Why the research is needed
Older care home residents often suffer from reduced mobility, confusion and infections when they are in hospital. Previous research by the Health Foundation found that 40% of the time, care home residents may not have needed to come to hospital if there were better specialist services to treat residents in their care homes.
NHS England introduced the Enhanced Health in Care Homes framework (updated 2023). The Framework is a set of recommendations to improve care for residents including recommending the provision of specialist services for care homes. This specialist care may mean residents are seen more often by a doctor or have their medications checked more often. This specialist care should mean older residents need do not need to be treated in hospital as often.
In some areas of England care home residents are six times more likely to be treated in hospital. There are differences in how the Enhanced Health in Care Home Framework is implemented across England which may contribute to this variation.
What is already known about the subject
One of the stated aims of the EHCH framework is to reduce hospitalisations of care home residents. Little is currently known about how the recommendations for enhanced care have been implemented in different parts of England and whether the framework has been effective in reducing hospitalisations of older residents.
What we will do
We want to know why older care home residents need treatment in hospital more often in some parts of England compared to others. We also want to know how the NHS can best provide care for older residents in their care home.
First, we will measure how often care home residents need emergency treatment in hospital in different parts of England. We will use healthcare data collected by general practitioners (GPs) (between 2022 and 2024) and a database of care homes in England.
Next, we will use what we find from the data to identify six areas in England with low, medium or high rates of emergency hospital use by older care home residents. We will look at these six areas in detail and interview health and social care professionals, care home staff, residents and their family and friends. We want to understand what NHS services are available and how they work in each place. We will then explore whether NHS services work better in the areas with lower rates of emergency hospital use and if these services could be replicated in other parts of England.
Finally, will we survey the organisations that fund regional health and social care across England to map out where different specialist services for care homes are present.
How patients and the public are involved
We are very grateful to the different groups of family members and carers who helped develop this project. This includes the Sheffield Emergency Care Forum, HDR UK North frailty group, the Niche Leeds Family and Friends group and a PPIE group from an NIHR-funded review of interventions for reducing hospital admissions from care homes.
We will continue working with key stakeholders, including health and social care professionals, care home residents and their family members/friends, to:
1) Make sure study information is clear and understandable.
2) Design interviews and help understand what they mean.
3) Help decide how what we find out is used by the NHS.
4) Help share what we find out.
What the benefits will be
We will develop a tool to help care home managers, the organisations that fund regional health and social care and the Care Quality Commission (CQC) monitor hospitalisations and plan specialist services in care homes.
We will also provide recommendations for how specialised services for care homes can be improved.
When the findings will be available
As we complete different parts of the study, we will make the findings available. The final findings will be available in Summer 2027.
How we are planning for knowledge mobilisation and implementation
• We will co-produce recommendations to develop the Enhanced Health in Care Homes framework and ways the statistical tools developed can be used to monitor and plan services.
• We will collaborate with PPI and advisory group to determine how the findings should be shared. These stakeholders will also support us in sharing the findings.
• We will use the Knowledge-to-Action Framework.
