Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care: An interview study from England

Claire Goodman, Susan Davies, Adam L. Gordon, Julienne Meyer, Tom Dening , John Gladman, Steve Iliffe , Maria Zubair , Clive Bowman, Christina Victor, Finbarr Martin

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
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Objectives: To explore what commissioners of care, regulators, providers and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of NHS services to independent care homes.
Methods: Qualitative, semi-structured interviews with a purposive sample of people with direct experience of commissioning, providing and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health.
Results: Participants identified three overlapping approaches to the provision of National Health Services (NHS) that they believed supported access to health care for older people in care homes. These were: 1. Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff; 2. The provision of age appropriate clinical services and; 3. Governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive.
Conclusion: The three approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organisations
Original languageEnglish
Pages (from-to)427 - 432
Number of pages6
JournalJournal of the American Medical Directors Association (JAMDA)
Issue number5
Early online date14 Feb 2015
Publication statusPublished - 1 May 2015


  • Care homes, older people, health services, frailty, health care, realist review


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