Safer Care Homes – the story so far….

Safer Care Homes Programme Lead, Caroline Rogers, talks us through the journey of Safer Care Homes so far…

This was (and is) the challenge. Find up to Salford 12 care homes who are willing to take part in a year-long improvement programme, get them to attend 3 learning sessions (and a summit event – the fun bit) and in between the learning sessions – during the action periods – they will have to make changes in their care homes. To do this they need to be prepared to think differently, act differently, to fail, to try again and hopefully succeed in making improvements!

But before we could do any of that we needed to be clear about what was expected of our participating homes, and to do this we formed an ‘expert panel’. The panel consisted of a number of key Salford stakeholders from Salford Royal NHS Foundation Trust (SRFT), Salford City Council (SCC), Salford Care Homes Forum, Salford Clinical Commissioning Group (CCG) and the Care Quality Commission (CQC). We met at the end of September 2016 for an ‘Expert Panel Meeting’.

We began the session by ‘painting a picture’ of the where Salford care homes are up to with regard to safety, what the international picture is – it was actually difficult to find information specifically relating to safety in care homes – although what we did find was quite alarming….. “They are dangerous, dangerous places” (Mollot cited by Allen, 2014). We then brought the focus back onto UK care homes and welcomed Bernadette Mossman, manager of one of two English care homes with an CQC rating of ‘outstanding’ for safety, who talked to us about her experience of opening a brand-new home (with private owners) and achieving an ‘outstanding’ rating by the time of the second inspection.

Bernadettes’ talk probably had the most influence on the group that day as she spoke movingly and passionately about how a brief spell on elderly care ward caring for people with dementia changed the direction of her career and started her on the path to becoming the manager of Vida Hall. She spoke eloquently and in detail about how the positive culture of the care home is key to its success. She also described the efforts she (and her team) consistently make to employ the right people and place them with the right people (both in terms of mentorship, and in relation to which residents they work with). She explained her commitment to providing ongoing training and development opportunities, and the importance of her role as a visible and accessible leader, who demands high standards, but is willing to listen and learn from her workforce.

After the presentations, the group were asked to begin to help us develop the driver diagram (i.e. define the programme aims and objectives) and there ensued a lengthy and lively discussion. Within the timeframe available we created the bare bones of the driver diagram, then took it back to Haelo to scratch our heads and think some more! Eventually, Version 1 was complete and sent back to the expert panel (and Haelo’s senior team) for comments. More head-scratching, a bit more work with our Operational Steering Group (more about this group later) and Version 2 was ready!

Alongside our work to establish an expert panel and develop the driver diagram, was our recruitment drive to engage 12 care homes to undertake the improvement programme. We involved a few a key people in this who have a good insight into how the homes work, which homes are experiencing difficulties that may hinder their level of commitment to the programme, which care homes were well placed to take it on and which care homes might benefit the most from the programme.

Having liaised with Gail Winder, Specialist Nurse Safeguarding Adults, Liz Walton Designated Nurse Safeguarding Adults at the CCG, Keith Darragh Assistant Director (Resources) Division of Salford Health and Social Care (SRFT) and Marie Roberts, End of Life Care Facilitator for Care Homes (SRFT) we developed a list of 15 potential care homes. Through a combination of emails, telephone calls and visits we quickly recruited 12 of these to take part in the collaborative. We were only aiming to recruit ten, but prior experience (of the Six Steps End of Life Care Programme) had taught me that we should expect at least 2 to drop out of the programme at some stage.

We now had a driver diagram, an expert panel of advisors and a team of 12 care homes ready and willing to take part. Next, we needed to develop an Operational Steering Group including the strategic lead (Keith Darragh), a clinical lead – and we were extremely fortunate that Dr. Louise Butler, Consultant Geriatrician, agreed to take on this role, Bob Diepeveen, an experienced improvement adviser at Haelo, and Paul Walsh, Integrated Commissioning Manager (Older People) for Salford City Council and the CCG. Paul had shown a particular interest and enthusiasm for the programme and we were therefore delighted that he agreed to be part of the group. Most recently, in recognition of the close links between Safer Salford and Salford Together (and due to her earlier work in Salford Care homes) we invited Sarah Cleverly, Salford Together, Programme Manager (SRFT) to be part of the group also, and she will join us at our next meeting. The group has and will continue to meet monthly to ensure that we are on track, help overcome challenges as they arise and enhance our understanding at Haelo of how Salford care homes perform and operate on a day-to-day basis.

Our final pre-collaborative challenge was to engage with service users and sense-check with them that our goals and aims are robust, sensible and appropriate for the people who matter the most – that is those people who live in Salford Care Homes. With the help of Tony Belvedere from Wentworth House, I was able to meet with two relatives of Wentworth House residents and spent a couple of hours with them, discussing the programme and their experiences of the care home system. Our intention now, is to invite them to the learning sessions and, if and where, appropriate, involve them in one of the improvement teams.

We are currently in the process of putting together an engaging and informative first Learning Session which will take place on the 31st January 2017. For this we need to identify a keynote speaker (ideally someone with experience of improvement programmes in care homes) and attendees! To ensure that the level of commitment, interest and enthusiasm of the care home managers is sustained between the launch event and learning session one, I am also endeavouring to meet each home and ensure that they are focused on putting together improvement teams and starting to think about what they would like to work on. I am already (for the most part) highly impressed with the ideas and the efforts being made so far. Alongside this, we are continuing to develop the driver diagram by asking the care homes to provide us with baseline data regarding numbers of pressure ulcers, falls and medication errors to ensure that we identify an aim that both stretches the teams but is potentially achievable.

I feel we have made a fantastic start to this collaborative and have personally been delighted with the level of enthusiasm and interest, not only from the care home managers involved, but other key stakeholders, especially Dr. Tim Pattison, Consultant Geriatrician, Dr. Louise Butler and Paul Walsh. We are also collaborating outside the area, which Essex City Council and University of Nottingham, who are running similar programmes. I believe that we can truly make a difference in these care homes and I hope that they will learn and develop skills and knowledge throughout this year that will enable them to continue to make improvements long after the collaborative is completed.