Walsall nursing home out of special measures (#2970)

Idea Description
Overview of Innovation:
A Walsall care home rated as inadequate following a visit by the Care Quality Commission in August 2017, is now out of special measures.

Ash Grange Nursing Home has seen improvements in all five of the CQC’s questions (Safe, Effective, Caring, Responsive and Well-led) and is no longer rated as inadequate overall or in any of the key questions. The home is now rated as ‘good’ in both the Safe and Effective categories.

During the visit in August 2017, the CQC found there were not enough staff to meet people’s needs safely, people’s needs had not been assessed or managed to reduce the risk of avoidable harm, residents did not receive care that was responsive to their needs and systems and processes to monitor the safety and quality of care people received was not effective.

But now following an unannounced inspection on 21 and 23 February 2018, inspectors from the CQC found the home was now following regulations:
  • Residents said they felt safe and staff knew how to report concerns and escalate risks about people’s safety. Risks to people’s health and care needs were assessed and effectively managed. There were sufficient numbers of staff available to meet people’s needs.
  • Lessons were learnt following incidents and effective infection control procedures were followed.
  • Staff had the skills and knowledge to meet people’s needs. Staff sought people’s consent before providing care. People’s capacity to make specific decisions had been assessed and care records reflected how decisions were made in a person’s best interest.
  • People and their relatives had been involved in the assessment and review of their care. People and their relatives knew who to contact if they were concerned about any aspect of their care and were confident issues would be dealt with appropriately.
  • Systems and processes to monitor the quality of the service were effective at improving and identifying concerns.
Ash Grange Nursing Home also won the ‘Most Improved Safety Culture’ Award at this year’s Walsall SPACE Conference where Elaine Proud, Area Quality Director at HC-One, spoke about the progress Ash Grange have made. Click here to view the video.
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Overview summary:
The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (WMPSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.  The programme is being evaluated by the NIHR Collaboration for leadership in applied health research and care (NIHR CLAHRC).  
Challenge identified and actions taken :
Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse
safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on:care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data
on hospital activity by residents at participating care homes will be compared to matched controls. 
Impacts / outcomes: 
This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety.
events such as falls and pressure ulcers, and potentially reduce care home resident’s use of acute services.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Improved Quality of care, Prevention of adverse events, Improved staff morale, Improved Dementia Care
Supporting quote for the innovation from key stakeholders:
"Giving the Care Sector a voice"
"supporting each other to provide a positive safety culture"
Plans for the future:
Evaluation to be published in 15 months time 
Regional Care Home Conference in October 17 in the north of the Midlands 
Contact for further information:
Helen Hunt 
Assistant Programme Manager - PSC 
0121 371 8057
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Innovation 'Elevator Pitch':
Nearly 40% of NHS staff have reported feeling unwell as a result of stress (NHS Staff Survey).
Mental Health First Aid is an evidence based programme designed to help individuals to prevent, identify and tackle stress and mental health problems.
Overview of Innovation:
NHS staff are more likely than the rest of the working population to become patients, increasing demands on the system they work in (King's Fund).

Altruist Enterprises are experienced in providing training to help organisations to prevent, identify and tackle stress within organisations.

Since forming in 2013, we have grown from 1 trainer to 3 members of staff and 10 contracted trainers delivering courses nationally with notable customers including Birmingham Children's Hospital, Solihull Council and WMAHSN.

We currently offer the following main courses to the NHS:

Resilience Training - A 3 hour course which helps employees to manage stress and build resilience in an everchanging work environment using proactive approaches.

“I learnt how to recognise situations in my daily working and home life that I can work on to reduce my personal stress and build my resilience. We were taken through a process which allowed us to challenge our negative thoughts and look at things from a different perspective. A very helpful course”. Federica Merella, Consultant Anaesthetist, Birmingham Children’s Hospital

Mental Health First Aid Lite - A 3 hour evidence based mental health awareness course accredited by the Royal Society for Public Health.

