Evaluating the organisation, delivery and impact of person-centred ‘neighbourhood-based, integrated health and care’ models of home care: a multi-method study

RESEARCH QUESTION This project will evaluate the organisation, delivery and impact of person-centred ‘neighbourhood-based, integrated health and care’ models of home care, to provide national understanding of what they look like, how they work in practice, and how they can be implemented and evaluated in future. BACKGROUND Policy-makers have outlined their ambitions to provide joined-up care closer to home to enable people to remain independent in their own homes. Home care and support is a central component of meeting these ambitions; however, care workers often have unsatisfactory working arrangements (low wage, zero-hours contracts, paid only for the time they spend with clients, lack career structure) and are limited to providing personal care only. Service users often experience a lack of continuity of care workers, and multiple visits from health and care professionals that are not ‘joined up’ to meet their needs. New models of commissioning and delivering home care are emerging in the UK with a focus on providing integrated health, care and community support to service users: putting their needs first, promoting continuity, reducing visits from multiple health and care professionals, and enhancing neighbourhood connection to support people in their local community (e.g. signposting to support or social groups). Some models also include new approaches to staff training and contracting which have potential to improve workforce satisfaction, autonomy, stability and quality. The introduction and piloting of new approaches is proceeding at pace, but there is no national framework to guide their introduction, leading to regional variation; and there is little evidence to support their development and evaluation. Detailed exploration to support future implementation, scalability and evaluation is required. AIMS AND OBJECTIVES This project aims to: a) explore and describe current integrated models of home care service delivery implemented across UK regions b) evaluate in-depth the models’ components and functioning associated with outcomes of importance for people using, delivering, providing and commissioning integrated models of home care; including perceived benefits, disadvantages and unintended consequences c) make recommendations to inform future implementation and evaluation of integrated models of home care. METHODS A multi-method study using participatory and case-study approaches with 3 phases, underpinned by national stakeholder engagement and consultation throughout: 1) Evidence synthesis of the literature on integrated home care models (including model descriptions) 2) Case studies in two diverse cities to explore integrated home care models’ core components and impact 3) Consultation with stakeholder panels to establish feasibility and acceptability of wider implementation of these models, and develop a methodological framework for future evaluation Throughout, we will work with and consult our PPI co-applicant, collaborator, PPI group and community groups to ensure their views inform our approach. TIMELINES FOR DELIVERY Commencing in May 2025, the study will run for 30 months. ANTICIPATED IMPACT AND DISSEMINATION National policy makers and other health and social care organisations will be provided with recommendations and elements that are key drivers of efficiency for integrated home care. We have developed a plan for wide dissemination of our findings to commissioners, providers, home care staff and the public.