Relationship between care home staffing and quality of care: a mixed methods approach



The aim of this study is to explore and explain the relationship between use of the care home workforce (and the mix of care home staff) and how this affects the quality of care; outcomes for residents, relatives and staff; and how money is used to pay for care and its impact on quality. Our overall aim will be addressed through the following objectives 

  • describing variations in the characteristics of the care home nursing and support workforce 
  • identifying the dependency and needs of residents and relatives in care homes and its association with care home staffing 
  • examining how different care home staffing models (including new roles) may impact on quality of care, resident outcomes and the use of NHS resources 
  • explaining how the care home workforce (numbers, skill mix and stability) can best meet the dependency and needs of residents 
  • exploring and understanding the contributions of the nursing and support workforce (including innovations in nursing and support roles) in care homes to enhance the quality of care 
  • translating methods used for modelling the relationships between staffing and quality to provide a platform for sector-wide implementation. 


To meet our objectives we have 5 work packages (WP).  First, we will better understand how and why the characteristics of the care home workforce vary so much across England.  To do this, we will review existing research and survey care home managers and staff (WP1).  

Having put forward some possible ways in which care home staffing and quality are related, we will use data on quality from two organisations (WP2) - Skills for Care (who help adult social care organisations in England recruit, develop and lead their workforce) and the Care Quality Commission (who regulate quality in services in England and Wales) - to test these ideas and develop understanding of the national picture.  Working with Bupa Care Services, we will then use organisational data to further understand the relationship between staffing and quality and costs (WP3).  

Having explained the associations between staffing and quality, we will explore why quality varies as staffing changes by studying in detail what happens in six care homes (WP4).  We will watch care being delivered and gather the views of residents, relatives, care home and NHS staff (WP4).  The government has established six care home ‘vanguards’ to improve care for people living in care homes so we will share our findings with a group (staff, residents, relatives) from each site (WP4).  

Finally, we will identify who and what helps care homes spread new ways of working and use this knowledge alongside a combined picture from the results of all the work packages to encourage all English care homes to consider ways in which they might implement and use the research (WP5).   


In the UK, 405,000 older people live in 18,000 independently owned care homes (5,153 nursing and 12,525 residential homes).  People are entering care homes older, sicker, frailer and have needs that require specialist help, such as dementia.

Residents in residential homes today would probably have been cared for in nursing homes 5-10 years ago. These increased demands on care homes will continue as health and social care systems adapt to having less money from government. Staffing is the largest expense in most care homes and quality depends on the staff working in the home. So, to provide high quality we need to understand how to make best use of the staff employed in those homes.

In recent years quality of care and staffing in the care homes has often been criticised by professionals, people who live in homes and their relatives, and the policymakers making decisions about how much society can afford to pay for this part of the care system. Beyond recognising that ‘staff influence quality’, we don’t know much about the people who work in care homes and how they affect quality of care; including how people living in care homes experience care and how much quality costs.


Principal Investigator:

Professor Karen Spilsbury, University of Leeds 


Professor Andy Charlwood, University of Leeds 

Professor Carl Thompson, University of Leeds 

Dr David Alldred, University of Leeds 

Dr Kate Farley, University of Leeds 

Paul Edwards, BUPA UK 

Lucy Brown, BUPA UK 

David Griffiths, Skills for Care 

Professor Barbara Hanratty, Newcastle University 

Professor Anthony Arthur, University of East Anglia

Professor Julienne Meyer, City University London 

Professor Heather Gage, University of Surrey 

Additional team members: 

Dr Danat Valizade, University of Leeds 

Dr Gianluca Veronesi, University of Leeds 

Will Fenton, Skills for Care 

Jake Jordan, University of Surrey 

Funding body: National Institute for Health Research Health Services and Delivery Research Programme: Commissioned call – 15/144 Improving the quality of care in care homes by care home staff (£922,217) 

Contact: Professor Karen Spilsbury, University of Leeds