• A collaboration between care homes, Essex County Council, the health sector, UCLPartners and Anglia Ruskin Health Partnership
  • Run in residential and nursing care homes in Essex
  • Aimed to improve safety and reduce harm for vulnerable care home residents, who are at particular risk of admission to hospital or significant deterioration in their health and quality of life
  • Used quality improvement methods to reduce preventable harm from falls, urinary tract infections and pressure ulcers. 

A significant proportion of people in care homes have complex health care needs, as a result of multiple, long-term conditions, significant disability and frailty. Systematic approaches to improving quality, which are becoming more commonplace in the NHS, are virtually unknown in care homes.

The PROSPER programme was a ground-breaking initiative to test whether quality improvement methods could be implemented in the care home context. It involved working with residential and nursing homes across Essex to reduce the number of falls, pressure ulcers and urinary tract infections (UTIs) – not only improving system performance and professional development, but also changing behaviours and culture.

The initiative involved using data collection methods, the Manchester Patient Safety Framework to understand the safety culture, and building on the NHS Thermometer principles to strengthen insight and understanding.

Supporting the programme was an embedded and formative evaluation, carried out by a team at University College London, examining the extent to which the interventions worked and their mechanisms of action. Methods included telephone interviews, discussion groups, an online survey and analysis of incident figures.

The evaluation found that PROSPER helped to increase knowledge and awareness of resident safety, and encouraged new approaches. Two-thirds of care homes reported changing care processes, including proactively tracking data and making safety issues more visible. Two-thirds of homes reported changes in safety culture, including a greater focus on proactive prevention and monitoring of safety incidents, and care staff feeling more empowered to suggest ideas.

Data analysis suggests that there were reductions in the rates of falls and pressure ulcers after PROSPER, but an increase in UTIs and A&E attendances. However, this analysis was challenging for a number of reasons, including an increase in reporting of incidents due to being part of the programme, and difficulties in attributing change to the intervention.

The programme has generated learning about transferring quality improvement approaches from the health to the care sector, and has showed that these approaches can be implemented in a care home context, with careful adaptation and support.

Challenges encountered included competing priorities of care home staff and high staff turnover. Teams also needed clinical support in addressing the challenges – a toolkit of starter interventions was invaluable and was a catalyst for generating more ideas from the teams themselves.

Essex County Council has agreed to fund the project for an additional year. This will extend the intervention to care homes across the county and provide a longer time-frame for evaluation.