Last week the Improvement Analytics Unit (IAU), a joint initiative between the Health Foundation and NHS England, launched its latest report – Emergency admissions to hospital from care homes: how often and what for? – highlighting the results of a national analysis of emergency hospital use among care home residents.
At a time of significant change for the health and care sector, the IAU’s briefing offers vital insights for system leaders making national policy decisions on the future of care, as well as for those leading change on the front line.
The NHS Long Term Plan set out new, wide-ranging proposals for how care is delivered. One of its key components are Primary Care Networks (PCNs), which launched on 1 July and are seen by many as the most significant reform to general practice in a generation. A major goal of PCNs is to integrate primary care with secondary and community services, and bridge a gap between general practice and the emerging Integrated Care System. The NHS Long Term Plan also included a commitment to rolling out the Enhanced Health in Care Homes (EHCH) framework to provide additional NHS services, including enhanced GP support, in care homes across England.
We are potentially going to see seismic shifts in the way care is delivered, and how primary and social care services are integrated. As such, it has never been more vital for robust evaluation about the effectiveness of interventions to be available to those making key decisions at a national and local level.
What does the IAU’s analysis tell us?
Care home residents have several health and social care needs, with most of them being frail and many having dementia. Despite care home residents being only 2.8% of the population aged 65 or over in England, they were responsible for 6.5% of all visits to emergency departments and 7.9% of all unplanned admissions to hospital for their age group. Our analysis found that more than four in ten (41%) emergency admissions to hospital involving care home residents could be potentially avoided with better provision of preventative primary care, community support or NHS care in care homes. The report also drew on learning from evaluations conducted by the IAU on four vanguard sites that had introduced enhanced partnership working between the NHS and care homes, with three out of the four sites showing encouraging results.
Most of the local initiatives evaluated had an impact on some of the outcomes for patients. In Rushcliffe, we found that care home residents were admitted to hospital as an emergency 23% less often than a comparison group and had 29% fewer A&E attendances; Nottingham City care home residents had 18% fewer emergency admissions and 27% fewer potentially avoidable admissions than a comparison group; and Wakefield residents had 27% fewer potentially avoidable admissions.
Analysis sheds light on the way forward
The benefits of this analysis are far reaching. It helps to illustrate the potential impact that better integration of services could have on care home residents. Further, it shows how this type of analysis, when done effectively, can build our understanding of patients’ current use of services.
Benefits to patients and the health system
It is not always possible for NHS leaders to have such robust evidence at their fingertips ahead of a national system-wide rollout. Our findings from the local site reports showed that there is significant potential for care home residents, and the overarching health and care system, to benefit from the national roll out of the EHCH. Our evidence can provide better insights to decision-makers who are looking into implementing the NHS Long Term Plan, as well as those who are in the early stages of implementation of the EHCH framework.
Developing a better understand of local population health needs
It is important that local and national leaders, as well as care home managers and front-line staff have a good understanding of the care home population and their health and social care needs. Our analysis was unique in that it was able to capture a national picture of emergency care use among residents. This isn’t always possible because information on care home residents is often dispersed across care homes, GP practices and hospitals without being routinely reconciled into a single system.
Linking data gives a complete picture
Routine access to linked data is a powerful tool for health service improvement. However, assessing it is not always straightforward. Identifying care home residents has been a challenge at both national and local level. Making a direct comparison between patients’ addresses and care home addresses can be difficult, as these may be recorded in different ways. In our analysis, we adopted a new method for linking data, developed by the IAU, that allowed us to identify care home residents in hospital data at a national level for the first time. Housley and colleagues in Nottingham and Burton and colleagues in Scotland have also conducted methods research on this topic. Bringing this information together unlocks the possibility of constructing a more complete picture of patients. It also enables a better understanding of how health care services may impact patients' health and wellbeing. In Evaluating the impact of health care interventions using routine data, my colleague Geraldine Clarke illustrates the key points to consider when leveraging routinely collected data to evaluate the impact of health care interventions.
Data to maximise potential of health care initiatives
The national analysis and evaluation studies carried out by the IAU show the potential to derive insight from linked patient information. It also strengthens the case for having routine access to linked datasets like these, to maximise the potential impact of improvement programmes. This is why I am passionate about using data in the NHS to its full potential to ensure that future decisions on health and care services are backed up by robust, reliable evidence.