Case study: Managing deterioration in care homes

Partners: Kensington & Chelsea and Westminster Bi-Borough Local Authority, NW London ICB, NW London Patient Safety Collaborative (PSC)

Photo credit: Centre for Ageing Better

Effective use of deterioration management tools in carse homes is vital in helping staff to identify a patient’s declining health at an early stage. This early intervention can help care home residents stay out of hospital, as per the wider aims of Mission 2, enabling more days at home.  

The adoption of deterioration management tools in care homes is part of the Managing Deterioration Safety Improvement Programme (part of NHS England’s National Patient Safety Improvement Programme). The need for improvement in the management of deterioration in care homes in the Bi-Borough was identified as part of learning from the COVID-19 pandemic.  

ICHP was commissioned by the Bi-Borough to lead a comprehensive review of these 15 care homes to identify and address barriers to support effective, sustained use of deterioration management tools.  

A three-phased approach comprised: 

  • Diagnostics and scoping (June – August ‘23): Including site visits to 14 care homes and 70 structured interviews with Local Authority teams, GPs, care home managers, nurses, and carers to understand the care home landscape, current escalation pathways, and barriers to using deterioration management tools  
  • Design and development (September – October ‘23): Design of training materials, including validation and hard-copy resources, with outputs including a complete training package and toolbox 
  • Deployment (November ‘23 – May ‘24): As of May ‘24, ICHP have delivered 14 training sessions to over 110 staff, with two further sessions planned. We have also evaluated these sessions and conducted further interviews with care homes to understand the impact and their plans for sustainability. 

Qualitative analysis has confirmed that the training delivered to date, and the toolbox, has resulted in positive changes to both staff confidence and competence, and in some care homes has promoted policy changes/reviews. The developed resources, alongside in-person training, were specifically designed to encourage sustained and self-directed learning within care homes, after project close. A series of recommendations to ensure future sustainability has also been shared with the Bi-Borough team.  

“The training was an eye-opener for all of our staff. We have started applying the learning on NEWS2, which we didn’t really utilise before. We are now in the process of creating baselines for all of our residents.” Care Home Manager 

“Carers who attended the training have been upskilled to really understand baselining and the concept that ‘abnormal is not necessarily abnormal’… As a clinician we know that, but carers are not always aware. This aspect of the training was especially useful.”  Care Home Manager (with clinical background) 

“We will include the recorded session into our induction process for new starters and also use the content to inform our weekly clinical meetings, where we focus on skills and competencies.” Care Home Manager 

“ICHP’s track record on delivering innovative solutions to improve patient outcomes made them a natural choice for us when choosing a partner to support our commissioned programme.

The project has delivered a detailed understanding of the needs of care homes, a toolkit and training package. These together with the multiagency task group means that we are in an excellent position to build on the progress made and continuously improve the management of deterioration in our care homes.” Kevin Gormley, Care Markets Team Manager, Adult Social Care, Integrated Commissioning Directorate for Kensington and Chelsea