With the population living longer than ever, care homes have become a significant provider of healthcare alongside the NHS. Most residents are aged over 85 and have varying degrees of frailty – which has overtaken cancer as the biggest cost to the NHS as of 2021 – alongside other complex needs and long-term conditions.
Although only 2.8% of the population are care home residents over the age of 65, they make up 8% of total emergency admissions. Furthermore, 41% of these emergency admissions came from conditions that could be treated outside of an acute care environment or prevented entirely.
With the NHS operating at capacity, we must look at how we can better support and empower care home staff to identify and manage deterioration-associated harm by improving the prevention, identification, escalation and response pathway. Empowering care home staff to not only identify early signs of deterioration, but to ensure timely treatment can be sought will not only reduce pressures on emergency departments but also ensure greater comfort and quality of life for residents.
The Health Innovation West Midlands (HIWM) [formerly known as the West Midlands Academic Health Science Network] Patient Safety Collaborative has worked with six Integrated Care Boards (ICBs) across the region on the ‘Improving Deterioration in Care Home’s programme since April 2021. The programme aims to create sustainable, long-term change across regional and Integrated Care System levels to accelerate learning, share best practices and work to roll out bespoke deterioration strategies region-wide.
HIWM recognised that, to facilitate long-term and sustainable change across care homes, we needed to involve stakeholders across the whole pathway of care – including care home staff, primary care, urgent community response teams, ambulance trusts, senior leadership, pathway leads, and local authorities.
We supported in the creation of a Care Home Deterioration Pack bespoke to each of the six ICSs to develop sustainable training build confidence, knowledge and adoption of these new tools and techniques. for care home staff, and signpost services in their area.
In support of this, we also produced a webinar series intending to increase the confidence, knowledge and level of adoption of deterioration tools amongst care home staff, GPs and advanced nurse practitioners to support system alignment.
To date, HIWM and ICB partners have engaged with and supported 1,679 (100%) care homes with 85% of these (1,431) adopting deterioration management tools. 55% of these (919) have sustained use of these tools for 12 months or more. Importantly, this has reduced some of the pressures on the local NHS services.
A modelling evaluation by Unity Insights of the West Midlands suggested that between January 2021 and September 2022, there were:
- 2,236 fewer 999 calls resulting in a saving of £19.94 per care home
- 3,232 fewer emergency admissions resulting in a saving of £13,590 per care home and 34,900 fewer bed days
If scaled up nationally by the 7,040 care homes who are using some deterioration management tools– in the same 21-month timescale – there would be 31,1116 fewer 999 calls, 44,969 fewer emergency admissions, and 485,654 fewer bed days.
These outcomes are hugely encouraging, with some extremely positive results that not only benefit residents and carers, but also work towards supporting and helping to alleviate some of the stresses on, the NHS.
Looking to the future, we are now taking these learnings nationally, working to develop a national change package, in line with the PIER (Prevention/Planning, Identification, Escalation and Response) framework. We expect this to be rolled out across all 42 ICBs in 2024, providing carers with more support in spotting and managing the signs of deterioration.
