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Time for the NHS to see care homes as partners, not problems


Healthcare provision to residents in care homes across England is often ‘erratic and inequitable’, according to a major three-year study led by the University of Hertfordshire and in conjunction with Brunel University London and five other UK universities.

The Optimal study, funded by the National Institute of Health Research (NIHR), found that a narrow focus by NHS decision-makers on care homes as a drain on resources, rather than as a solution, can result in short-term interventions that compromise relationships between NHS and care home staff, and can affect the confidence of care home staff in being able to meet residents’ health needs.

The study analysed the impact of different approaches by the NHS in providing healthcare to people living in care homes across England, and identified several examples of successful partnership working between NHS and care homes.

However, it concluded that high-quality healthcare provision to care homes can only be achieved nationwide if close collaboration between the NHS and care homes becomes part of the ‘landscape of care’. This means ensuring, through targeted investment, that visiting healthcare professionals and care home staff are given the opportunity to work closely together to identify, plan and implement care protocols.

The best results were achieved when healthcare professionals working with care homes on a regular, ongoing basis were linked in with other NHS services as part of a wider network of expertise. This created naturally occurring opportunities to meet and discuss care, and nurtured a mutual appreciation of the challenges faced by both NHS and care home staff. It also reduced demand on stretched urgent and emergency care services, and increased staff confidence around decisions not to admit a resident to hospital or to discharge patients from hospitals earlier.

Researchers found that NHS initiatives which ‘threw money’ at care homes to achieve minimum standards of care without any meaningful interactions with care home staff – for example, paying certain GP practices more money to work with care homes – were unlikely to work. Where the same amount of money was used to provide ongoing support and to enable NHS and care home staff to work together more closely, the investment delivered positive outcomes, the study said.

Care homes integral to health and social care system

Chief investigator Professor Claire Goodman, from the University of Hertfordshire’s Centre for Research in Primary and Community Care, said: “It is essential that residents in care homes – some of the oldest and frailest in society – have access to healthcare that is equitable and equivalent to those received by older people living at home.

“The Optimal study shows what needs to be in place for this to happen, and found many examples of effective integrated working. Across England, however, access to healthcare for care home residents continues to be highly unpredictable.”

Goodman, who is also a NIHR Senior Investigator, continued: “There is an unrelentingly negative narrative in the public consciousness around bad care in care homes. Yet with 460,000 people living in UK care homes, occupying three times the number of NHS hospital beds, care homes should be seen as an integral and important part of the health and social care system.”

Co-investigator Professor Christina Victor, Brunel’s Ageing Studies theme leader and Vice Dean of Research for the College of Health and Life Sciences, added: “There is a very real need for NHS decision-makers to see care homes as a central part of the system of care provision for older people, and not as something separate from the rest of the health and social care system.

“Because of the increasing complexity of care needs, such an integrated approach is needed not just for those already in residential care, but also so that we get it right for future generations.”

In addition to the lead partner the University of Hertfordshire and Brunel University London, the study involved the University of Nottingham, the University of Surrey, King’s College London, University College London and City, University of London.

The full Optimal study report, ‘Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings’, is available from its NIHR research project page.

Find out more about Ageing Studies at Brunel University London.

Reported by:

Joe Buchanunn, Media Relations