Hospital at Home in Scotland: What the Shift Towards Care at Home Means for Social Care 

Hospital at Home in Scotland: What the Shift Towards Care at Home Means for Social Care 

Scotland is accelerating plans to deliver more healthcare in people’s own homes and communities. 

On 2 September 2026, the Scottish Government confirmed that expansion of Hospital at Home will be a key part of NHS reform, with capacity set to increase so that more than 10,000 people can benefit this winter. 

The announcement follows the Health and Care Improving Flow Plan 2026–2031, which sets out a wider “home first” and “Community First” approach. For social care providers, this matters because more people may be supported at home while receiving treatment, monitoring or recovery support that might previously have happened in hospital. 

What is Hospital at Home? 

Hospital at Home provides hospital-level assessment, treatment and monitoring in a person’s own home when clinically appropriate. 

It is not the same as ordinary home care. Clinical responsibility remains with the relevant healthcare team, which may include doctors, nurses and other professionals. Depending on the service, people may receive remote monitoring, point-of-care testing, treatment and regular clinical review without being admitted to a ward. 

The Scottish Government’s latest plan says home-based care will expand as part of a continuum ranging from self-care and digital support through to intensive Hospital at Home and Care at Home services. 

Why is Scotland expanding it? 

The aim is to help people receive the right care in the right place, avoid unnecessary hospital admission and support earlier recovery at home. 

The Improving Flow Plan highlights risks associated with longer hospital stays for older people, people living with frailty and those with complex needs, including physical or cognitive decline, loss of independence and hospital-acquired infection. 

Hospital at Home capacity will increase alongside earlier discharge planning, Discharge to Assess and stronger community pathways. 

What does this mean for social care? 

Hospital at Home is led by healthcare services, but its expansion reinforces the need for close working between health and social care. 

A national evaluation published in June found that Hospital at Home teams valued multidisciplinary working, but also identified difficulties accessing social care and community service input. It recommended stronger links and communication across local pathways. 

For providers, this may mean supporting more people whose health needs are changing while they remain at home. 

Social care workers may therefore need to be confident in: 

• Recognising deterioration. 

• Following updated care and support plans. 

• Recording and reporting changes promptly. 

• Communicating with healthcare professionals. 

• Supporting medicines safely within their role. 

• Using infection prevention precautions. 

• Knowing when to seek advice. 

This does not mean care workers should take on clinical responsibilities simply because someone is receiving hospital-level care at home. 

Clear responsibilities matter 

One challenge identified by the national evaluation was uncertainty in some areas about where responsibility sat between different parts of the healthcare system. 

As services become more integrated, clarity becomes even more important. 

Providers should understand: 

• Who has clinical responsibility. 

• What the social care team is expected to do. 

• What changes must be reported and to whom. 

• How advice can be accessed, including out of hours. 

• Whether any new activity has been formally delegated. 

• What training or competency assessment is required. 

Workers should never be expected to improvise or work beyond their role because care is being delivered at home rather than in hospital. 

Recognising deterioration 

Care and support workers are often well placed to notice when someone is becoming unwell because they know the person’s normal presentation. 

Changes might include increased confusion, reduced mobility, unusual tiredness, breathlessness, reduced appetite or fluid intake, new pain or simply that the person is “not themselves”. 

The worker’s role is not to diagnose the cause. It is to recognise the change, record relevant information and escalate it through the agreed pathway. 

As more people with complex needs receive care at home, this ability to notice and communicate change becomes increasingly important. 

Delegated healthcare activities 

Hospital at Home also highlights the importance of safe delegation. 

Where a regulated healthcare professional delegates an activity to a social care worker, the provider and worker need to be satisfied that the arrangement is safe. 

Appropriate learning, person-specific instruction, practical training and competency assessment may be required depending on the activity. 

Completing an eLearning course can provide useful underpinning knowledge, but it should not be treated as evidence that a worker is competent to carry out a delegated clinical task. 

What should providers do now? 

The expansion will develop differently across local areas, so providers do not need to redesign services overnight. 

However, it is worth reviewing five areas: 

1. Check escalation routes so staff know who to contact when someone’s condition changes. 
2. Review staff knowledge around deterioration, infection, medicines and other common risks. 
3. Keep care plans current so updated healthcare instructions are reflected promptly. 
4. Clarify responsibilities whenever health professionals introduce new activities or equipment. 
5. Use supervision and team learning to discuss multidisciplinary working and professional boundaries. 

These areas support the Scottish Government’s wider ambition for health, social care and community services to work as a more connected team around the person. 

A more connected system needs a confident workforce 

Scotland’s direction is clear: more care will be delivered at home and in communities, with health and social care expected to work more closely around the person. 

That has the potential to help people remain independent and avoid unnecessary hospital stays. But successful care closer to home also depends on communication, competent staff and clear professional boundaries. 

Supporting social care teams in Scotland 

As more care is delivered at home and in the community, social care workers need learning that reflects both the complexity of their roles and the Scottish context. 

CareTutor provides health and social care training for organisations across Scotland, including Scotland-specific courses and learning designed to support the Health and Social Care Standards and relevant Scottish legislation and guidance. 

Our courses cover areas that may become increasingly important as more people with complex needs are supported at home, including infection prevention, medicines, sepsis, falls prevention, trauma-informed practice and Adults with Incapacity. 

Digital learning should sit alongside local procedures, professional guidance and practical competency assessment where required. 

Want to strengthen the knowledge and confidence of your workforce in Scotland? Explore CareTutor’s health and social care training and speak to our team about learning that supports safe, person-centred care closer to home.