NHS Western Isles marks major expansion of Hospital at Home and Integrated Front Door Services

NHS Western Isles has announced significant progress in the further transformation of urgent and unscheduled care across the islands, following substantial investment and the successful recruitment of a new multidisciplinary workforce within the Integrated Front Door Services (IFDS).

The 2025/26 end‑of‑year report highlights a pivotal year for the three interconnected services that make up IFDS: Hospital at Home (H@H), Urgent & Unscheduled Care (U&UC) and the Acute Assessment Unit (AAU). Together, these services aim to ensure that more patients can be assessed, treated, and supported safely in their own homes – reducing unnecessary hospital admissions and improving patient experience.

Funding of more than £1million for Hospital at Home and £400,000 for improved flow and frailty services has enabled NHS Western Isles to more than double its virtual ward capacity to 26 beds, now the largest virtual ward per head of population in Scotland.

This expansion includes:

• Significant recruitment across nursing, paramedic, medical and frailty specialist roles
• Investment in diagnostic equipment for home‑based imaging and blood tests
• Introduction of self‑monitoring kits to help prevent deterioration and reduce acute admissions

In terms of the impact on hospital admissions and Emergency Department pressures, the early data shows a reduction in Emergency Department attendances from October 2025 onwards and sustained growth in Hospital at Home activity, particularly through admission avoidance. There has also been improved support for care homes, enabling more residents to be cared for without transfer to Western Isles Hospital.

The rapid recruitment drive, completed largely in February and March 2026, has enabled the service to put in place:

• A single Senior Clinical Decision Maker (SCDM) providing seven‑day medical oversight
• A new frailty service delivering Comprehensive Geriatric Assessment and early supported discharge
• A dedicated OPAT Nurse Lead expanding intravenous antibiotic therapy in the community
• Seven‑day administrative support, enhancing communication and freeing clinical time
• A forthcoming Senior Charge Nurse and Pharmacist, completing the new structure

Over the next 12 months, IFDS will focus on embedding its new workforce and delivering key objectives, including a single point of contact for all admissions to reduce unnecessary hospital stays, and expanding frailty assessment for all patients aged 65+ at the front door. The aim is also to support more people to spend the end of life at home, where this is their wish; to increase diagnostic capability in the community; and to develop a single electronic record for all three services.

The programme strongly supports national priorities including Realistic Medicine, reducing unwarranted variation in care, and delivering health services closer to home.

NHS Western Isles Medical Director, Dr Sara Else said: “This year marks a major step forward for how we deliver care in the Western Isles. By expanding our Hospital at Home model and strengthening our integrated front door services, we are ensuring more people receive high‑quality care in the place they most want to be—at home. We are proud of the team’s achievements and excited for what the coming year will bring.”