Hospital at home guiding principles for service development – summary: October 2025

The guiding principles contains information for NHS boards and local authority staff involved in the development of hospital at home services in Scotland.

Purpose of the guiding principles

It is intended to assist in the local and regional planning of specialist services which support people to receive hospital-level care at home. The guidance provided in the document is an update to our previous publication focusing on services for frail older adults. It also includes new guidance on respiratory and heart failure adult hospital at home pathways.

This is not intended to be a stand-alone guide to setting up a hospital at home service. Instead, we recommend using it alongside support from us and the Scottish hospital at home community.

Further guidance and resources are available via our learning system, on our website and via our Microsoft Teams community page.

Key points

  • Hospital at home is a service that provides acute, hospital-level care by healthcareprofessionals in a home context, for a condition that would otherwise require acute hospital inpatient care.
  • Two key drivers for developing a hospital at home service are:
    • providing a more person-centred care experience for the patient, and
    • the need to reduce pressures on acute hospitals.
  • The evidence for hospital at home is positive. It demonstrates similar or improvedoutcomes for older adults when compared to hospital care as well as increased patient and caregiver satisfaction, and cost-effectiveness. However, more high-quality evidence, relevant to the Scottish context and disease-specific pathways, is required.
  • Hospital at home aligns with the objectives of the Public Bodies (Joint Working)Scotland Act 2014, Carers (Scotland) Act 2016, the Scottish Government Operational Improvement Plan 2025, the Health and Social Care Service Renewal Framework 2025, Realistic Medicine and Value Based Health & Care.
  • Hospital at home complements other community healthcare services that aim tokeep patients at home. It provides a distinct level of care in patients’ homes to avoid unnecessary hospital admission.
  • Hospital at home interfaces with a variety of other health and social care servicesto provide a holistic service.
  • All hospital at home services in Scotland align with the current definition.However, services are adaptable to local need and operate differently depending on local context.
  • Safe and effective hospital at home services are achievable with:
    • clear referral pathways
    • effective processes
    • appropriate workforce planning
    • strong senior leadership and governance, and
    • impactful evidence, experience and engagement activity.
  • Healthcare Improvement Scotland has produced a set of maturity criteria forservices to measure their progress.
  • Several tools and resources are available for hospital at home professionals. These can be accessed via multiple sources.