Every day, unpaid carers in England are providing hospital-level medical care at home for sick relatives—often without any formal training or support. This study tracks 158 of those carers across two NHS Hospital at Home services, using questionnaires and in-depth interviews to measure their physical health, mental wellbeing, and financial strain during and after a patient’s care episode. The problem is that Hospital at Home services, which are expanding across the NHS, depend heavily on these informal carers. Yet almost nothing is known about what carers actually do, how much time it takes, or what toll it takes on their own health and finances. Without that evidence, services cannot be designed to support them—and the entire model risks burning out the people it relies on. If this research succeeds, it will produce concrete, actionable recommendations for NHS policymakers and service managers. That could mean changes to how Hospital at Home teams communicate with carers, what respite or financial support is offered, and how patient discharge is handled. The result would be a more sustainable model of community-based acute care—one that keeps patients out of hospital without quietly breaking the people who make that possible.
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Research Question What are the experiences and caregiving activities of informal (unpaid) carers in a Hospital at Home (HaH) setting, and their physical and mental wellbeing and economic status? Background Hospital at Home (HaH) services, increasingly implemented across the NHS, deliver hospital-level care in patients' homes, reducing hospital admissions and aligning with patient preferences. These services depend heavily on informal carers, who provide essential day-to-day support. However, carers potentially face significant physical, emotional, and financial challenges, which could impact their well-being and the quality of care they provide to patients. Despite the vital role of carers, research on their experiences, activities, and support needs within HaH is limited, representing a critical gap in evidence that this study seeks to address. Aims and Objectives To understand the experiences, health, and well-being of informal carers in HaH settings and develop actionable recommendations to support them effectively. Objectives will include Identify themes from carers experiences during and after HaH. Explore relationships between carer characteristics and perceived burden. Document caregiving activities and their frequency/duration. Assess the economic impact of caregiving on carers and identifying societal costs associated with carer health and social care resource use. Develop recommendations for supporting carers to enable and improve the delivery of HaH. Methods A mixed-methods approach will integrate quantitative and qualitative data collection over 18 months. Quantitative data from 158 participants will be gathered using validated questionnaires assessing carers health, well-being, and economic impact at two time points: during HaH care and four weeks post-discharge. A subset of 40 carers will participate in in-depth interviews, exploring their experiences, activities, and support needs. Data will be analysed thematically for qualitative components and through regression models and descriptive statistics for quantitative measures. Recruitment will occur across two NHS HaH sites, representing urban and suburban/rural populations. Timelines for Delivery Pre-study phase (Months -3 to -1): Ethics and protocol finalization, recruitment of research fellow, and NHS service setup. Data collection phase (Months 1-14): Recruitment of participants, baseline data collection, and follow-up measures. Analysis phase (Months 9-16): Qualitative and quantitative analyses conducted concurrently. Dissemination phase (Months 14-18): Reporting, publication, and sharing findings with stakeholders. Anticipated Impact and Dissemination This study will deliver evidence-based recommendations to support carers, improving patient and carer outcomes and bolstering the sustainability of HaH models. Findings will be disseminated via peer-reviewed journals (e.g., BMJ Open, BMC Health Services Research), presentations at national HaH and healthcare conferences and summaries for NHS policymakers and patient/carer advocacy groups. By exploring carer needs, this research aims to contribute to improved service delivery and service acceptability. Enhancement of carer wellbeing will directly support improved patient experience and feasibility of providing community-based alternatives to acute hospital care.
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