New grants to tackle NHS problems, prevent needless admissions of elderly to A&E

Just how the elderly can be prevented from needlessly being referred to A&E along with how the NHS can improve the transfer of research-based evidence to the frontline is to be examined by academics from Warwick Business School.

The University of Warwick has been given £384,000 to look at how the National Institute for Health and Care Excellence (NICE) can transfer its knowledge and research to the frontline using the newly appointed Clinical Commissioning Groups (CCGs). Professor Jacky Swan, of Warwick Business School, which is part of the University of Warwick, will lead this study.

While a £465,000 grant has been awarded to University Hospitals Coventry and Warwickshire NHS Trust to examine how to stop needless admissions of the frail elderly to A&E. This will be led by Warwick Business School Professor Graeme Currie.

Funding for both of these projects has come from the National Institute for Health Research Health Services & Delivery Research (NIHR HS&DR) Programme.

Professor Swan will lead a research project that will aim to improve CCGs’ capabilities to use NICE guidance in their decision-making so that patients receive the latest and best available treatments and services. 

“The implementation of evidence-based guidelines produced by NICE should ensure equality of access to treatments and care pathways,” said Professor Swan, a Professor of Organisational Behaviour. “But uptake of guidelines can be patchy across NHS organisations. Further work is needed to identify how NHS organisations can develop and improve their capabilities to use evidence more effectively.”

Professor Swan and her team will be looking specifically at how the CCGs will need to set up their organisation and management to ensure that NICE’s research reaches the right people.

To find the best way of transferring knowledge Professor Swan will follow the ‘journey’ of recommendations from NICE on ‘what to do’ and ‘what not to do’ through 10 CCGs.

The research will trace how fast the recommendations reach the frontline, how much effort it takes to get there, how satisfied decision-makers, patients and stakeholders are and whether, and why, recommendations are adhered to or modified.

Professor Swan added: “This will help us to understand the complex challenges that CCGs face and make the journey of guidelines into practice smoother.”

Professor Currie will lead a team of researchers looking at how 12 CCG-led commissioning networks deal with the frail elderly to stop them needlessly ending up in A&E when they and the NHS would benefit from them being treated elsewhere in the system. The lessons learned from the study will be transferable to other parts of the NHS.

“We will look at how we can enhance the ability of CCGs to understand problems properly and use that to reduce unplanned frail elderly acute hospital admissions,” said Professor Currie, a Professor of Public Management and Associate Dean. “Exploratory interviews suggest that CCGs are very good at acquiring knowledge, but not so good at assimilating and using that knowledge effectively.

“CCGs have the intelligence and strategic intent, but the challenge is how we exploit that intelligence and use it to drive real change in the system. Commissioning networks need to use their intelligence to move resources concentrated on hospital-based elderly care to primary care and other settings, where frail elderly patients would prefer to receive their care.

“I believe we will find problems that will encompass more than a single disease pathway as the elderly often suffer many different problems that will see them cross into several different organisations and professions, not just in the NHS, but outside it as well. This will help us generate lessons that are transferable beyond just the elderly care domain.”