Key points

  • This briefing presents the findings of an evaluation into the effects of providing enhanced support for older people living in care homes in Sutton, south London. Specifically, the Improvement Analytics Unit examined whether the enhanced support had a discernible effect on hospital utilisation for new residents who moved into one of 28 residential and nursing care homes in Sutton between January 2016 and April 2017.
  • The enhanced support was commissioned by the Sutton Homes of Care vanguard from March 2015 for all care homes within the Sutton clinical commissioning group’s (CCG) area. It was organised around three priority areas (or ‘pillars’). The first pillar was a series of measures aimed at improving integrated care, and included the hospital transfer pathway (the ‘Red Bag’ scheme) and weekly health and wellbeing reviews. The second pillar supported ongoing education and development for care home staff, for example through e-learning on continence care, dementia care and person-centred thinking. The third pillar promoted quality assurance and safety, for example through a joint intelligence group to share information among local health and care partners and a dashboard to benchmark care homes performance.
  • The support offered by Sutton Homes of Care consisted of multiple initiatives carried out at different times in different ways and degrees of coverage to different care homes. While some elements of the support were available to all homes, nursing homes were initially the focus of the intervention from November 2015 to July 2016, with residential care homes receiving more attention from November 2016. We examined hospital utilisation data up to April 2017.
  • The Sutton residents were compared with a matched comparison (‘control’) group, which consisted of individuals broadly similar on a range of characteristics measured prior to the roll-out of the enhanced support and who moved into care homes of a similar type in comparable areas of England.
  • Overall, there was no strong evidence that Sutton residents in the study used hospitals more or less frequently than the matched control group. However, there were some indications that the Sutton residents might have experienced more emergency admissions than the matched control group, including more admissions that could be considered potentially avoidable through better care outside hospital.
  • Indications of higher potentially avoidable emergency admissions were strongest in nursing homes, where we estimate that Sutton residents were 122% more likely to be admitted than the control group (95% confidence interval: 19% to 327% higher). Further investigation may be required to shed light on the specific factors driving this difference, since it might suggest that the enhanced support had an unintended effect for this group.
  • There were some indications that Sutton residents who moved to a care home during the second eight months of the study period experienced fewer visits to accident and emergency (A&E) departments than the corresponding control group, although this did not seem to result in fewer admissions.
  • We ensured that the matched control group was as similar as possible to the Sutton residents in the study on observed characteristics (eg demographic mix and past hospital activity). Sutton and control residents may, however, have still differed in unobservable ways (for instance in individual levels of health care need or in the quality of care received), which could have affected the results. Assuming that the two groups were comparable, the findings suggest that the quality of care offered to people living in care homes in Sutton was broadly the same as in the control group, at least as measured by hospital use.
  • There are several possible explanations why we might not have seen significantly lower hospital use among Sutton residents than the control group. One possibility is that it was too early to see an effect. Other research has highlighted that the implementation of new models of care needs to be given time to take effect, so that the teams introducing these changes can be supported to work through initial implementation challenges and learn from experience. However, we cannot rule out the possibility that the enhanced support was unable to significantly reduce emergency admissions among the new Sutton residents in the study, and that there needs to be changes to the nature of the interventions offered. Another possibility is that the context in which the teams were working was not conducive to there being an effect on hospital activity of new care home residents.
  • Looking ahead, further quantitative analysis examining the impact on hospital outcomes since April 2017 would support Sutton CCG in its continued implementation efforts, providing further learning to enable it to deliver sustainable change. These findings need to be looked at alongside any qualitative or local evaluation to help identify whether the interventions carried out are sufficient, or if changes to implementation may be needed, to achieve the desired effect.
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