AN INCREASED reliance on hospital-at-home services should not be allowed to pile extra pressure on unpaid carers, doctors have warned. 

The Royal College of Physicians Edinburgh (RCPE) said that while it welcomed increased investment in efforts to get patients out of hospital earlier and reduce admissions, such initiatives will require extra staffing. 

It added that the impact of the expansion of Hospital at Home provision on informal carers "must also be fully assessed".

It comes as MSPs prepare to debate the issue after the Scottish Government announced extra funding of £3.6 million for Hospital at Home earlier this month to create 156 additional "virtual beds" - an increase of 50 per cent. 

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The scheme, which has received nearly £11m since its rollout in 2020, is designed to provide short-term targeted acute hospital care in an individual's own home. 

Setting out its position, the College warned that Scotland is experiencing a shortage of trained healthcare staff and that Hospital at Home services must be in addition to - not instead of - current care provision.

Professor Andrew Elder, president of the RCPE, said: “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."

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A UK-wide study by the National Institute of Care Research (NICR) published last year found that over-65s who were cared for at home were slightly less likely to be admitted into a care home, and that the hospital-at-home service was not associated with any increased level of deaths within six months or a year compared to hospital admissions. 

It was also cheaper, and both patients and their caregivers preferred the service over hospital care. 

The findings, based on 1000 older adults in nine UK locations, also found that the homecare group had less risk of delirium at the one-month follow-up. 

However, researchers added that the "impact on caregivers of looking after someone with delirium at home needs to be considered in future studies". 

Prof Elder added: “Informal carers, who are more frequently female and may be family or friends of the older person, already provide a massive amount of domiciliary support to older people.

"We must therefore also ensure that any additional impact on carers of managing the older person at home during intercurrent illness is adequately evaluated.

"The provision of respite care for informal carers in Scotland is already scant, and an expectation that such carers also take on care during periods of increased patient need, cannot pass unquestioned.

"Finally, we would wish to emphasise that access to acute hospital care for older people has been hard won over many years and their right to access such care should not be eroded by the development of alternative domiciliary services, unless those services can fully meet each patient’s individual needs.”

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Health Secretary Michael Matheson said: “Hospital at Home has already proved to be very successful and most importantly, beneficial to patients and the wider system.

“That’s why we have allocated a further £3.6 million so more people can be managed at home rather than in hospital.

“Patients have spoken very positively about the service and it also reduces pressure on A&E and the Scottish Ambulance Service by avoiding admissions and accelerating discharge.

"Hospital beds will always be available to people who need them, but this is a better alternative for many.”