13 - 2025-09-17 IJB - Hospital at Home
North Lanarkshire Council · 17 September 2025
Back to Health and Social Care Integration Joint Board — 17 September 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 13 SUBJECT: Hospital at Home TO: IJB Performance Finance Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NL HSCP Author(s) of Report Nicola Kelly, Interim Service Manager Contributor, Dr Claire Steel, Clinical Lead Hospital at Home DATE: 17 September 2025 1. PURPOSE OF REPORT This paper outlines the current provision of the Hospital at Home (H@H) service within Lanarkshire, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: prepared by Nicola Kelly, Interim Service Manager and reviewed by Lorraine Smith, Interim General Manager and Maggs Thomson, Head of Health, NHSCP. Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ 3. RECOMMENDATIONS
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2 It is recommended that the IJB note that in line with the Board’s Unscheduled Care strategy, that work is underway within the H@H service with the aim to expand the virtual bed capacity and equity of services with the roll out of provision to Cambuslang/Rutherglen locality. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND The Hospital at Home (H@H) service in Lanarkshire has been operational for over 12 years and was the first established service in Scotland. Currently there are 103 virtual beds and with expansion, the plan is to increase this to 125 virtual beds. It continues to be the largest H@H service, consisting of four hubs across Lanarkshire with links to each of the three acute hospitals, this would increase to 5 hubs and extend links to GG&C hospitals for patients accessing Hospitals in Glasgow from Cambuslang and Rutherglen. The service has expanded from its original admission avoidance to include step-down support following inpatient admission. Crucially, the H@H service is a key part of the Board’s health and social care strategy “Our Health Together 2024- 2031” to keep people well at home and to deliver better care by maximising care delivered in the community closer to patients’ homes. North Health and Social Care Partnership have received funding from Scottish Government to deliver whole-system and sustainable improvement through the existing Unscheduled Care for 2025/26. The additional funding for H@H service is £1.2m to scale up capacity and equity of services across the Partnerships. This is in addition to the annual Budget of £3,965,945. Both North and South Health and Social care Partnerships in addition to the Scottish Government funding arrangements jointly fund this annual budget. This new initiative gives an additional £1.2 million to continue to fund the service within the Clydesdale Locality and to develop a new service within the Cambuslang/Rutherglen area and development of a pharmacy support team. 5.1 WORKFORCE The service is currently Medically (Consultant) led and each of the 3 original Hubs are supported by Consultant Geriatricians from the associated Acute Yes ☐ No ☒ N/A ☐
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3 Hospital Site. Non-recurring funding has resulted in recruitment challenges with staff facing redeployment and an inability to recruit to vacancies, as posts are not on a permanent basis. The core budget for the service is £3,285,182 this is supplemented by non-recurring funding from Healthcare Improvement Scotland (HIS) £356,689 and South Health Social Care Partnership funding of £324,074. Replicating the original operating model into Clydesdale provided challenges due to the lack of available Consultant Geriatricians within the recruitment market. This meant a Consultant led model was not possible. As an alternative, the introduction of Advanced Nurse Practitioners and Advanced Practitioners (ANPs & APs) into the H@H model was developed. In principle, qualified and experienced Advanced Practitioners could work autonomously as a clinical decision maker working in collaboration with Consultant Geriatricians. To support this model, a Specialty Doctor was recruited for the Wishaw Hub to support the expansion into Clydesdale. This year has seen qualified ANPs increase to five. There are a further three Trainees currently being supported by a Senior ANP, Team Leaders and Practice Development. One of the remaining trainees is due to complete training by March 2026 with the remaining two Trainees expected late 2026. Further expansion into the team, has seen the introduction of GP Trainees, with seven GP Trainees having worked within the Service since August 2024. The recruitment process is underway to develop H@H services within Cambuslang & Rutherglen. Approval to recruit to posts has been agreed until 31st March 2026. 5.2 PERFORMANCE Admissions to H@H are a vital alternative to hospital admission as well as providing step down care for patients discharged from hospital who would benefit from ongoing medical intervention. On average 80% of patients within the service, are for admission avoidance and 20% are step down patients. From January to July 2025, there have been 2508 patients’ referred into the service. The breakdown is noted below: Location Admission avoidance Stepdown Total
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4 UHM 753 214 (22%) 967 UHH 559 101 (15%) 660 UHW 588 96 (14%) 684 Clydesdale 156 41 (20%) 197 Total 2056 452 (18%) 2508 On average, there are 358 patients per month referred to H@H. This is an increase from 2023 which saw an average of 260 patients per month. The average length of stay figures for each Hub are noted below: 2021/2022 2022/2023 2023/2024 2024/2025 UHM 6.01 5.7 4.55 4.87 UHH 8.02 7.4 7.5 6.5 UHW 10.48 9.3 7.77 6.14 Clydesdale x x 8.4 10 Total 8.17 7.46 7.05 6.87 The average length of stay in Clydesdale is greater than all other Hubs. This may be reflective of the nurse led model and has influenced proposals for the Cambuslang & Rutherglen model. 5.3 FINANCE The annual budget for H@H is £3,965,945. This includes pays and non pays. The budget is made up of substantive and yearly allocations from Health improvement Scotland, Scottish Government and NHS Lanarkshire.
