Title: Supporting the spread of effective integration models for older people living in care homes: A mixed method approach
Funder: Department of Health and Social Care

Abstract: Research question: The project seeks to identify, classify and compare the types and extent of locally-implemented integrated care policies in relation to care homes in England. Background: Closer integration of social care and health services is a policy priority in many countries. The NHS Long Term Plan committed to rolling-out innovative integration practices across England with a specific emphasis on initiatives aimed at care home residents. However, the optimal mix of integration care home initiatives, when and in what context is unknown. Comprehensive knowledge of existing integrated initiatives, their types, the factors which enable or hamper implementation and their effect on key outcomes is key to supporting their efficient and effective, national roll-out. Aims and objectives: We will create an online policy extraction and mapping tool that allows commissioners, advocates of potential/current care-users and researchers to examine the presence and extent of local care home integration interventions across England. Data will be summarised in accessible ways to rank localities across multiple domains of integration and to examine the association of these domains with key indicators of social care and health system performance, with care home market characteristics and local authorities procurement strategies being mediating/moderating factors. Findings will empower: i) care service users /relatives decision-making, through transparent and accessible information; ii) local commissioners, by better shared learning on best practices; iii) national decision-makers, to track the progress of integration and to support the scale-up of best-practice; and iv) researchers, by enabling comparison of locally implemented integration interventions implemented. Methods: We will identify integration interventions referenced in official documents by customising and using existing artificial intelligence methods (text mining and machine learning). The information we collect will be synthesised in a policy map (grid of interventions by locality and year), validated by researchers during piloting, and by a national survey about local policymaker activity. We will construct a diagnostic index of integration using latent factor structural equation models, validated by panel discussions with experts and PPI/E representatives. We will investigate the relationships between local contextual and care market factors, the extent of integration and key social care and health systems performance indicators using multivariate regression models. Timelines for delivery: The project will be delivered in 24 months, including an initial 6 months piloting in Greater Manchester with results disseminated in month 7, and subsequent national scale-up, with results disseminated in months 13, 20, 21 and 24. Anticipated impact and dissemination: Decision-makers, provider organisations, local community groups and also individual service users and carers must consider carefully how to make informed use of the resources available to them. We will consult with them to maximise impact and disseminate results effectively in a variety of formats. Our outcomes will: i) promote informed decision-making and incentivise best-practice; ii) track changes in integration to support national roll-out; iii) support local authorities in market shaping and in `fostering service quality; iv) provide evidence on the optimal mix of integration activities that maximise improvements in residents outcomes.

Lay abstract: Challenged by increasing demand and financial pressures, local authorities are struggling to provide person-centred care to older people. This can lead to service users needs not being met. It may also have knock on effects on NHS services, care worker shortages and increase dissatisfaction. The NHS Long Term Plan [1] promised to introduce inventive ways to bring social care and NHS care together across England, working with the private and voluntary sector, and users and carers. Emphasis is placed on initiatives, already tested, which focus upon care home residents. The recent COVID-19 pandemic is showing us how important it is to have joined-up (&ldquo;integrated&rdquo;) care and health services, especially for caring for the vulnerable people living in care homes. We do not know the best way of integrating services or what factors lead to successful integration. There is no detailed review of locally implemented integration policies to enable people to compare them. We need this to understand what works best and why, to identify areas for improvement and encourage good practice nationally. Although the NHS Long Term Plan says we should have a measure of integration, to date we do not. This project aims to identify the barriers and facilitators to successful integration of health and social care services for older people living in care homes. Through a team of people with expertise in different fields, we will build research capacity in social care. We will collect data using smart computer programs and analyse them using advanced methods. We will gather stakeholders perceptions of our findings and use these to help co-produce outputs. The project will: Describe ( map ) the types of integrated care for care homes that exist across England (piloted initially in Greater Manchester); Classify these different types of policies and bring data to produce a measure of the extent of integration (the dose of integration); Identify things that may help or hinder integration, understanding whether these are associated with how local authorities agree terms and tender for care home contracts; Examine how dose of integration could relate to aspects of care such as staff retention, resident satisfaction, hospital activity and management of end-of-life care. We will present the results in way that helps potential/current care-users, policymakers, commissioners and providers of care with their decision-making. Two carers, with lived experience of organising and supporting parents in care homes, have reviewed our application. They recommended dissemination of findings in accessible ways. We will continue consulting the public and a wide stakeholder group to help us with producing and spreading knowledge from the results.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE