Helping people stay independent for longer
and avoiding hospital admissions


Medical care has changed over time and more care can now be provided at home or in homely settings such as care homes.

By developing the types of care based in local communities, we can care for more people safely in their own homes. This means far fewer people will need to be admitted to hospital.

Some of our buildings are no longer suitable to deliver our services, so we need to change how some of our services work.

We don’t yet have firm proposals. But we’d like to begin gathering your views to help us develop this part of our proposal to change the way we use community hospitals and introduce intermediate care beds.

We’ve already started developing new community-based services. These services help people regain their skills and strength.  We do this either in someone’s home or in a care home, depending on their health condition and needs. This means that the community hospitals can then deliver support to people who have a high level of care and those who need 24-hour care.

We are proposing to continue to develop and extend these new services so that we can avoid unnecessary admissions directly to the acute hospital as well as keeping people safe, well and independent for longer.

What happens at the moment?

In 2017 we cared for 2,804 in community hospitals across Fife:

  • St Andrew’s Community Hospital
  • Adamson Community Hospital
  • Cameron Community Hospital
  • Randolph Wemyss Community Hospital
  • Glenrothes Community Hospital
  • Queen Margaret, Community Hospital

Their average age was 82 years.

We’ve been testing different types of bed-based care options to find out what works best.

Here are some of the different types of care we offer just now:


  • Short Term Assessment and Reablement (STAR) beds – This type of care aims to help people return to their own homes in a short period of time, typically around six weeks. Our teams work to help people become independent and offer the specific skills and support they need to do this. There are currently a total of 36 STAR beds in three care homes in Kirkcaldy, Lumphinnans and Glenrothes.
  • Assessment beds – This type of care allows us to support people when they leave hospital, but are not able to go home. By moving out of hospital and into this type of care, we can assess exactly what someone needs in the long term and where that needs to be. There are eight care homes providing 49 assessment beds in Anstruther, Cowdenbeath, Kinglassie, Glenrothes, Kirkcaldy, Auchtertool and Kelty.

People who had been unwell or injured used to be moved to a community hospital to get the support they needed to help them get home. People have told us that they want us to provide more care nearer to their homes.

Why we need to change

  • At any one time, around a third of people in our community hospitals are ready to leave but most of them can’t leave hospital because they’re waiting for us to put together the right package of care for them at home or are waiting for a bed in a care home.
  • We need to support people’s wish to stay at home or near to home rather than be in hospital.
  • Some of our community hospital buildings are old and won’t be suitable in years to come.
  • We need to respond to our growing and ageing population now.

Dr Sue Pound, Consultant Physician and Geriatrician talks about the possible care options for people as we look to change services in Fife:

Developing care in people’s homes or near to home will allow us to reduce the amount of time people spend in community hospitals. We want to continue to develop different ways to give people the support they need from us.

How can we change?

We’re not always providing care in the right places so that everyone has access to the right type of beds to meet their needs. Figure 10 shows where we’re providing care just now.

We propose to do the following:

  • Move some of our workforce from hospitals to teams based more locally.
  • Make sure our community hospital buildings and grounds meet our needs for the future.
  • Consider how and where we would deliver the different types of care within community hospitals. This could include where we would deliver care for people recovering from a Stroke through to people who require long-term hospital care.

If you have more complex care needs

We know some people who are recovering from illness or injury will still need more care than we can safely provide at home or within a care facility.

Our proposal would mean that there will be enough community hospital beds for people needing the following:

  • Specialist rehabilitation beds – these are for people with specialist medical, nursing and therapist care needs.
  • Neurological rehabilitation beds – these are for people who need nursing care, medical review and specialist therapy for example people who have had a stroke, have a neurological condition or have suffered a brain injury.
  • Hospital based complex clinical care beds – these are for people who require complex clinical care whose needs can only be met in a hospital.

How do we know this approach could work?

Our staff have tried it.  Based on real patient experience, here’s *Emily’s story:

*not her real name.