Key points

  • Nottingham City Clinical Commissioning Group (CCG) provides an enhanced package of care to its care home residents, aiming to improve health outcomes and the care delivered. This package, whose elements were first introduced in 2007, has since been steadily developed and expanded. By September 2014 the package of care largely consisted of the Dementia Outreach Team, the Care Home Nursing Team, Age UK Nottingham & Nottinghamshire Advocacy, and GP Local Enhanced Support.
  • This briefing presents the findings of the evaluation into the effects of providing enhanced support for older people living in a care home in the Nottingham City CCG’s area from September 2014 until April 2017 at which point, as part of NHS England’s new care models programme, a Clinical Pharmacy service and Telemedicine facility were established on top of the existing enhanced package of care. Specifically, the Improvement Analytics Unit examined whether the existing enhanced support had a discernible effect on hospital utilisation for new residents who moved into one of 39 residential and nursing care homes in Nottingham City between September 2014 and April 2017.
  • The Nottingham City care home residents were compared with a matched comparison (‘control’) group, which consisted of individuals broadly similar to those in Nottingham City CCG care homes on a range of key characteristics measured prior to the roll-out of the enhanced support and who moved into a care home of a similar type in comparable areas of England.
  • The rate of emergency admissions into hospital for Nottingham City care home residents was estimated to be 18% lower compared with the control group. This impact on emergency admissions is even stronger when focusing on emergency admissions relating to conditions which are ‘potentially avoidable’ – for example, through better provision of primary care or community support at an earlier stage in the patient’s care pathway. Nottingham City residents experienced a potentially avoidable emergency admissions rate estimated to be 27% lower compared with the control group.
  • There was no discernible difference in the number of Accident & Emergency (A&E) attendances between the Nottingham City care home residents and the control group, although Nottingham City residents had 20% fewer A&E attendances that did not result in admissions compared with the matched comparison group.
  • When comparing residents from nursing care homes with residents from residential care homes, we found a significant difference, indicating that the lower rate of hospital activity is driven by residents of residential care homes. Compared to the control group Nottingham City residential care home residents had 34% fewer emergency admissions, 39% fewer potentially avoidable emergency admissions, 20% fewer A&E attendances, and 35% fewer A&E attendances that did not result in admission. We found no statistically significant difference in hospital use between nursing care home residents in Nottingham City compared with the control group.
  • Assuming that Nottingham City care home residents and the control group were comparable, the most likely explanation for these findings is that they reflect higher quality of care being delivered to residents of care homes in Nottingham City. The matched comparison group had similar age, gender, health conditions and prior hospital utilisation to the Nottingham City residents, although they may have still differed in unobserved ways.
  • The evidence in this briefing indicates that there is potential to reduce emergency admissions to hospital and A&E attendances for care home residents, and reduce pressure on NHS hospitals. Roll-out of the EHCH framework announced in the NHS Long term plan can play an important role in this, and future evaluation of EHCH initiatives can help inform the implementation of these initiatives.
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