The role of ambulance services in reducing avoidable transitions to hospital for older people living with frailty and care home residents

This prestigious White Rose network studentship will focus on development and testing of an intervention to build resilience and independence for older people with frailty.

Older people with frailty and care home residents account for around £15 billion of health and social care expenditure in England. The dominant element of expenditure is in emergency department attendances and acute hospital admissions with protracted lengths of stay. This is costly from a NHS perspective, but also impacts on the independence of older people, who risk loss of independence as a result of immobility and deconditioning in hospital.

It is recognised that a proportion of hospital admissions for older people with frailty may be avoidable, and there is an increasing NHS policy focus on providing appropriate care for older people living with frailty within their own homes. Additionally, some nursing home residents experience multiple transitions to hospital in the last year of life, which can be burdensome, futile and potentially avoidable.

In this PhD studentship, we plan to investigate the potential role of ambulance services in reducing avoidable transitions to hospital for older people living with frailty and care home residents, using a range of novel, integrated methodological approaches.

Objectives to include

1) Reviewing the international literature on the role of ambulance services in preventing avoidable emergency transitions to hospital for older people living with frailty and care home residents.

2) Applying methods to linked routine data from NHS and social care organisations across Yorkshire & Humber to study variation in transition rates for older people living with frailty.

3) Use case study methods to study ambulance service organisation and delivery in selected Yorkshire & Humber areas identified as highly performing in terms of transition rates to hospital.

Network

The successful candidate will join the Bouncing Back Network – an interdisciplinary network of three PhD studentships across the Universities of Leeds, York and Sheffield. They will work independently but alongside two other PhD students researching related projects.

The Network is funded by White Rose as part of NIHR ARC YH - an important programme of applied research, delivered through a regional partnership including universities, the NHS, Local Authorities, voluntary and community organisations. The Network is led by Prof Clegg at the University of Leeds, who also leads a theme focusing on improving care for older people with frailty in NIHR ARC YH, and includes collaborators from across NIHR ARC YH. All collaborators have a track record of providing cohesive cross-university co-supervision.

The Bouncing Back Network focuses on use of novel methods to answer key research questions, drawing on the internationally-leading cross-disciplinary expertise. This will allow PhD students to receive cutting edge, applied training in novel research methods, ensuring that they will be well positioned to develop as leading researchers in the strategically important and internationally relevant area of improving care for older people living with frailty.

The Network will bring considerable added value for successful students, through collective input into all PhD studentships from all supervisors, a focus on student-led activities to develop student confidence and skills, and a strategic focus on preparing students for next steps in terms of post-doctoral research applications. The Network will engage closely with the NIHR ARC YH White Rose Early Life Studentship Network, led by Prof Kate Pickett, University of York, to ensure that learning is shared across Networks. This will include collective meetings three times a year that will be attended by all students and lead supervisors, and an annual event to present PhD findings from research across the lifecourse to all co-applicants from NIHR ARC YH.

Training

To complement the applied training of the studentship with ScHARR and the AUECR, the successful PhD student will include access to appropriate courses/modules at the Universities of Sheffield and Leeds, including those relevant to analysis of routine data and qualitative research methodology. We will also identify appropriate training courses to meet the needs of the individual student across the White Rose University partners, and externally. The linkage of the studentship to the NIHR ARC Programme will enable opportunities for training courses provided by NIHR such as the NIHR Doctoral Research Training Camp.

Entry requirements

Candidates must have a first or upper second class honors degree, a master’s degree and/or significant research experience and have an interest in analysing large datasets using statistical and/or computational methods. The studentship may be of particular interest to those with a background in health informatics / data analytics.