Better healthcare in care homes

Research at the University of Hertfordshire is helping to identify ways to improve healthcare for the nearly half a million people living in care homes in the UK.

Care homes provide the majority of long-term healthcare to older people, with most relying on the NHS for access to medical and specialist care. As the population ages it is a sector experiencing increasing demand. The NHS services older people in care homes receive, however, varies greatly.

The Optimal study, funded by the National Institute of Health Research (NIHR) and led by Professor Claire Goodman built on earlier work that had found residents’ access to healthcare provision was ‘erratic and inequitable’. It studied all the different ways that the NHS in England works with care homes, identified common elements within the different approaches likely to lead to improved outcomes and tested this by tracking what happened to 242 residents living in care homes in 12 care homes distributed across England.

The study findings concluded that there was not a single ‘right’ way of delivering healthcare to care homes. There were however core elements within services that needed to be addressed. Key was when NHS decision-makers recognised care homes as partners, rather than as a problem or a drain on NHS resources. It called for more time to be given to NHS staff to learn how to work with care home staff to discuss, plan and review care and strengthen ties with existing health care services. It identified that activities that supported working more closely together provided the best evidence for improved healthcare. It also argued for the need to ensure that both NHS and care home staff had access to and support from dementia specialist services

When a care home was seen by the NHS as a valued partner, rather than a problem or a drain on resources, then tension and a culture of blame receded, and the healthcare that older people received tended to be better.

Professor Claire Goodman,
University of Hertfordshire

Professor Goodman’s research has had national impact. The findings were disseminated to care home professionals and healthcare decision-makers using briefings and video animation and have been widely cited by national policy think-tanks such as The King’s Fund and national press.

Her findings are timely as the need to address how health and social care work together has become a policy priority. This research directly informed NHS England’s flagship initiative ( known as Vanguard sites) to develop new care models that will inspire the wider health and care system and act as blueprints for the future of the NHS working to improve the quality of life, healthcare and health planning for people living in care homes.

Her emphasis on care home and NHS staff forging closer working relationships has meant that there is evidence both within the vanguard areas and beyond  of a shift in how  care homes and their representative organisations  are working with the NHS, local authorities, the voluntary sector, carers and families to optimise the health of their residents.

Professor Goodman’s ongoing research for NHS England has included assessing care home capacity to become involved in innovation, evaluation of initiatives that support quality improvement and leading workshops with care home staff, commissioners, GPs and practitioners to strengthen learning and ongoing work to improve the care of older people living and dying in carehomes.

Forging closer working between the care home and health care sectors is an ongoing outcome of Professor Goodman’s work. In November 2017 Professor Goodman working with the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) brought together a national collaboration of researchers, care home, health care and PPI representatives. This collaboration agreed research priorities for the sector and produced a a briefing for NIHR on the big interventions needed to improve how care homes are aligned to, and work with, the NHS.