they are admitted to hospital.

“We are very clear, however, that Hospital at Home services must be developed and resourced in addition to existing services, not instead of existing services. In addition, they should not be resourced at the expense of existing services, particularly in the hospital sector which remains under such great pressure.

“Hospital at Home services require the input of adequate numbers of well-trained staff across multidisciplinary teams including medical, nursing, rehabilitation therapy and care staff. We do not have sufficient numbers of such staff at present, either in hospitals or in the community, and we will need to see more recruited as our population continues to age and their care needs rise.”

The Aberdeen researchers say their past research also suggests other alternatives to hospital admissions for unwell children – like out of hours GPs and short-stay observation areas within hospitals – are largely ineffective.

However, the team says telemedicine has shown considerable promise in reducing admissions.

Dr Dick says it is vital Scotland finds interventions that work to bring down the “unsustainable” year-on-year increase in paediatric urgent hospital admissions, with hospitals “bursting at the seams”:

“Around 60% of children admitted to hospital as an emergency case are in hospital for less than 24 hours. This suggests that many of those children might have been treated at home rather than in hospital.”  

Read more: Expanding hospital at home services;

 

 

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