Background 

Across England, more health and care services are being delivered in people’s homes. Approaches such as hospital at home (virtual wards) and neighbourhood-based care aim to reduce pressure on hospitals and support people to receive care where they live. 

However, people’s home environments vary widely. Some homes make it easy and safe to receive care, while others present challenges such as limited space, poor housing conditions, accessibility issues, digital barriers or changes in household circumstances. If these factors are not recognised early, people may face avoidable harm, unmet needs or delays in leaving hospital. 

Current research and practice often focus on whether someone is well enough to return home, with less attention given to whether their home is suitable for safe and effective care. This project explores how home circumstances influence people’s ability to receive fair, high‑quality care at home. 

Aims and Objectives 

The aim is to understand how someone’s home situation might affect their experience of moving from hospital to home, and whether this leads to unfair differences in care or outcomes. 

Objectives: 

• Identify aspects of home circumstances that affect whether care can be delivered safely and effectively at home. 

• Explore how policies shifting care into the community may disadvantage people living in homes that are unsafe, inaccessible, overcrowded or digitally excluded. 

• Examine how home circumstances are currently considered in community health teams and hospital discharge processes. 

• Highlight gaps in current practice and opportunities to improve fairness in access to care. 

Methods 

We will use fast, practical research methods to understand how home circumstances affect access to suitable and fair care at home. These methods support current policy needs and lay foundations for future in-depth research. 

1. Evidence review: A rapid review of evidence on the impact of home circumstances on the delivery, experience and outcomes of health and social care delivered in home settings. 
2. Interviews: Semi‑structured interviews with staff involved in neighbourhood care, virtual wards and hospital discharge to understand how home circumstances are assessed and used in decision-making. 
3. Integrated gap analysis: Bringing findings together to identify what is known, what is missing, who may be underserved and priorities for further work. 

Policy Relevance 

This project supports national plans to shift more care from hospitals into the community, as outlined in the 10‑year plan for England. As hospital at home and neighbourhood health teams expand, people’s home circumstances will be central to how well these models work. Our research aims to ensure these changes do not create or widen unfair differences in access, experience or outcomes. The findings will also support Integrated Care Boards and local authorities involved in programmes such as Changing Futures. 

It also helps answer key DHSC priorities: 

• Helping people stay safe and independent at home for as long as possible. 

• Understanding how councils use early support to prevent problems from worsening and maintain independence, and what impact this has. 

• Identifying what helps local areas design and scale effective preventative approaches that support healthy ageing. 

Delivery dates 

May 2026 to April 2027

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