Northern Ireland & Scotland: taking a country partnership approach to maturing and developing Hospital at Home services.

3: Public Health Agency, Belfast, Northern Ireland Introduction: Hospital at Home (H@H) services have been in development for 10-15 years in both Scotland and Northern Ireland. They aim to provide hospital level, acute care for patients within their own home for a range of conditions that would usually require hospitalization such as severe respiratory infections, acute heart or kidney failure. Potential benefits of H@H include improved patient experience, reduced length of stay, and an increase in bed capacity in acute hospitals. The emerging evidence is particularly strong for patients living with frailty syndromes and at risk of delirium, deconditioning and falls. As services matured in capability and capacity, both Scotland and Northern Ireland at country-level find themselves with similar themed challenges around quality assurance and maintaining safety and effectiveness, longer term funding and investment and maximising the contributions of these highly-skilled multidisciplinary teams. Target community: Older adults with acute care needs which can be provided in the community. Who did you involve and engage with? We convened regular high level engagement forums between the policy and senior leadership groups at NHS Scotland and the Department of Health Northern Ireland. This included senior clinical and operational leaders working within the offices of the Chief Nursing Officer in Northern Ireland and that of the Deputy Chief Medical Officer for Scotland. What did you do? We explored key themes. Progress in embedding and developing H@H teams. How best to assure ourselves that the focus remains on managing acute rather than subacute or primary care matters. How to develop the workforce, secure funding and strategic attention in a competitive and busy health and social care landscape full of constraints. How to develop the scope and contribution of these teams for the future. What results do you have? Since mid 2020, there has been particular focus on H@H. In Scotland there has been a 294% increase in the number of patients managed by these services and in Northern Ireland we estimate almost 10% of all acute care admissions for this group are now being managed by H@H services. We are developing consensus on core features of Hospital at Home services, the best approaches to monitor acuity and risk to ensure these are proportionate and appropriate. We are standardizing reporting arrangements to compare between our nations. This will provide a platform for critique, encouragement and development as we seek to develop these services further. What is the learning for the international audience? Learning between clinical teams and organisations are well established practices that yield benefits for individual patients and organisations. What is less well practiced are granular discussions at country level – shared challenges and opportunities, including tacking pragmatically issues that in isolation might otherwise be filed under ‘too difficult’. What are the next steps? Building on our alliance and learning system that demonstrates clarity of purpose, agreed measures, venues for convening, mutual coaching and applying a critical friend mindset. Collaborative working across the 2 nations will continue to raise the profile of H@H, and allow us to overcome challenges. Q+A thereafter.