Healthcare provision to residents in care homes across England is often ‘erratic and inequitable’, a major three-year study led by the University of Hertfordshire, funded by the National Institute of Health Research (NIHR), has found.
The Optimal study found 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 affect care home staff confidence in being able to meet residents’ health needs.
The study, involving seven UK universities, 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.
Other key findings
– Care homes rely on the NHS for access to medical and specialist care. As many as 27 different NHS services can visit to provide care and treatment for residents.
– Access to healthcare for care home residents was highly unpredictable. While one care home could receive a significant amount of NHS support, for example through visits from nurse specialists and therapists, residents in another care home could struggle to see a GP.
– 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 both NHS and care home staff face. 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 NHS initiatives that ‘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.
– Seventy per cent of people living in UK care homes have dementia, which complicates healthcare provision. Some health services struggle to deal with this complexity and many NHS staff reported how difficult they found visiting care home residents with dementia, especially when they had no ready access to specialist dementia services from elsewhere in the NHS.
– The study revealed examples of residents being admitted to A&E departments if care home staff needed a psychiatric opinion, putting further pressure on hospital wards. In contrast, when visiting nurses from a care home specialist team were linked to other NHS services they were able to involve, and work with, specialist services and hospital admissions were avoided.