“We learnt about some of the main mental health problems, how to support others who may be experiencing issues and also discussed ways to support our own well-being. The course was very thought provoking”. Sophia Nasreisfahany, Solihull Council

Adult Mental Health First Aid - A 2 day evidence based indepth mental health awareness course accredited by the Royal Society for Public Health.

"This 2 day training delivered by Altruist was one of the most fulfilling training courses I have attended.  Having worked in the NHS for 17 years and managing staff for 13 of those I found this course enlightening.  It compounded how mental health affects us all no matter what your background is.  It also really tackled the stigma of using the words “mental health”.  Practical advice, tips and scenarios were used to give us a toolbox of strategies to help staff.  On reflection of my own career I now realise I have been in this position many times and now I feel more empowered and equipped to deal with these sensitive situations". Helen Hunt, WMAHSN

We measure outcomes including increases in knowledge and personal confidence in supporting others. We can also measure reduction in absenteeism and recently helped a local charity reduce absence by 25%.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wellness and prevention of illness / Education, training and future workforce
Benefit to NHS:
Increase in Confidence and Knowledge - Consultant Anaesthetists at Birmingham Children's Hospital saw a 32% increase in personal confidence of managing stress levels following our Resilience course. (Delegates are asked to rate their personal confidence, scale of 1-10 in managing stress levels and knowledge of resiliency building skills before and after the course).
Reduction in sickness absence - Stress affects the health and quality of life of staff. The benefits of tackling work-related stress are the obvious ones of more staff at work more of the time, and the reduction in sickness absence and its associated costs.
Improved Employee and Community Engagement - It also demonstrates the organisation’s commitment to its workforce and to addressing their health needs. This, in turn, affects how the organisation is perceived by both staff and the local community in terms of being a good employer.
Reduction in costs-  employees who are away from work because of stress will have to have their work covered by other staff, frequently bank or agency. Investment in stress management can reduce the need for this expenditure – one NHS trust reported a saving of £500,000 a year in agency cover costs.
Improved patient care - Chronic stress can lead to an increase in accidents and cause safety issues for staff and patients. Investment in resilience and stress management training will help reduce the risk.
NHS seen as innovators - There is a current campaign in government to make Mental Health First Aid a compulsory element of First Aid training in the workplace.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Mental Health costs the West Midlands region £12 billion a year & affects around 70,000 people (West Midlands Combined Authority). Poor mental health results in enormous distress for individuals, greater pressure on public services and reduced economic productivity.
Current and planned activity: 
We recently delivered our Resilience course to doctors at Birmingham Children’s Hospital. We also recently delivered a Mental Health First Aid pilot course to NHS staff in partnership with WMAHSN.
We appreciate that the NHS are a large employer and that budgets are continuously being squeezed as demand for services increases. That is why we would introduce a Train the Trainer programme which will allow knowledge, skills and best practice to be cascaded throughout the organisation.
Trainers will be selected based on their knowledge of mental health, facilitation skills and willingness to be the go-to person for any concerns.
We envisage that the Train the Trainer programme will include an initial mental health workshop to give delegates the opportunity to experience the course first hand, presentation skills and facilitated tasks and assessments.
Alongside this, Altruist’s expert trainers will also continue to deliver Resilience and Mental Health First Aid courses to selected groups.
What is the intellectual property status of your innovation?:
Altruist Enterprises are licensed providers of the Mental Health First Aid courses.
The Resilience course and its materials were produced and is owned by Altruist Enterprises UK Limited.
​Altruist Enterprises UK Ltd was incorporated in February 2013 and began trading in August 2013. 
www.altruistuk.com and altruist.community and its content is owned by Altruist Enterprises UK Ltd.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Regional Scalability:
We would introduce a Train the Trainer programme which will allow knowledge, skills and best practice to be cascaded throughout the organisation therefore aiding scalability.
Alongside this, Altruist’s expert trainers will also continue to deliver Resilience and Mental Health First Aid courses to selected groups. Altruist operate nationally and work with 10 regular contracted trainers and have access to a further bank of 35 specialist trainers.

