NICHE-Leeds is a partnership between academics at the University of Leeds and care home staff, residents and their families. The partnership brings together experts from the caring profession and those working in research to address the questions that matter for care homes.
The impetus was about making sure the voices of people living or working in care homes were heard in the process of generating research and evidence that would really make a difference for those people.
NICHE-Leeds replicates the Living Lab in Ageing and Long-Term Care at Maastricht University, the Netherlands, which has been running for 25 years. The model is based on building research projects around questions generated by the care home sector and fostering genuine collaboration.
During the first two years, we built relationships, helping people living and working in care homes to understand what we were trying to achieve, and why and how it would benefit them, and those conversations have led to the development of a number of research projects. This method ensures we are asking the right questions.
Some care home staff and family members are co-applicants on some of our National Institute for Health and Care Research (NIHR) grants. They have a say in the actual delivery of the research and help us consider how to share results with the people we need to influence to have the greatest impact.
How it works
The model, established in 2018, is a partnership between the University of Leeds and care providers Westward Care and Springfield Healthcare, working also with Leeds Care Association and Leeds City Council. In 2023, HC-One, Britain’s largest care home operator with almost 300 care homes across England, Scotland and Wales, and Leeds Beckett University also joined the partnership.
A university researcher acts as a scientific linking pin, funded by the care organisation and working in the care home one day a week. A care home staff member acts as a practice linking pin, facilitating the researcher’s work in the care home and ensuring stakeholders are involved in the generation of research ideas.
The university provides infrastructure – how we leverage those ideas and attract funding – and the management of the grants. So far, we have been associated with grant income of around £6.5m on different projects. Sometimes commissioned calls come from funders, which gives us an opportunity to ask care homes whether there is something they’d like to do on this topic. However, quite often the ideas come from care homes, and we wait for the right opportunity or funding pot to become available.
Residents and the public are involved from the get-go. Not everything raised is a research question – it is really about audit or best practice, and it is something you could implement tomorrow. Sometimes we know evidence exists and we can share that knowledge with those who are asking for it.
Bringing together scientists and people delivering care in the care home environment is a massive win and a lot of the projects we’re doing are just coming to delivery. These are ideas that care home staff are saying are really important and useful to them. In the future, these projects will start to make a difference every day.
Recently, we held a five-year celebration event where carers spoke about their experiences. Senior managers described having queries about medication for example and being able to get in touch with us to get answers quickly and learn from our academic expertise.
The impact is increased care home staff confidence; it helps them value what they do and understand it is alright to have questions about how to do things better. Senior care home staff can access extensive knowledge that may otherwise have been closed off to them.
Research projects
REcruiting and RetAining nurses, and carers in Care Homes: What works, for which staff, under what circumstances, and at what cost? The REACH Realist Review.
This research project focuses on attracting, recruiting and retaining nurses and carers to care home work. Using evidence from research articles, reports, policies and other relevant materials, it will build an explanatory framework which will describe what is needed to attract, recruit and retain staff and why, as well as describing the differences between staff and outlining the costs involved in staff recruitment and retention.
Key to the project are the views of people working in care homes. Registered nurses and care workers have been interviewed about their experiences and their views have contributed to building a picture of what is needed and why to attract and keep nurses and carers in care home jobs. During the project, researchers have met regularly with care home residents, relatives, staff and people working in social care. Their involvement is helping to ensure the research messages are relevant and reflect the views of people who live and work in care homes.
The project is due to be completed this year, and the findings will be shared with care homes across the country and published in research journals. Through NICHE-Leeds, the researchers will work with partnering care home organisations to support them in implementing the findings into practice.
Maintaining and improving mouth care for care home residents: A participatory research project
This project was developed after a care home worker asked researchers how to help residents with mouth care, particularly when they resisted that care, as is common among people with dementia. As well as promoting mouth care for residents, the project aimed to bring about mouth care practice changes in its partner care homes, if needed.
The project explored existing literature to develop accessible guidance on strategies that staff could use to support residents to maintain and improve oral care. The review was used to determine knowledge levels within the care team, which highlighted skills and knowledge gaps, and the training needed to address this. Resources were developed for care homes from the project and informed a larger study, which will be published later in 2024.
Future of the partnership
We are gradually growing the number of partners, which takes time. We are also widening the net so other care homes know they can be part of our projects and benefit from our expertise and resources, even if they are not part of the partnership.
In the future, we hope our work will make a difference to people living in care homes, and support people working in these environments to understand best practice informed by research. We hope staff will have confidence in what they do and know they can ask questions when they do not know.
The NICHE-Leeds model provides a blueprint of how research should be done, acknowledging that collaboration is essential if research is to have any chance of making a difference for people in the sector.
Partner perspectives
‘Joining the NICHE-Leeds research partnership has improved standards of care, as well as staff skills and knowledge, and has raised our profile as professional care providers in the health and social care community. NICHE-Leeds has given access to a whole new world of knowledge, and the participatory research approach has improved work culture, with staff telling us they feel valued as recognised professionals.’ Peter Hodkinson, Managing Director, Westward Care Ltd.
‘We have been part of innovative developments relating to the management of COVID-19, gained support when implementing our digital care planning system, enhanced our oral care delivery and supported our staff to understand the impact of activities on residents’ wellbeing.’ Angela Randle, Head of Kindness Care and Quality, Springfield Healthcare.
‘Over 70% of care home residents have dementia and doing research that helps care homes to deliver the best quality care to this vulnerable group is really important. As well as the opportunities to do research together to directly impact practice change, NICHE-Leeds is also exciting because it is building capacity and interest in research in the care home sector, who traditionally have had fewer opportunities than NHS staff to engage in this.’ Claire Surr, Professor of Dementia Studies, Leeds Beckett’s Centre for Dementia Research.
‘NICHE-Leeds provides a great opportunity to bring researchers and care staff and residents together to find out what the issues are and use research help to identify a solution.’ Michelle Atkinson, Chief Officer, Leeds Care Association.
‘Often such research remains academic and does not impact on day-to-day practice. The NICHE-Leeds approach results in practically useful outcomes that improve quality by changing practice. One clear example is the oral hygiene work we have been involved in, which has been well received by staff and because of this has impacted on the wellbeing of residents; similarly with the work around dementia.’ Richard Graham, Care Quality Team Commissioning Programme Leader, Leeds City Council.
‘Working as a Practice Linking Pin since 2023 in the NICHE-Leeds Partnership offers HC-One the opportunity to really explore what matters to our residents and staff. Colton Lodges in Leeds, a large nursing, resident and dementia care home with 130 beds over four units, has welcomed this partnership.
‘We are finding out what really matters by being curious, searching the literature for credible evidence to support best practice and being creative, formulating ideas for change. Currently we are exploring stress and destress behaviours, which is such an important subject with the care home sector.’ Allyson Sanderson, Regional Senior Nurse – Northeast, HC-One. <end box>
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Karen Spilsbury is a Professor of Nursing at the University of Leeds and Academic Director at NICHE-Leeds.
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