Summary of the impact

This research into what is believed to be one of the largest care home closures programmes in Europe had three key impacts in terms of:

• Helping to design the initial closure process at local level
• Evaluating outcomes of the subsequent closures to ensure that local policy and practice were safe (for frail older people in potentially very vulnerable situations)
• Producing national guidance for all English Councils on managing care home closures and contributing to local/national planning and a change in public opinion regarding care home closure in the wake of the Southern Cross scandal.

Underpinning research

In 2007 the School of Social Policy (University of Birmingham) was commissioned by Birmingham City Council to undertake research in support of their modernisation of older people's services. Following longstanding debates, the Council had decided to close all local authority care homes for older people, reassessing and resettling all current service users. Given Birmingham's size and the existence of a large in-house sector, this was believed to be the largest home closure process in Europe.

Before embarking on this process, Birmingham City Council commissioned the University's Institute of Applied Social Studies to produce a review of the literature on care home closures and an extensive review of local authority guidelines. This found that there was very little empirical evidence on the process or impact of care home closures and that there were few, if any, reliable benchmarks against which to evaluate the Council's closure programme. The Council therefore modelled its approach directly on the more general good practice and key themes identified by the reviewers (see R1 below).

Subsequently, researchers in the Health Services Management Centre were commissioned to undertake a three year real-time evaluation of this major service reconfiguration (2008 - 2011, R2). This was specifically designed to feed back to the City Council part way through the closure process so that changes could be made if any negative outcomes were found for older residents. In the event, the study found positive outcomes for those older people who took part and identified a series of key ingredients of this success. This led the Council to continue its initial approach — but with crucial external assurance that the approach adopted to such a sensitive area of policy and practice was as robust as possible.

Following publication and dissemination of the evaluation report, in 2011 researchers at HSMC were commissioned by the national Association of Directors of Adult Social Services (ADASS) to produce a national guide to best practice when supporting older people during residential care closures. This was published in conjunction with the Social Care Institute for Excellence (R3). The guide was distributed by ADASS to all 345 local authorities in England, who at the time were involved in planning for the potential closure of the Southern Cross chain of care homes (which had around 31,000 beds across the country) and taking stock of other potential independent sector closures stimulated by this crisis. In addition to the emerging data from the Birmingham evaluation, the guide included a review of the literature and interviews with social care leaders with prior experience of home closures. While the received wisdom was that closures could lead to negative outcomes, the findings of the additional research undertaken for this guide, combined with the evaluation data, revealed that care home closures, if well managed, could be implemented without making things worse for residents. This was a crucial component of national negotiations between ADASS, the government, Southern Cross and the administrator, contributing to a smooth transition and minimal disruption for the older people and families affected.

Research in the Birmingham study and subsequent guide was conducted by the following key researchers at the University of Birmingham: Professor Jon Glasby (Professor of Health and Social Care); Dr Suzanne Robinson (Lecturer, Health Services Management Centre, 2004-2012) and Dr Kerry Allen (Research Fellow then Lecturer, Health Services Management Centre). The initial literature review was produced by Rosemary Littlechild (Senior Lecturer) and Nick Le Mesurier (Honorary Research Fellow, 2007-2010) at Institute of Applied Social Studies, University of Birmingham.

References to the research

Research output:

Research grants:

• Glasby, J (P), An evaluation of the modernisation of older people's services in Birmingham, Sponsor: Birmingham City Council. May 2008 - March 2011. £100,000.

Details of the impact

This research was crucial to the initial development of Birmingham's care home closure methodology, with the summary of good practice provided by Le Mesurier and Littlechild (R1) directly influencing the subsequent design of local policy and procedures.

After this, the subsequent evaluation by the University of Birmingham was specifically designed to report interim findings part way through the closure process so that any emerging lessons about outcomes for older people (positive or negative) could be directly incorporated into subsequent closures. This provided a crucial form of external, independent scrutiny and meant that the research findings would directly influence policy and practice. In the event, the research found improved outcomes as a result of the closure process and so Council procedures were confirmed and continued. Had mortality increased, however, there would have been a major opportunity for the City Council to rethink its approach and change its methods/working practices. The impact of the research then was the provision of a `sense check' and safeguard in the process for Birmingham's older people and their families.

