Piloting innovative approaches for evaluating health and social care integration policies for care home residents in Greater Manchester

There is a crisis in social care in England. Social care provides the additional support services to those who the NHS sees most, e.g. those in old age or in poverty. This crisis, then, has a direct impact on health services, leading to unmet patient needs and avoidable use of health services.1,2 A significant proportion of hospital admissions from older care home residents are found to be potentially avoidable with appropriate actions.3 An often advocated solution is to better integrate, or better co-ordinate and join up, health (particularly primary care) and social care services.

There are multiple ways to integrate services across different settings. Evidence suggests that, on average, targeted integrated policies to care home residents are found to work better than population-based integrated policies in reducing hospital admissions.4 However, this evidence is based on evaluation of six pilot (Vanguard) sites across England, each implementing variations of an over-arching model and no robust evidence on what specific aspects work best. The NHS Long Term Plan, published in January 2019, describes rolling out integrated care home policies nationally.

To produce robust, useful evidence of integrated care home policies to inform this roll-out, however, we need to address two key issues: i) how to accurately and systematically describe what integration policies have been implemented, where and when; ii) how “outcomes” specific to the care home population, like emergency hospital use by care home residents, can be identified from available data.

We will pilot innovative approaches for evaluating the impact of health and social care integration policies in care home settings, working with local academic and non-academic stakeholders in an advisory capacity to inform our approach. We will test our methods in Greater Manchester to be further developed and scaled nationally within a larger NIHR Grant proposal in progress.