Care home services at the vanguard: a qualitative study exploring stakeholder views on the development and evaluation of novel, integrated approaches to enhancing health care in care homes

Stocker, Rachel, Bamford, Claire, Brittain, Katie, Duncan, Rachel, Moffatt, Suzanne, Robinson, Louise and Hanratty, Barbara (2018) Care home services at the vanguard: a qualitative study exploring stakeholder views on the development and evaluation of novel, integrated approaches to enhancing health care in care homes. BMJ Open, 8. e017419. ISSN 2044-6055

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Official URL: http://dx.doi.org/10.1136/bmjopen-2017-017419

Abstract

Objectives:
To explore stakeholders’ understanding of novel integrated approaches to enhancing care in care homes (a care home ‘vanguard’) and identify priorities for evaluation.

Design:
A qualitative study, using semi-structured interviews with commissioners and service providers to/within care homes, and third sector organisations with thematic analysis.
Setting A Clinical Commissioning Group (CCG) area in England.

Participants:
Thirty interviewees from: care homes, the National Health Service (England) and local authority, third sector (10 care home managers, 5 general practitioners, 4 CCG employees, 4 local authority employees, 1 national (NHS England) vanguard lead, 2 specialist nurses, 2 geriatricians, 1 third sector, 1 health manager).

Results:
Four higher-level themes emerged from the data: understanding of proposed changes, communication, evaluation of outcome measures of success, and trust and complexity. The vision for the new programme was shared by stakeholders, with importance attached to equitable access to high quality care. Support for the programme was described as being ‘the right thing to do’, inferring a moral imperative. However, the practical implications of key aspects, such as integrated working, were not clearly understood and the programme was perceived by some as being imposed, top down, from the health service. Barriers and facilitators to change were identified across themes of communication, outcomes, trust and complexity. Importance was attached to the measurement of intangible aspects of success, such as collaboration. Interviewees understood that outcome-based commissioning was one element of the new programme, but discussion of their aspirations and practices revealed values and beliefs more compatible with a system based on trust.

Conclusions:
Innovation in service delivery requires organisations to adopt common priorities and share responsibility for success. The vanguard programme is working to ensure health and local authorities have this commitment, but engaging care homes that may feel isolated from the welfare system, needs sustained dialogue over the longer term. Evaluation of the programme needs to measure what is important to stakeholders, and not focus too closely on resource consumption.

Item Type: Article
Uncontrolled Keywords: Health Policy; Health Services for the Aged; Qualitative Research; Residential Facilities; Delivery of Health Care, Integrated
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Paul Burns
Date Deposited: 21 Feb 2018 10:08
Last Modified: 26 Apr 2018 01:28
URI: http://nrl.northumbria.ac.uk/id/eprint/33453

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