by Dr Sarah Damery, Research Fellow, Long-term Conditions theme, University of Birmingham.
There is a growing recognition of the need to identify and manage deterioration in care homes to improve resident care. People living in care homes may be frail and have complex care needs, making them susceptible to sudden and unpredictable illness. Care home residents are disproportionately represented in transfers to A&E and hospital admissions, yet many emergency admissions from care homes could be avoided if the signs that a resident was becoming unwell were identified and managed early. Care home staff are ideally placed to recognise these often subtle ‘soft’ signs of deterioration, but varying skills and competencies within the care home workforce may hamper efforts to do so, worsened by a lack of appropriate pathways through which to escalate resident care when concerns arise.
The national Managing Deterioration Safety Improvement Programme (ManDetSIP) was introduced to identify best practice in patient safety, promoting continuous learning and quality improvement in care homes to reduce the risk of harm. ManDetSIP implementation was led locally by colleagues at Health Innovation West Midlands (HIWM). The goal was to support the adoption and spread of deterioration management tools within care homes, improve staff skills in recognising deterioration and collaborate with multiple system partners across health and social care to define pathways for managing deteriorating care home residents.
Researchers from the long-term conditions theme of ARC West Midlands carried out a rapid, independent evaluation of ManDetSIP across the region, commissioned by HIWM. This involved analysing multiple information sources and interviewing key stakeholders to assess programme implementation and outcomes. The evaluation highlighted multiple impacts:
- Service delivery and capacity: 98% of West Midlands care homes participated in deterioration management training; 74% adopted deterioration management tools and 43% showed sustained adoption for at least 12 months.
- Economic impact: Data demonstrated a 1% reduction in 999 calls, 4% reduction in hospital admissions and 5% reduction in hospital stay. If scaled up across England, this would equate to 31,000 fewer 999 calls, 45,000 fewer emergency admissions and c. 500,000 fewer bed days.
- Systems impacts: The formation of multiple deterioration and care home patient safety networks and escalation pathways allowed a consistent approach across the region and shared learning between the six participating ICBs.
- Skills and workforce: A webinar series trained care home staff to use deterioration management tools, and embed their use into routine resident care.
- Operational impacts: Policy was adapted to embed deterioration management as an expected standard in Quality Assurance Frameworks for sustained, long-term adoption.
Through its independent assessment of ManDetSIP implementation, the ARCWM evaluation enabled HIWM to demonstrate the impacts of their programme, which has now been recognised by NHS England and adopted as a national example of good practice in achieving service change and cross-system collaboration. HIWM’s approach went on to be highly commended in the ‘Provider Collaboration of the Year’ category at the 2023 Health Service Journal (HSJ) awards.