Greater delegation needed to improve older people's care, study finds

Older people’s care can be ‘significantly’ improved across England through better coordination of services, a leading thinktank has said

Older people’s care can be ‘significantly’ improved across England through better coordination of services, a leading thinktank has said.

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In 2016 NHS England launched the Enhanced Health in Care Homes framework to promote closer working between the NHS, local authorities and care homes.

The framework is aimed at improving quality of care through work such as more coordinated visits, organising regular GP visits, and shared information and training across different organisations.

Thinktank The Kings Fund studied 15 areas in England to evaluate the effects of the model – finding reduced hospital admissions, earlier discharges, improved wound care and better continuity of care, among other benefits.

 Delegation issues

Each area studied for the Enhanced Health in Care Homes: Learning From Experiences so Far report became involved in shared training.

Care home staff were often able to access NHS courses and become more confident and qualified to carry out tasks.

But, problems occurred when NHS staff, including nurses, sometimes failed to then delegate those tasks, the report said.

‘In these cases, healthcare was provided at whatever time the NHS staff were able to visit (rather than when was suitable for the resident) and could involve a significant number of uncoordinated visits.’

The thinktank said most areas began by focusing training on care home staff, but later found NHS staff could also benefit from learning how care homes work.

Some areas, the report said, then saw staff use the knowledge to carry out ‘root-cause analysis’ for each admission to hospital from a care home – with the aim of improving future care.


One NHS provider said: ‘It’s an eye-opener to see what care is like, outside your own sphere of usual practice.

‘Our district nurses went in and out of care homes, but they didn’t actually recognise the issues that care homes faced until they worked more directly with them and saw how specialist palliative care was delivered.’

Organisations working as equal partners was also found to be essential.

One NHS provider said: 'You can’t possibly do this unless you really engage with the care homes. People make this mistake the whole time.’


The report suggested although extra resources were initially needed to promote better partnering, the amount was small enough to expect the enhanced health model to be ‘realistically achievable in any area of England’.

Yet, they warned no single method of enhanced health could be replicated across the country, as each area needs a tailored plan to meet local needs.

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