Early Deterioration in Home Care Project

About the project

In September 2020, the Early Deterioration in Home Care Project was established following a successful bid to the Better Care Fund by Fosse Healthcare, which coincided with, and was joined by, a similar project proposed by the Nottingham and Nottinghamshire Clinical Commissioning Group.

The Project’s mission was to explore the concept of how domiciliary care could better contribute to the early identification of changes to a person’s habits and routines, which may indicate declining health in that person. It is believed that with a successful ‘managing deterioration’ tool and the aid of digital technology, the Project can demonstrate the benefits of new ways of working between adult social home care and healthcare, with the result being better experiences and outcomes for care recipients.

Since its launch the project team has grown, with input on this work provided from:
• Fosse Healthcare Limited
• Primary Care Network in Newark
Nottingham and Nottinghamshire CCG
Nottinghamshire County Council
East Midlands Academic Health Science Network
Birdie Care Services Ltd
Nottinghamshire Alliance Training Hub

How does it work?

In January 2021, Fosse Healthcare implemented a Managing Deterioration tool within the Newark district, enabling care workers to recognise and respond to ‘soft sign’ changes of approximately 150 care recipients.

In addition, and to complement the above, the next phase of the project commenced with the introduction of a Level 2 Care Worker in March 2021. When concerns for a client’s health are identified, the L2 Care Worker – a senior, trained care worker – will visit the client as soon as possible to perform medical observations,* which are shared with Primary Care professionals via Birdie’s digital care management app.

These observations draw on the RESTORE2 framework and include NEWS2 vital sign measurements and a structured handover of the care recipient’s health (the SBARD communication tool).

In all incidences, if either a Level 1 Care Worker or Level 2 Care Worker deem the situation to be a medical emergency, they will ring Emergency Services promptly and remain with the client until told by Emergency Services that it’s safe for them to leave.


*A Level 2 Care Worker is strictly taking observations only and not applying any clinical judgement. The Level 2 Care Worker merely provides an additional service, complementary to the existing Care Workforce in Newark, by collating useful data points and sharing these with the relevant clinical professionals; clinical decision making will remain with the clinician or relevant organisation.

Progress reports

We’ll let you know how the pilot is progressing here!

September 2020 – Better Care Fund bid accepted and EDHC Project team formed


February 2021 – All care staff have now been trained using the Restore2 Mini Managing Deterioration tool


March 2021 – All Level 2 Care Workers are now fully trained, drawing on the Restore2 framework.

All clients and staff have been notified of the project, and all local Primary Care professionals have been notified of the pilot and their involvement, if any.

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