The research was also key to securing buy-in from the people of Birmingham (including the affected older people and their families) ahead of a controversial closure plan. The commissioning of the evaluation demonstrated the commitment of Birmingham City Council to ensuring they carried out their closures in a responsive way and that their decisions were transparent and robust, being endorsed by verifiable research (indeed, the Birmingham study is believed to have provided the most extensive publicly available data on care home closure in the country). As part of this process, the studies produced by the University of Birmingham (R1 and R2) were made publically available and the process and findings held to scrutiny. As a result the research also contributed to the smooth continuation of the closure plan, in conjunction with the positive experiences of those moved in the closures (source 1).

In 2011, towards the end of the study, the high profile news story on the financial problems in Southern Cross began to emerge. The University of Birmingham was commissioned by ADASS to produce high quality but rapid guidance (a 2 month project from start to national dissemination) for all local authorities in England based on their research. This was carried out in very difficult media and political circumstances owing to the very large nature of Southern Cross, the significant distress being caused to older people and their families and political pressures on the then Health Secretary (who was facing criticisms of potential privatisation around the Health Bill just as a major private company was in trouble in adult social care). The situation was also made more complicated by media stories about the quick wins/high risk nature of venture capital investment in Southern Cross, the complexity of understanding the various holding companies and off-shore banks involved, and the fact that one of the investors that might have withdrawn money and triggered bankruptcy was RBS (a bank owned by the tax payer).

It was for this reason that the University of Birmingham was approached to conduct the research in the first place — given its longstanding reputation for `rigour and relevance', its ability to conduct confidential research quickly and discretely, and its role as a critical friend to health and social care policy. In addition, the University was already collecting important outcomes data into the Birmingham home closures process, and was therefore able to draw on original research findings as well as a detailed knowledge of policy and practice in order to produce the subsequent guide. The guidance was made publically available in June 2011
(www.birmingham.ac.uk/news/latest/2011/06/08JuneCareReport.aspx).

The former President of the national Association of Directors of Adult Social Services is clear that the research, and the guide in particular, was of great benefit through the process. For him, it not only `proved crucial during negotiations with government and with Southern Cross [and] helped to ensure a smooth handover to new providers without the major upheavals that might otherwise have occurred', but it aided his work with the media `helping [him] to summarise the evidence base and explain what [ADASS] were doing to protect the older people involved'. The findings were also used by ADASS and others in their negotiations with Southern Cross and its landlords to make sure that no homes closed quickly (given a key finding about the importance of time and space to plan closures well and work at the pace of individual older people). Eventually all homes were transferred to alternative providers without any older people being forced to leave their home.

In addition to this, the guide itself received exclusive coverage from The Guardian (source 2), as well as being featured by ITV News, The Telegraph, the Today programme and a range of other outlets. The lead author, Professor Jon Glasby, was subsequently invited to a private briefing with journalists at the BBC to help them understand the implications of long-term care funding — speaking alongside the chair of the Social Policy Association and Andrew Dilnot (author of the recent Dilnot review on the funding of adult social care and now Chair of the UK Statistics Authority).

The impact is ongoing as closures continue around the country. More recently (in early 2013), Glasby worked with Surrey County Council to develop their revised Community and Care Home Provider Closure Protocol. The Council drew on the Birmingham good practice guidance and evaluations. They are clear that the documents were `vital...in shaping and defining SCC's protocol and in particular formed the basis of the chapter on best practice, which was to be applied to all potential closure scenarios' (source 3). By July 2013, the protocol was already `in full use by practitioners' and part of Surrey's core training.

In summary, the research contributed to the design of effective local policies and procedures, helped to ensure that local practice was safe for frail older people and contributed to national policy, public and media debates about care home closures in the wake of the Southern Cross scandal.

Sources to corroborate the impact

[1] Factual statement provided by former President of the national Association of Directors of Adult Social Services, Birmingham City Council

[2] Glasby, J. (2011) Achieving closure: how to deal with closing care homes, The Guardian, 12 July. Available online via: http://www.guardian.co.uk/housing-network/2011/jul/12/closing-care-homes?INTCMP=SRCH

[3] Factual statement provided by Strategic Director for Adult Social Care and Fire Service, Surrey County Council