An uncertain future

Providing services traditionally associated with secondary care in the community is a feature of health policy both in Britain and abroad. “Hospital at home” is currently a popular response to the increasing demand for hospital beds. Cutting costs by avoiding admission and reducing length of stay in hospital is a central goal of such schemes. Changes in medical technology, improvements in housing, and an increasing emphasis on primary care have all encouraged the idea that some hospital services can be provided safely and more cheaply in the community.

A national survey of purchasing authorities in Britain shows that most authorities are either supporting, or planning to support, a hospital at home scheme (S Iliffe and A Haines, unpublished data). All 136 health authorities, commissions, and health boards were asked to report planned or operational hospital at home schemes in their district. Hospital at home was defined as the provision of a service that prevented hospital admission, …