Does the National Health Service want hospital-at-home?

There has been increasing interest in the development of hospital-at-home within the National Health Service (NHS) as a way of shifting resources from secondary to primary care. We describe the development of hospital-at-home schemes in London and draw on data from an evaluation of five such schemes to discuss support for hospital-at-home within the NHS. The study has identified a small but important group of patients who do not want hospital-at-home, as well as resistance to it from some health care professionals and managers, particularly in hospitals. These organizational issues must be taken into account in any evaluation of hospital-at-home, along with issues of quality, outcome and cost. Feasibility studies are needed to identify possible organizational barriers to hospital-at-home and the development work that is required. 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.