We are currently 1 year into a 2 year training contract with Stoke on Trent City Council, delivering the Mental Health First Aid Lite course to employees. Delegates that have attended these courses have seen between a 30% - 60% increase in personal confidence of supporting others experiencing stress/mental health problems.
All delegates that attend our training courses are required to complete an evaluation form to measure the impact that the workshop has had. Delegates are asked to rate their knowledge of resiliency building skills, personal confidence in managing stress and confidence in supporting others on a scale of 1-10 before and after the course. Percentage increases are then calculated. For this particular contract, we would look for between a 35% - 55% increase in knowledge/confidence following courses.

We will aim for a minimum of 80% good/very good feedback from delegates.
Adoption target:
Minimum of 3 x NHS Trusts enagaged
3 x 5 day train the trainer programmes to be delivered within first 12 months
24 x 3 hour courses to be delivered within the first 12 months
12 x 2 day courses to be delivered within the first 12 months
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Innovation 'Elevator Pitch':
Amaven is an online health, fitness and wellbeing profiling tool which measures, tracks and improves bio-motor abilities and prescribes evidence-based physical activity programmes to prevent and treat medical conditions and age-related diseases.
Overview of Innovation:
The Amaven programme adheres to up-to-date guidelines & best practise to deliver an effective & safe approach to caring for the wellbeing of older people. All our programmes have been designed by occupational therapists/physical activity specialists. One of our exercise programmes is based on the Otago exercise programme which has been proven to reduce falls and injuries from falls.

We follow guidelines from: CQC, DH, NICE falls guidance, Cochrane Reviews, Sherrington Effective Exercise to Prevent Falls Review, Public Health England, British Heart Foundation National Centre Research, FaME trial. 

Health, fitness & wellbeing profiling tool. We use health assessments to identify risks & create an in-depth health, fitness & wellbeing profile for individuals. Assessments are simple to do & can be carried out by family members, care workers/other professionals or Amaven Health Mentors. Regular assessments produce evidence of progress or deterioration, highlight risks & can lead to prevention of damage. Information can be shared via reports with individuals & organisations involved in their care.

Person-centred wellbeing programmes. Specific scores & indicators are used to inform a personalised activity programme that can be done safely at home or in other settings, either done individually or in a group all activities prescribed promote physical, social & emotional health to positively impact an individual's life. 

Individual health assessments provide practitioners with a complete picture of a person’s health helping to identify any risks & prevent potential injuries. Staff can discuss results with relevant professionals such as GPs if the person needs additional help. All information a person chooses to share is confidential unless they wish to share it further. They can log onto the Amaven platform at any time & view their wellbeing profile. 

Amaven is personalised to the needs of the individual & a personalised activity plan is generated to work on areas that need greatest attention. The programme also helps to create a wellbeing community in residential homes & group activity sessions help people to be more social. 

Staff will be fully trained to use the Amaven platform & receive on-going support (phone/email) if required, using the information gathered to work with the individual’s practitioners & family members to improve the delivery of care. 

