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Supporting the spread of effective integration models for older people living in care homes: A mixed method approach

What were we trying to do?
In the UK, care homes provide residential and nursing care to older adults or vulnerable people and they can be run and owned by local government or privately. Many care homes provide additional bed capacity for the health and care system, meaning there are frequent transitions of residents to and from hospital, which can have an impact on health and economic outcomes. This makes care homes a critical part of the integration of health and social care delivery.


This research project aimed to identify what prevented and encouraged successful integration of health and social care services for older people living in care homes.


There were no detailed reviews of locally implemented integration policies, so we needed to map existing integration initiatives to understand the factors which influenced their successful implementation.  


Through a team of people with expertise in different fields, we collected data using smart computer programs and analysed them using advanced methods. We also gathered stakeholders’ perceptions of our findings and used these to help co-produce outputs.



Why was it important?
The COVID-19 pandemic showed us how important joined-up health and care services are, and this was especially true when caring for vulnerable people like the elderly living in care homes.


The 2019 NHS Long Term Plan promised to introduce inventive ways to bring social care and NHS care together across England, working with the private and voluntary sector, as well as users and carers. Emphasis was placed on initiatives that were already tested, and which focused on care home residents.


It was thought that the integration of social care and NHS care would occur through ‘place-based’ initiatives including Integrated Care Systems (ICSs), which replaced Clinical Commissioning Groups in 2022. ICSs were, geographically, much larger than CCGs and this made the changeover more challenging, as one ICS might contain a mix of initiatives from several former-CCGs. However, this also offered an opportunity to create ‘best-practice’ ways of integrating care that would be consistent across England.



How did we do it?
We gathered together evidence on how successful current integrated health and care policies in England were, and measured how these policies were associated with a range of social care and health outcomes.


This project required the development and use of new methods that combined artificial intelligence (AI) with document analysis, online surveys, and latent factors structural equation modelling (a way of describing the links between measurable and non-measurable factors). Our methods were initially piloted in Greater Manchester, before being extended nationally.


This research project had four work packages (WPs):


  • WP1 - Policy mapping - Building on an existing framework, we used AI methods and surveys to map integrated care initiatives that were already being used in care home settings.
  • WP2 - Index of integration - Data was used to generate a ‘diagnostic index of integration’. Then, we held focus groups with stakeholders, patient and public representatives, and academics, where we checked that the ‘diagnostic index of integration’ measured data in the intended way.
  • WP3 - Care market and local authority procurement – We created a map of local authority activities which was used to assess the differences before and after the implementation of integration policies.
  • WP4 - Evaluation - We gathered together data about outcomes from multiple sources to look for links between integration and a range of indicators of health and care system performance. 



Who did we working with:




This research was funded by an award of £374,806 from the National Institute for Health and Care Research (NIHR) under its Research for Social Care within Research for Patient Benefit (RfPB) Programme (NIHR201872).



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Senior Programme Lead
Mike Spence


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