‘Managing deterioration’ refers to spotting that a person’s physical condition is worsening and responding appropriately to support best health outcomes, keep them safe and provide a positive experience of care.'  

East Midlands Patient Safety Collaborative (PSC) delivered the Managing Deterioration Safety Improvement Programme (ManDetSIP) from April 2022 – June 2023, commissioned by NHS England.  

The programme was part of the National Patient Safety Improvement Programme and is strongly aligned to the NHS Patient Safety Strategy. 

To find out more about the current Managing Deterioration Safety Improvement Programme (ManDetSIP) click here.

You can read the end of prgramme report here.

The challenge 

Deterioration can happen quickly and if unnoticed can lead to health complications and avoidable deaths. Deterioration is more prevalent in care homes than other settings based on the demographic of residents, who are more likely to have pre-existing medical conditions. 

In 2019 a joint report by the Health Foundation and NHS England found that 41% of emergency admissions to hospital involving care home residents could be potentially avoided. 

The solution 

The programme aimed to reduce deterioration associated harm by increasing the use of a PIER framework (prevention, identification, escalation and response) to address physical deterioration through better system co-ordination, and as part of safe and reliable pathways across health and social care: 

• Prevention – Enhancing and maintaining health and well-being to ensure best health. 

• Identification – Identifying when someone becomes unwell and responding as needed. 

• Escalation – Communicating people’s needs when they become unwell to access the right care from the right people. 

• Response – Responding in a timely and appropriate way when somebody’s health deteriorates. 

Impact and outcomes 

Managing deterioration of care home residents 

Our work supporting the management of deterioration in care homes focused on: 

• Supporting East Midlands ICSs to deliver a managing deterioration identification 'train the trainer' package to their care homes. The training was based on RESTORE2mini and supported the PIER framework and local pathways and resources to ensure residents get timely and appropriate care.  

• Extending the training to primary care and those working with care homes as well as to Domiciliary Care workers, who provide key care to people in their own homes. 

• Working with The University of Nottingham Pharmacy School we piloted a project to place students at Ashfields Care Home, Derbyshire to support care home staff to use the managing deterioration tools and learn about medicines management in care homes. Feedback was positive and we are supporting the University of Nottingham to expand the pilot to place 200 students in East Midlands care homes from September 2024. 

• An East Midlands care conference and awards event attracted 200 attendees and 35 exhibitors. This year the awards were opened to domiciliary care as well as to care homes, as the programme’s reach extended. You can find out more about the awards here. 

• Developing a free online training package to support training for care homes - REACTO Deterioration 

• Signposting and supporting quality improvement methodology.  

• Promoting and enabling the involvement of residents, carers, and families to share lived experiences and develop services. 

• Working with local partners to map and progress opportunities for digitalisation. 

• Working with a small cohort of care homes to undertake a detailed evaluation of the training and support on quality improvement and the introduction of managing deterioration identification tool, to provide impacts on outcomes, and staff confidence and experience 

• Delivering quarterly Connecting Together webinars for care home staff on key learning topics such as frailty, which include hearing from care homes who can highlight and share best practice. 

Contact 

If you would like to get involved with any aspect of East Midland’s patient safety work, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..