Swedish healthcare colleagues look to NHS Borders Hospital at Home service as an example of good practice

International visit highlights how innovation, teamwork and continuous improvement are helping more people receive safe, specialist hospital-level care in the comfort of their own homes.

Last week NHS Borders welcomed healthcare professional colleagues from the Sahlgrenska University Hospital in Sweden to learn from our expanding Hospital at Home service, which is helping people receive acute, consultant-led care in their own home, rather than being admitted to hospital.

The visit provided an opportunity for members of our Hospital at Home team to share practical learning with colleagues who are expanding a similar service in Gothenburg. Discussions covered how the Borders model has grown from a small, weekday service in one locality into a seven-day service with capacity for around 30 patients and reach across almost the whole region.

The Hospital at Home service supports a wide range of people, including older people living with frailty, adults with multiple long-term conditions or advanced illness, people with complex learning disabilities, care home residents and some surgical patients. By bringing hospital-level expertise into the home, the team can often avoid an admission or support an earlier discharge, while helping people remain close to family, carers and familiar surroundings.

Hospital at Home is a clear example of NHS Borders delivering our Clinical Strategy. It supports the ambition to shift the balance of care by providing more person-centred care closer to home, reducing reliance on hospital admission and using resources in ways that better meet the needs of patients and communities.

Dr Mat Topping, Consultant Geriatrician and Clinical Lead for Hospital at Home said: “Hospital at Home is about giving people the level of clinical care they would receive as an inpatient, without taking them away from the place they know best. For many patients, being at home supports their independence, keeps them connected to family and carers, and avoids the disruption that a hospital stay can bring.”

“We were proud and delighted to have an opportunity to showcase our service to our visitors from Sweden and reflect on the journey we have been on in developing the service over the past three years. This service has grown because our staff have been willing to test ideas, learn from data and patient feedback, and work across traditional boundaries. It is a strong example of NHS Borders putting improvement into practice and using evidence to shape care around what matters to patients.”

Care designed around a rural community

To meet the challenges of delivering care across a large rural area, the team has developed a flexible hub-and-spoke model based around the Borders General Hospital and community hospital sites. Staff, medicines, oxygen and portable clinical equipment can be deployed closer to where patients live, reducing unnecessary travel and making better use of clinical time.

The service works closely with acute medicine, emergency care, primary care, ambulance services, community nursing, pharmacy, diagnostics, rehabilitation teams and other specialties. Daily consultant input and virtual ward rounds help maintain strong clinical oversight, while local hubs allow teams to adapt to changing demand and geography.

Improvement driven by evidence and experience

Quality improvement has been built into the service from the outset. The team monitors activity, referral patterns, capacity, geographical coverage and reasons why referrals cannot be accepted. This evidence has informed decisions about staffing, weekend cover, referral routes and the phased expansion of the service.

Feedback is sought from every patient supported by Hospital at Home and is used alongside operational data to guide further improvement. The team is also exploring new ways to improve care and efficiency, including remote monitoring, mobile documentation, portable infusion technology and closer integration with established community services.

Dr Peter Hällgren Nordhage said: “NHS Borders has shared openly not only what has worked, but also the lessons learned while building and expanding the service. The visit has given us valuable practical insight as we develop Hospital at Home in Gothenburg, particularly around multidisciplinary working, rural delivery and the use of data to support safe growth.”

The visit reflects international interest in models that provide high-quality acute care beyond hospital walls. For NHS Borders it was also a chance to celebrate the expertise, determination and partnership working that have turned a pilot service with the capacity for five patients each day into an established service for communities across the Borders.