Visit the website & learn more about our programmes for Independent Living, In-care, Low Back Pain & Parkinson's.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness
Benefit to NHS:
Early intervention is proven to reduce costs significantly.
Amaven is an online health, fitness & wellbeing profiling tool which measures, tracks & improves bio-motor abilities & prescribes physical activities to prevent & treat medical conditions & age-related diseases.
The programme is designed for older people to stay independent & allow them to live in their own homes & keep them out of hospitals & care homes. 
Falls remain a major cause of injury & death amongst the over 70s & account for more than 50% of hospital admissions for accidental injury. Hip fractures resulting from falls are reported to be the most serious type of injury, affecting approximately 60,000 people per year in the UK (Husk et al. 2008).  
  • 1/3 of all UK households are older households*
  • 3.5 million 65+ live alone (36% of all people aged 65+ in GB)*
  • 2 million people over 75 live alone*
  • There are 11.6 million people aged 65 or over in the UK*
  • Falls are the largest cause of emergency hospital admissions for older people & significantly impact on long term outcomes*
  • Falls account for up to 40% of ambulance call-outs to homes for people aged 65+ costing £115 per callout*
* Source Age UK, Later Life in the United Kingdom, June 2016
Amaven tracks progress to highlight impact, inform personal needs & deliver specific outcomes. Specific programmes for strength & balance have been shown to reduce the risk of falls by as much as 60 percent (Skelton, 2001).
The Amaven platform adopts a person-centred approach to wellbeing. The activity programmes have been designed to build resistance against conditions such as osteoporosis & dementia & improve the overall health & wellbeing of older people. 
Low back pain is a major health-care problem resulting in disability & often depression & job-loss. It is reported that 60-80% of the population suffer from low back pain.
For Parkinson’s, in addition to medications, there are some activities that may ease the motor symptoms of Parkinson’s, improve quality of life & increase adherence to the medication. There is also now scientific evidence to suggest that certain activities, including exercise, social connectedness & creativity may not only be therapeutic for Parkinson’s symptoms, but could alter the brain by creating new pathways of communication among brain cells & to create new cells.
Visit our website to learn more about the Amaven programmes for Independent living, In-Care, Low Back Pain & Parkinson's.
Online Discussion Rating
6.00 (1 ratings)
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Demand pressures facing the NHS are increasing with emergency admissions crowding out elective admissions. Cost pressures facing the NHS include a growing and ageing population, the increasing prevalence of chronic conditions across all age groups, and the rising cost of delivering care.
Amaven is an online health, fitness and wellbeing profiling tool which measures, tracks and improves bio-motor abilities and prescribes physical activities to prevent and treat medical conditions and age-related diseases.
The platform is a cost effective and convenient tool that helps health practitioners to deliver outstanding care, keeping people independent in their own homes and out of hospitals and care homes.
National data shows that the number of hospital admissions amongst older people is increasing. Over the last 10 years hospital discharges (and therefore admissions) for those over 75 have been rising at a much faster rate than ageing trends in the population; almost four times faster (38% compared to 10%)*.
The growth in hospital readmissions has been higher still, up by 86% for those over 75. This national picture is supported by the results of research by Royal Voluntary Service: of 401 people over 75 who had been in hospital within the last 5 years, 13% had been readmitted within three months. * (* source:  Royal Voluntary Service)
Amaven will prescribe personalised activity programmes that promote physical, social, and emotional health to reduce the incidence of frailty and falls. Regardless of age or ability, personalised physical activities will be prescribed to either maintain or develop the key components of health, helping the individual stay active and self-sufficient into old age.
By supporting people effectively in the community, Amaven can help those with long-term health and care needs to stay out of hospital or residential care, thereby reducing costs to the NHS and social care by avoiding the need for more costly interventions whilst maximising outcomes for patients and service users.
Click here to watch how Amaven has helped the residents of St Johns Nursing Home in Bromsgrove. 
Current and planned activity: 
We would like to see greater regional awareness and adoption of the Amaven Exercise Medicine Programme, working in partnership with providers to focus on individual patient outcomes and to effectively embed technology enabled care to deliver services that are truly person centred. 
Return on Investment (£ Value): 
Return on Investment (Timescale): 
Ease of scalability: 
Regional Scalability:
Apart from initial training and support and ongoing email and telephone support, the programme is delivered through an online platform which is designed to be person centred. It will therefore be easy to provide across the region and further afield.
The platform includes an assessment aspect which generates reports as and when the user/s require. Through regular assessments (3 months, 6 months, etc.) comparable data will be generated to identify and monitor the user's heath, using specific indicators such as risk of falls, strength, balance, cognitive function, etc.

Reports can be generated for an individual, a group or a whole setting or area, providing robust data for the user as per their needs and requirements.

As much of the programme is delivered through the platform it is very cost-effective and not labour intesive.

The aim of the programme is to identify, prevent or improve older people's well-being, specifically focussing on risk of falls and frailty.
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