Advanced Care Research Centre

New Models of Care

The seventh work package of the Advanced Care Research Centre.

Care now is often delivered as discrete services that are variably integrated and largely reactive to events rather than responsive to the wishes, priorities and needs of individual people in later life. We will work with citizens, carers, and health and social care partners to both understand and evaluate recent service innovations, and to co-create new models of care which are responsive to individual circumstance and have the potential to be implemented at scale within health and social care sectors.  

Work-package seven (WP7) ‘New models of care’ is the translational end of all the other work-packages. Drawing on the initial findings of all the research work-packages, we will work with all stakeholders to co-create new models of care which are grounded in detailed qualitative (work-package 4) and quantitative understanding of individual need, which use existing data and predictive tools to support risk-stratification (work-package 5), which flexibly incorporate proven new technologies as they become available (work-package 6), and which are integrated with existing health and social care services. 

WP7 is a collaboration with colleagues from Newcastle University’s Institute for Ageing, which hosts the National Innovation Centre for Ageing. Our collaboration with this world-leading research Institute and centre at Newcastle University greatly strengthens the networking opportunities for the ACRC and thus future funding opportunities for both Universities. 

Dissemination Outputs and Impact

The overall aim of WP7 is to work with health and social care providers to support and evaluate the development of new models of integrated care. To do this we need to understand existing and evolving models of care, and to develop, optimise and test innovative new models of care in Scotland and England. Specifically, we are interested in identifying variation both early in the trajectory of care when interventions are of necessity less intensive and more directed to self-management at home, and later when more intensive multidisciplinary interventions and residential care are more common. Given that health and social care policies have commonalities but also significant divergence between the two countries, our objectives are: 

Objective 1: to study the international changes in health and social care systems in response to the global challenges of ageing populations, multimorbidity, and frailty, and to relate these findings to the evolving health and social care integration and reorganisation of primary care in Scotland and England, and the intended and actual impact on those with complex care needs 

Objective 2: in the context of objective 1, to explore in-depth multidisciplinary team care for people in later life with a spectrum of care needs in South East Scotland and North East England, identifying case studies of innovative practice in community and primary care, and barriers and facilitators to change in areas where care has not significantly evolved. Selected case studies will then be examined in-depth (deep dives) 

Objective 3: to synthesise findings from WP7 and the other work-packages (especially WPs 4-6) in collaboration with health and social care stakeholders and public/patient partners to design new models of care for implementation and evaluation at scale. 

Objective 4: To submit a series of major grant proposals to rigorously test these new models of care in terms of effectiveness, safety, and cost-effective.   

We will focus on four areas that influence key care pathways in this work-package.  

  1. Community and third-sector support for people in later life living in the community 
  1. Integration of statutory health and social care services for people in later life living in the community 
  1. Transitions into care homes  
  1. Improving the care of those already living in care homes 

Context

Health and social care in the UK is in a state of rapid change with major initiatives in health and social care integration, primary care reform and new general practice contracts, supporting self-management, and better targeting of new kinds of statutory and third sector care. There are also considerable opportunities for collaborative working to shape and evaluate new models of care as they emerge in service innovation and/or are developed as part of research. 

Two key developments in many areas of the UK relate to the use of asset-based approaches to care (particularly in initial assessment and intervention), and developing more multidisciplinary comprehensive assessment and intervention for people with the highest care needs. Implementing a new service model brings many challenges, and new tools for sharing information about services have the potential to help break down some of the traditional barriers to self-care and autonomous decision making in this context. Such democratisation of knowledge, that promotes individuals themselves as experts in knowing what will work for them in their lives, is critical.  

Research Design

Objectives 1-4 of WP7 will be met through a series of work-streams, which will be carried out by researchers at the Universities of Edinburgh and Newcastle, in a collaborative and integrated approach.  

Work-stream One (Objectives 1). This work-stream will involve reviewing the international literature, and English and Scottish policy documents. Interviews will also be conducted with key stakeholders. The aim of this work-stream is gain comprehensive and up-to-date knowledge of the international and UK landscape regarding new models of care in community and primary care settings across our 4 areas of focus. This work-stream will be completed in the first 12 months of the project. 

Work-stream Two (Objective 2). This work-stream will involve gathering local information on established or evolving innovative approaches for target groups of patients in South East Scotland and North East England, in order to identify and document in-depth case studies of new models of care across our four areas of focus. We will take a mixed-methods approach combining qualitative interviews with quantitative approaches. The time-line for this will be months 6-18.  

Work-stream Three (Objective 3). This work-stream will integrate and synthesise the findings from the previous work-streams in WP7 and will also incorporate emergent developments in work-packages 4-6. We will use a co-design approach to develop and optimise new models of care for evaluation and implementation at scale.The aim of this work-stream is to have a range of rigorously developed interventions across our four areas of focus ready for testing at scale. The time scale for this will be months 18 – 30. 

Work-stream Four (Objective 4). To submit a series of major grant proposals to test these new models across our four areas of focus of care at scale in terms of effectiveness, safety, and cost-effective. Time-scale for grant submission is 30-36 months.