Creating the evidence base for a new model of community nursing care

When housing and healthcare work together to change how people are cared for in the community, Integration Authorities need evidence about how successful these initiatives are to make future funding decisions. 

Here, we share how an evaluation by the ihub of a pilot project in Forres, Moray was used to examine the effectiveness of one such example of a new model of care.

What we evaluated
In response to an ageing population and the pending closure of a community hospital, Health and Social Care (HSC) Moray decided to test an alternative model of community care during 2017 and 2018. This led to a collaborative way of working between housing and healthcare, and the piloting of a new nursing model for older people with complex care needs in Forres.

  • Five apartments were leased from sheltered housing provider Hanover Housing in the Varis Court complex to offer a positive recovery environment for people aged over 65 receiving inpatient care. These extra-care flats were called the Augmented Care Unit (ACU).
  • A new nursing team called the Forres Neighbourhood Care Team (FNCT) was set up to give 24-hours a day, 7-days a week support to the Varis Court residents and other people living in the Forres area.
  • The FNCT provided community nursing and medical care for people with acute and chronic conditions (including end of life). Care was provided in the ACU at Varis Court and in peoples' own homes, while allowing people to move between different care settings as required.

But did this change lead to improved levels of care? What was the impact on overall costs?

How we supported HSC Moray
HSC Moray had already gathered data from staff and people using the service so they knew that a good quality of care was provided. The service reduced social isolation, improved user experience and quality of life, and was a rewarding workplace for staff.

However, they also needed to know if the FNCT was having an effect on hospital admissions and whether there were any cost savings. The ihub's Evidence and Evaluation for Improvement Team (EEvIT) helped HSC Moray develop their evaluation questions and then looked at the routinely available data to answer them.

Since the ihub has already supported projects with health-economic analysis and fact-based evidence interpretation – underpinned by our experience of the complex interdependencies at play between the NHS and social care services – we were able to provide an evaluation to answer HSC Moray's questions.

We went on to perform a health-economic analysis which examined the changes in emergency hospital admissions, 28-day readmissions and length of stay following the introduction of the FNCT.

In addition, a health economist ran a before-and-after comparative analysis of hospital admission costs for a sample group cared for by the team. We presented our findings in a summary report.

What we found
Our analysis of the data over time for emergency admissions, 28-day readmission and average length of stay for people in the Forres area aged over 65, provided some indications that the new model of care may be reducing hospital admissions with associated efficiency savings. A comparative analysis of hospital admission costs of a cohort of people before and after they were cared for by the FNCT also found evidence for reduced costs associated with hospital admissions and length of stay.

Presenting and discussing the analysis with the team enabled them to reflect on how wider changes within the health and care system may also have influenced these outcomes. It was concluded that, although the model showed promising signs of a positive impact, further analysis including a longer follow up period was required to determine whether this new model was delivering sustainable reductions in acute hospital use.

What happened next
Evaluation of new service models, such as the trial in Forres, provides valuable information for health and social care organisations to inform decisions about commissioning new care services.

The result of the evaluation report from ihub's EEvIT was that the Moray Integration Joint Board (IJB) – the commissioning body for new care services in this area – decided to continue funding the FNCT for an additional year.

"The report produced by ihub/HIS were absolutely crucial is securing the support of the Moray IJB and gaining confidence of the sustainability of the project." - Project Lead HSC Moray

Importance of evaluation
Our health and social care systems face many competing pressures.

The need to be robust in decisions about the allocation of resources, commissioning and investment, means that being able to highlight innovations which are beginning to make an impact is critical.

Building in evaluation expertise into plans and a longer follow-up evaluation can create better locally based evidence which can be used to inform decisions.

The evaluation report about this pilot project is available from the EEvIT web section.