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5 The financial position as at Month 4 2025/2026 financial year is as follows: The Pays budget is reviewed/scrutinised/managed accordingly in-line with allocated funds. 5.3 TECHNOLOGY Remote Patient Monitoring (DOCCLA) The introduction of DOCCLA into the service has facilitated remote monitoring of patients vital signs in real time, leading to improved patient outcomes and improving continuous patient engagement. The system also supports video calling potentially reducing face-to-face visits, a more responsive consultation time and overall efficiencies within the service. Although within its infancy, we are promoting DOCCLA with all new patients, particularly those within the Care Home setting. From July 2025, the service has used DOCCLA monitoring on 142 patients. Point Of Care Testing (POCT) POCT allows the testing of certain bloods within the patient’s home. This enables rapid diagnostic results on site. POCT could also enable healthcare professionals to provide diagnosis, monitoring and treatment without the need for the patient to visit the hospital. The service is evolving and developing each year with a recent expansion into a large, rural part of the county, Clydesdale. In 2024, the service decided to trial the use of point of care blood testing to address the need for new ways of working to overcome challenges in providing remote H@H care. Efficiency Core Budget 2,803,445 Clydesdale 324,074 Non recurring for 1 year HIS 356,689 Funding until 31/12/2027 Step Down 481,737 Non recurring funding via Scottish Government Total £3,965,945
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6 • In 54% of cases, point of care testing enabled a quicker decision to be made about a patient’s care. • In 35% of cases, the patient started treatment earlier than if a decision relied on a traditional laboratory route for blood results. • 21% of cases where POCT was used resulted in fewer visits to the patient’s home because blood results were known during the first visit. This had a positive impact on capacity and initiation of treatment plans in a timely manner. Point of Care Ultrasound (POCUS) Similarly, the introduction of POCUS would provide additional investigations within the patient’s home. Funding was included within the Scottish Government bid to purchase the necessary equipment. The service are currently undergoing training to progress roll out across the localities. 5.4 PHARMACY H@H received temporary pharmacy funding from Healthcare Improvement Scotland (HIS) for 2 years. This input has demonstrated significant value to the service, helped to mitigate (in part) risks previously identified in relation to medicines governance, as well as support the wider expansion of the H@H service. Benefits to the service include: Pharmacy expertise at ward rounds Poly pharmacy reviews undertaken Better communication between all interfaces Efficient co-ordination of medication changes Protecting safety of patients Protecting and supporting staff Facilitating staff training Free up time for current clinical team to optimize clinical capacity The lack of substantively funded pharmacy input to H@H presents a risk to the safe, effective and person-centered use of medicines as well as medicines governance within the service. 5.5 ASSOCIATED RISKS Risk factors to future expansions include non-recurring funding streams resulting
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7 in fixed term contracts, which are difficult to recruit to due to the lack of stability for staff. Qualified ANPs and Specialty Doctors are a highly sought after workforce making it challenging to recruit appropriately qualified staff. The service is not able to embrace innovation due to the strain on current resources. Sub optimum level of Multi-disciplinary input to care plans particularly the pharmacist role. Areas of NHS Lanarkshire will not be able to access the H@H service. Increase in admissions to hospital for patients who could be cared for at home. Organisational reputation of the H@H Service as it is held in high regards across Boards in NHS Scotland. 6. NEXT STEPS Liaise with South Health and Social Care Partnership regarding roll out of H@H services to Cambuslang/Rutherglen area and continued provision of service within the Clydesdale Locality. Recruitment drive for Cambuslang/Rutherglen Locality and Pharmacy staff to support the service as a whole. Monitor and review service impact, developments and data to assist with adaptations/expansion as required. All clinical, financial and staff governance will be governed appropriately under current arrangements within AHSU & North Health and Social Care Partnership. Expand the use of technology to enhance service provision. 7. CONCLUSIONS H@H services in NHSL has continuously increased virtual bed capacity every year since 2019 via expansion programmes and pilots. As a service, we are keen to continue to develop and expand the service into the Cambuslang/Rutherglen locality as well as continued provision to Clydesdale locality. 8. IMPLICATIONS As previous mentioned, the non-recurring funding to H@H services, could result in the inability to provide a H@H service within the Cambuslang/Rutherglen locality and the continued resource within the Clydesdale locality.
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8 8.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) 8.3 FINANCIAL This paper has not been reviewed by Finance however funding information has been confirmed and agreed: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Workforce – Recruitment & Retention High AHSU Management Team Inequity of service provision across NHSL High AHSU Management Team Unnecessary admissions to Hospital for Frail Elderly patients High AHSU Management Team
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9 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Locality management team, GPs, staff and patients. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Monthly meetings with Locality team with expansion of participants. ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No x N/A EQIA added to website:
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10 Yes No x N/A 9. BACKGROUND PAPERS Further data available on request. 10. APPENDICES Nil Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Nicola.kelly@lanarkshire.scot.nhs.uk Lorraine.Smith4@lanarkshire.scot.nhs.uk
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11 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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12 10 Performance Management / Governance arrangements 11 Date direction will be reviewed