DOES THE NATIONAL-HEALTH-SERVICE WANT HOSPITAL-AT-HOME

There has been increasing interest in the development of hospital-at-h ome within the National Health Service (NHS) as a way of shifting reso urces from secondary to primary care. We describe the development of h ospital-at-home schemes in London and draw on data from an evaluation of five such schemes to discuss support for hospital-at-home within th e NHS. The study has identified a small but important group of patient s who do not want hospital-at-home, as well as resistance to it from s ome health care professionals and managers, particularly in hospitals. These organizational issues must be taken inter account in any evalua tion of hospital-at-home, along with issues of quality, outcome and co st. Feasibility studies ave needed to identify possible organizational barriers to hospital-at-home and the development work that is require d, This service innovation should not be considered in isolation from other services, but rather within the context of a wider debate about the pattern of acute care.