A quality improvement collaborative focussed on safety in care homes in the East Midlands: lessons learned and possible models for scale-up

Care homes provide care for around 420,000 older people with disability and physical dependency in England. National initiatives are underway to improve healthcare delivery to the sector but do not address safety issues associated with adverse care events in care homes. These events include pressure ulceration, falls, dehydration, malnutrition and inadequate pain management. The Landelijke Prevalentiemeting Zorgkwaliteit (LPZ) is an international benchmarking initiative that uses robust data collection approaches in care homes to identify targets for improvement across multiple European countries. In the East Midlands we used this as the basis of a Quality Improvement Collaborative which met three times a year, and used benchmarking data, alongside training in Quality Improvement (QI) and care competencies, to enable care homes to lead and develop their own improvement plans. We found evidence of improvements in pressure care, falls, nutrition, hydration and pain management. In addition, we developed a group of QI-enabled care homes, who began to take increased ownership of the collaborative. This provided the basis for development of educational interventions for care homes and also acted as a foundation to introduce new improvement initiatives to the sector in a way which aligned with existing priorities for care home organisations and staff. Costs of such an approach are provided towards the end of this paper – the costs of running LPZ at a national level would be between £3.3m and £5.6m depending on the model avoided. There is evidence that LPZ is associated with a fall in incidence of pressure ulcers amongst homes which are recurrent participants, such that related savings to the NHS would be in the region of £207.56 per resident, equating to £87.2M across the 420,000 care home residents in England with respect to this condition alone. When other potential benefits are taken account including improvements in other conditions, improved staff training and wellbeing with reduced staff turnover, the return on investment is likely to be considerable. The COVID-19 pandemic has exposed the need for more collaborative working between the NHS and care home providers. There is an increasingly recognised moral imperative to do more for people with frailty and disability living in care homes. The learning from the LPZ initiative in the East Midlands provides a basis for collaborative working around quality improvement, focussing on avoidable harms, to build resilience in the care home sector that could be scaled up nationally.