A study has found that when NHS commissioners view care homes as an important pillar of social care, access to healthcare services improves. By Claire Goodman

Older woman and younger woman, nurse, smiling at each other

Care homes provide long term care to over 450,000 older people. They rely on primary care for access to medical support and referral to specialist services. For the NHS, care homes are often a conundrum; they care for the most vulnerable and frail in our society, provide care that used to be done by the NHS but are often perceived as providing poor care, making unreasonable demands on emergency and hospital services.  

Studies consistently show that healthcare provision to residents in care homes across England is unpredictable and inequitable. The NHS is not ignoring care homes and there is a long history of local healthcare services setting up care home services, often as time limited projects.

Studies consistently show that healthcare provision to residents in care homes across England is unpredictable and inequitable.

The recent investment in the six care home vanguard sites demonstrates that there is an ongoing desire to improve how the NHS works with long term care providers. The question is what needs to be in place for effective cross organisational working?

Study

A recently completed three year study into care homes has found that when NHS commissioners and healthcare professionals see care homes as an integral and important part of the health and social care system this supports appropriate access to, and use of, healthcare.

The Optimal study looked at how NHS services work with, and for, care homes across England and studied in depth different patterns of care provision in three geographically disparate sites, tracking the care 232 residents received over 12 months.

The Optimal study looked at how NHS services work with, and for, care homes across England

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.

No single magic bullet

Its conclusions are that there is not one “right way” or perfect service delivery model for the NHS to use when working with care homes but there are certain characteristics that are more likely to support effective working. Where there is ongoing investment in resources and services dedicated to care homes, this supports patterns of working that can accommodate the different priorities of health and social care staff.

This is most obvious in situations where commissioners and practitioners have learnt how to work together, having gone through several iterations of service provision to accommodate the different priorities and interests of care homes and NHS staff. These services have also developed robust links with other NHS services. 

If NHS decision makers primarily considered care homes as a drain on resources, this was observed to result in short term interventions that do not consider the priorities of the care homes

Single care home teams or nurse and therapist specialists can make a difference to residents’ experience of healthcare. However, by working apart from other services they risk being isolated, unable to sustain their service or access the relevant expertise they need to address the multiple needs of residents. As the majority of care home residents live and die with dementia, access to dedicated specialist care for residents with dementia benefits both NHS and care home staff.

If NHS decision makers primarily considered care homes as a drain on resources, this was observed to result in short term interventions that focus on failure and do not consider the priorities of the care homes and compromise working relationships between NHS and care home staff. 

Close collaboration needed

Commissioning arrangements for healthcare delivery to care homes should seek to formalise and legitimise the time spent by healthcare staff in dealing directly with care home staff and residents. Healthcare professionals should not be expected to fit their care home work within existing caseloads. Time limited and narrow commissioning arrangements which disempower relationship building should be avoided.

Healthcare professionals should not be expected to fit their care home work within existing caseloads.

High quality healthcare provision to care homes can only be achieved if close collaboration between the NHS and care homes becomes part of the “landscape of care”.  The findings from the evaluations of the six care home vanguard sites are reinforcing the conclusions of the Optimal study; it is time for the NHS to see care homes as partners not problems.