The relationship between care homes and the NHS is at the best of times a fraught one. Although care homes provide the majority of long-term healthcare to older people, they rely on primary care for access to medical support and referral to specialist services. Yet studies consistently show that healthcare provision for care home service users across England is unpredictable and uneven.
For the NHS, care homes are a conundrum; they provide care that used to be supplied by the health service, but are often perceived as a poor alternative that generates avoidable demand on hospitals.
So, what needs to be put in place to ensure more effective collaboration? In a recent study, researchers from seven UK universities tracked the care received by 232 care home service users over 12 months. A review of the evidence of what works, when and in what circumstances was carried out, and suggests that there are several key elements that contribute to effective cross-organisational working.
Somehow the NHS and the social care sector need to stop bickering over funding. The study found that when extra NHS provision was offered, either on a service users-by-service users basis or focused on a single issue – such as prevention of hospital admission – there could be unintended consequences. It could lead to a sense of “them and us” and mutual recrimination if the desired improvements in healthcare were not achieved.
In contrast, if the focus was on the care home as the provider of care to frail older people, there were more opportunities for NHS staff to discuss and plan with care home staff how additional investment or training from the NHS could improve service users’ healthcare. This approach clearly supported and sustained working relationships between the NHS and care homes.
Involvement of the right mix of people in design of healthcare provision
Ensuring that the right mix of people are involved in the design of healthcare provision from the outset, for instance, helps to develop a shared view about what needs to be done. Single care home teams, for example, or nurse and therapist specialists, can make an enormous difference to how service users experience healthcare. Yet by working apart from other services they risk being isolated, unable to access the relevant expertise to address the multiple needs of service users.
Access to specialist dementia care
As the majority of care home service users live and die with dementia, understanding the associated symptoms and behaviors of this condition in particular is crucial to working with care homes. The study found that access to specialist dementia care benefits service users, and improves the confidence and skills of NHS and care home staff.
Workload of Healthcare professionals
Healthcare professionals should not be expected to fit care home work within existing caseloads. They need protected time that allows them to develop experience and expertise working with social care. Ongoing investment in resources and services dedicated to care homes, as well as forging links with different services locally, would provide a way of working that can accommodate the different priorities of health and social care staff.
The achievement of greater integration in social care and healthcare
There is no one-size-fits-all answer for the NHS when it comes to working with care homes. The diversity of care homes in terms of size, approach, staff experience, proximity to other services and funding means it will always be context specific. But this is not an excuse for ad hoc and unequal healthcare provision.
To date, most of the research for answers has been driven by a healthcare agenda. This is not the starting point for service users and their families, who are interested in quality of life and quality of care. The study demonstrated the benefits of finding common ground but more work is needed to ensure care homes have an equal say on what matters for the health of their service users.
When NHS commissioners and healthcare professionals see care homes as an integral part of the health and social care system, and take the time to learn how to work together, there is a marked improvement in appropriate access to, and use of, healthcare. It is time, in short, for the NHS to see care homes as partners, not problems.
This study by points to inequality in the relationship between care homes and the NHS that needs to be addressed. The involvement of the right mix of people, the availability of dementia expertise, and the consideration of healthcare worker’s workload can bring about improvement. However, more focus should be placed on care homes to ensure staff have an equal say on what matters for the healthcare of their service users.
Acknowledgement: Claire Goodman professor of healthcare research at the Centre for Research in Primary and Community Care at the University of Hertfordshire,
Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy