Why we undertook this project
Older people living in care homes have some of the most complex health needs, yet successive studies have shown that they have variable access to health care and, as a result, high rates of unscheduled admissions to hospital.
Better integration between care homes, primary care, community services and hospitals can improve health outcomes and costs and lead to better experiences for care home residents and for staff. It involves GPs and other health professionals providing services in care homes and developing a partnership with care home staff. Together, they manage residents’ care needs prospectively – helping them to keep well, not just reacting to ill-health – and the health professionals support care home staff to develop their confidence and skills in providing health care. NHS England is promoting this approach nationally through its vanguard programme for new care models.
However, despite good evidence of effectiveness, there are significant challenges in establishing and sustaining integrated approaches and in deepening and extending integration over time.
There is no single way to make integration work; local context and relationships are key. Successful schemes involve mutual commitment to shared priorities and to ensuring that care processes and routines are negotiated across care homes, GP practices and NHS trusts; this – especially when they are all under operational pressure – requires skill, sensitivity and stamina. Furthermore, while everyone can agree on the need to invest in relationships, it’s not always clear what exactly this involves in practice.
We set up this project to help providers and commissioners to develop local approaches to better integration.
What we did
This project reviewed examples of integrating services in care homes from across England. It considered how people decided where to start and how they are evolving their approach, including common challenges; things that they would do differently with hindsight; and what they have found useful. It drew on the experiences of a learning network for care home providers, commissioners and local NHS partners that we run jointly with My Home Life and that has an advisory group including national, local and service user perspectives.
Although underpinned by a review of policy and research evidence, the project aims to reflect real-life experience of NHS and local authority commissioners and health and care service providers, gained through interviews. This focus on how people make integration work in practice complements reports by other organisations on what can be done.
The aim was to set out a broad range of information to help other areas think through how to start integrating health and care services in care homes or how to sustain and embed an existing approach. The focus was on:
- describing different approaches, how these are decided, and how they are experienced
- building effective relationships and trust
- how people who live in care homes are involved and the achievements understood from their perspective.
Our advisory group
Our advisory group includes NHS England, My Home Life, Age UK, Care England, British Geratrics Society and Royal College of General Practitioners.