What is the Vivaldi project?

There are more than sixteen thousand care homes across the UK, housing around half a million people. Staggering numbers. They are meant to be places of safety, routine, and quiet companionship for the people who live and work in them. But when COVID-19 arrived, they became one of the pandemic’s deadliest frontlines. Residents died in large numbers. Families were locked out. Many staff left the profession. And the systems meant to protect people often failed. In a bid to see what could be done, the Vivaldi Study - a nationwide effort to gather data from inside care homes - was launched. It’s been led by Professor Laura Shallcross, a public health researcher who wants to use data to improve the lives of people who live and work in care homes. I went to meet her at University College London…

Laura - There is a complete lack of data on people in care homes, so residents and staff. If you can't measure things, you don't know where problems lie, and that makes it really hard to know how to intervene to make improvements.

Chris - I must admit it was something of a shock to me when I learned that there are half a million people or so in care and in care homes, and we don't take any steps to actually monitor what's going on there.

Laura - Strictly speaking from an infection perspective, we have some monitoring – so we monitor outbreaks in care homes – but you're absolutely right, we don't have accurate data on who's in a care home, and this does seem to be a very important missed opportunity. If we don't know where the problems are, how do we fix them?

Chris - What sorts of things do you envisage measuring then?

Laura - So we can start quite simply, with things that are already measured in other settings. In the NHS, we have very good data on how many people go to hospital, on the reasons why they go to hospital, on the use of antibiotics, other medications, surgical procedures. These things are all recorded in the background all the time. If we could start by measuring some of those things for care home residents, that would be a massive leap forward. But longer term, what we really need to do is start thinking about the measures that matter to people in care homes – and so that's particularly thinking about things like quality of life – and we need new ways to measure those kinds of outcomes too.

Chris - Indeed, the thing we all talk about is evidence-based practice, but if you don't have the evidence, you don't know what is best practice. So if you've got care homes, and they're following a kind of code of conduct but they're not sharing data as to what to do under certain circumstances, that means there must be a huge gap there.

Laura - Yeah, I think that's really true, and I think it manifests in lots of different ways. One of the problems that, again, was really highlighted in COVID is that if you don't have data, it's ignorable. It's really easy for everybody to be, "Oh well, we don't know what's going on there, so we don't need to worry about it." As soon as we were able to start putting data out for the care sector, everybody realised the scale of what was going on, and that helped to trigger a lot of the things that were implemented to try and address the problem. But similarly, we've got some care homes who undoubtedly are doing brilliant and innovative things to tackle lots of problems, but that knowledge and experience isn't being shared across the sector. In the NHS, we have clinical trials to learn what to do – that's best practice for how to do something – and then that's really robust evidence that can be disseminated across the NHS. We need a similar approach in care homes.

Chris - Care homes are extremely busy; there's a huge demand put on staff, recruitment is difficult, and one of the things that they're all going to say – I can anticipate – if you say, "Can you just record some data?" they're all going to say, "Look, I don't have time." How are you going to do this in a way that passively collects everything you need and doesn't make their life a misery?

Laura - Yes, so this was so apparent to us during the pandemic, because you're right, the workforce is incredibly stretched. What we have done is design a research study that allows us to pull the data from systems that it's already being collected in. So we are not asking care home staff to collect any data for us at all. Now, longer term, if we want to do more complex studies, we may have to do some additional data collection, but the idea is that people can take part and we can learn a lot just by processing data that is collected in the background, not increasing workload.

Chris - How many care homes have you got on board to do this, to prove the point?

Laura - We're now up to nearly 700, which is a phenomenal number. There have been lots of research studies across the care sector in the past, but nothing in comparison with healthcare settings. What's completely novel here is the scale and the fact that we are doing this using routine data – and so that's a completely different approach, and it has huge potential to totally transform how we do research, and potentially surveillance and even policy-making in the care sector.

Chris - So the project presumably has a bit which is making the interface and how you pull the data in, and then it's got to have a component which is what you're going to do with the data.

Laura - So we've got two key outputs. One is dashboards – and these are for care providers and for policymakers – and the idea is we're working with those groups to understand what should we feed back, and how can we feed it back in a meaningful way. We're starting simply, making comparisons between care homes in a fairly rudimentary way. But then we're also using that data for research – so starting to measure things like variation in antibiotic use, why does this care home have higher rates of urinary infections than others, those kinds of things. And then, longer term, getting really excitable is thinking towards doing studies like we see in the NHS – so things like clinical trials in care homes. We're really excited about the opportunity to do things like vaccine trials – so getting new vaccines, say for norovirus, currently being tested in the general population – we should be doing these kinds of studies in care homes too.