Developing safer health and care systems

Health and care systems are the way health services are provided. The developing safer health and care systems theme is focused on looking at how services are delivered to identify ways to make them safer.

NHS England recognises that health and social care should be delivered in a way that meets the needs of individuals. This can be done by improving the way different services are connected, and by creating new ways of working, known as alternative care models.

These models are part of the health and care system. They aim to deliver care in a way that helps individuals to stay safe at home or, if needed, to stay safe when admitted to hospital and when they are discharged home.

NHS England’s Patient Safety Strategy identified the impact of these models on patient safety as one of the challenges faced by health and social care. This theme aims to address this.

As narrowing the gap in health inequalities is central to our research, we focus on underserved patient groups with complex health and care needs. These groups have often faced greater patient safety risks. We need to understand the impact on patient safety in the context of changing services.

The experiences of staff, carers and patients are central to our approach. Our research is designed with patients, carers and staff.

Our approach

We use an approach that aims to understand the rules that control how different systems behave, interact and how they affect each other. This is known as systems thinking.

It ensures our research helps individuals, organisations and systems to quickly adapt to provide care that is timely and centred around the patient.

We work closely with organisations such as integrated care boards, primary care networks and voluntary organisations. This enables recommendations from our research to be put in place quickly and to start making a difference across health and social care settings.

We then evaluate these changes. This theme works towards the NHS Long Term Plan of building ‘strong and effective integrated care systems across England’ that reduce health inequalities and improve safety outcomes.

Our research focuses on evaluating alternative service models for vulnerable and underserved patient groups across three priority areas:

Impact of virtual wards on the safety of older people with frailty

Delivering care at home rather than in hospital is known as a virtual ward. There is little research that looks at the safety impact of this approach on the safety of older people with frailty.

Our research looks at how safety is managed in practice, for example, risk assessments, early warning sign tools and the culture of safety within the organisations who deliver the care. We believe this will result in improving the safety of virtual wards for people with frailty.

Acute Kidney Injury (AKI)

AKI affects around half a million people in England each year. Our research has shown that people affected by AKI experience potentially avoidable patient harm after they’ve been discharged from hospital.

A range of approaches have been proposed to help improve how post-AKI care processes are followed. This includes post-AKI clinics as well as expanding the role of AKI nurse specialists. However, there is little research around how well these approaches work.

Our work aims to address this lack of evidence by researching the different models of delivering services. This knowledge will help to improve the safety of discharge from hospital following AKI.

People with learning disabilities and/or autism (LD&A)

People with LD&A face considerable health inequalities. Their life expectancy is around 20 years less than the average population. Many deaths, including aspiration pneumonia (an infection of the lungs caused by inhaling saliva, food, or liquid) and sepsis, are potentially avoidable.

Through our links with national and regional organisations, we’re exploring the views of people with lived experience. We’re also working with integrated care boards and primary care networks to evaluate current and new models of care being developed.

Our impact: case studies

This theme’s programme of work is based on the success of previous projects that our researchers have delivered. These are already making a difference across health and care systems.

Key people

Professor Caroline Sanders (theme co-lead)

Caroline is a Professor of Medical Sociology and leads on Public and Community Involvement and Engagement for the Manchester Academic Health Science Centre (MAHSC) and the NIHR Applied Research Collaboration Greater Manchester (ARC-GM).

She leads research focused on patient and carer experiences of health and social care with a particular focus on marginalised and underserved groups.

View Caroline’s research profile

Dr Tom Blakeman (theme co-lead)

Tom leads our AKI research. He is a GP and Clinical Senior Lecturer at the Centre for Primary Care and Health Services Research at The University of Manchester. He has led several AKI research projects and was a member of the Royal College of General Practitioners (RCGP) Clinical Champion for Acute Kidney Injury. View Tom’s research profile

Professor Umesh Chauhan

Umesh leads our work around LD&A. He is a Professor of Primary Care at the University of Central Lancashire and a GP. He is the Chair of the Society of Academic Primary Care (SAPC) LD&A Special Interest Group.

Umesh also has considerable expertise around care for people with LD&A, which is particularly useful when implementing change to improve the safety and care for people with LD&A.

View Umesh’s research profile

Our team includes clinical and research expertise across primary, social care, nursing, geriatrics, renal medicine, maternity, child and family health, and pharmacy.

Our researchers have experience of working with public contributors both on designing studies and gathering data.

The PSRC team

Learn more about the researchers who deliver this work.

Research publications

Read published papers about our safer health and care systems research.