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In August 2016, Care City was awarded a grant by Health Education England (HEE) to deliver an educational programme designed to empower the local health and social care workforce to make necessary efficiency savings, integrate and innovate.

Care City had identified demographic pressures, the changing burden of disease, rising patient and public expectations and reduced public funding as drivers behind these needs. Making these improvements is dependent upon a workforce that is skilled in Quality Improvement (QI), a systematic approach that uses specific techniques to make care safe, effective, person-centred, timely, efficient and equitable.

Over the last year, the Care City QI Programme developed and delivered:

  • The ‘Foundations of QI’ course, a one-day basic course in QI, with the aim of spreading QI knowledge and awareness to a high number of people across the system.
    A coaching programme to upskill a smaller group of QI champions to cascade learning to other frontline workers within and outside of their organisation, initiate and sustain quality improvement within their own organisations.
  • Access to IHI Open School licenses to allow those who could not partake in classroom learning the opportunity to train in QI through online distance learning.
  • four quality improvement collaboratives including falls reduction and improving AF detection and management, spurring on QI activity across the system and demonstrating what could be achieved.

Earlier this year Skills for Care were appointed to conduct an independent evaluation of the QI programme, with the aim of answering the following key question: How does the Care City Quality Improvement programme impact on staff: perceptions of their role in improving quality, the extent to which they feel empowered to engage in improvement activity, behaviour in their day-to-day roles and any improvement activity they engage in?

Evaluation Findings

  • The delivery of the QI programme has been a success and has added value to the local system. 
  • The programme is unique in its design, context and links to other initiatives, leading to locally specific learning and connections that are unlikely to have taken place without the experience of the programme.
  • The ‘Foundations of QI’ course has been delivered to over three hundred and fifty participants, and the coaching programme to fifteen.
  • The ‘Foundations of QI’ course was rated ‘excellent’ or ‘good’ by 97% of respondents.
  • Its facilitators were rated ‘excellent’ or ‘good’ by 100% of respondents
  • All the respondents from the coaching programme also rated every aspect of the course as ‘excellent’ or ‘good’.
  • Beneficiaries interviewed said that they found the learning for the course easy to fit around their job, enjoyed the course and found the pace good.
  • Beneficiaries interviewed also told of how completing the course had helped increase their confidence, refresh their skills and remind them of the importance of embedding QI in everyday activity.
  • Most coaching respondents said that they had both improved quality at their workplace and rolled out learning to other colleagues – on average four further people had been trained per coach.
  • Stakeholders agreed that Care City was the right organisation to deliver the QI programme. They recognised it has a local, unique and neutral position, cutting across research, education and innovation, approaching the system as a whole and having important relationships with other players.

Skills for Care commented “The Care City QI Programme appears to have been a resounding success. At reasonable value for money, an excellent team of staff have been recruited and made a positive impression with local stakeholders; and a curriculum has been developed which is widely considered high quality and has been adapted by two other major providers for their own use.”

Dean Rigg, Programme Manager, Care City commented “Evidence suggests that organisations that adopt QI practices are more likely to improve outcomes and experiences for people who use their services and achieve ‘Outstanding’ CQC ratings. We are delighted that Skills for Care has given our QI Programme the seal of approval and that we have been able to support local organisations to develop a culture of improvement where all staff feel supported to speed up and influence change.

“Simple to use and complete, interesting and thought provoking learning.” “Easy to understand and modules can be done anywhere, even on your phone while on the bus or train.” – E-learning participant.

“It reinforced good practice that I knew about, it has corrected some bad habits, it’s provided an aide-memoire in terms of some of the discipline around QI… I think it has been helpful in reminding me around the disciplines required.” - Participant on the ‘Foundations of QI’ course (NHS employee)

'Sense of place' is one of our Healthy New Town priority themes.  We know that so-called 'place attachment' is good for people's wellbeing. Place attachment is very much about having positive experiences of where you live, often to do with nature or history, and also to do with contact with people (and Connectivity is, of course, one of our other HNT themes).

As well as place attachment and social networks, we know that access to nature is great for people's health. Most of the evidence is about 'green space' and its health benefits (parks, gardens, street trees etc). More recent research has looked at 'blue space' and found that this can be even better for our health. So far, this is mainly about the sea and oceans. At Barking Riverside, we want to find out more about the potential health benefits of access to a river as well. For example, residents have told us that they want more peaceful places to help them relax and be calm. We think that an attractive and accessible riverside could be important for local people's mental health.

Developing a sense of place can be difficult in a new town, and when new residents are coming together for the first time.  However, Barking Riverside does have a history and also some great natural assets. This weekend, ThamesFest, in conjunction with Totally Thames and Silk Road, celebrates London's great river's past and present - as a working waterway as well as a place of enjoyment.

Look out for us and our partners from Sustrans, Living Streets and University College London at the Rivergate Centre on Saturday.  We are collaborating on a range of activities to encourage people to be more active in their everyday lives, find out more about the place they live - and enjoy the river.  We are calling on everyone to help us design a community mural, which will complement the Nature Garden, which shows how you imagine Barking Riverside in the future.

Author: Catherine Max, IKEN Associates. To read more from Catherine, why not visit her Sense of Place themed blog and the importance of access to blue space to health and wellbeing.

A new collaboration between Care City and GaitSmart aims to improve the lives of those at falls risk by bringing gait analysis and remote exercise prescription, delivered by healthcare assistants and remote physios, to local GP practices.

Care City is one of five National Health and social care test beds, and is the only one in London. It spans four boroughs, Barking & Dagenham, Havering, Redbridge and Waltham Forest. The Care City Innovation Test Bed seeks to test a combination of devices and software alongside new approaches to service delivery and patient participation, to assess whether we can measurably improve the wellbeing and resilience of older people with long term conditions, older people with dementia, and their carers.

Falls cost the NHS at least £2bn. Falls prevention is therefore vitally important, both for patients and for the healthcare system. Care City is now working with GaitSmart, as part of the NHSE Test Bed to trial the introduction of gait analysis with personalised exercise prescription inside health and care services. In just 10 minutes, the process can identify issues with a person’s gait, allowing a proactive intervention to reduce risk of falls, long before they arrive in A and E.

During the assessment, six small sensors are applied by elasticated retaining straps to the pelvis, thighs and calves and the patient walks a few metres in a straight line. The resultant GaitSmart report contains kinematic data that identifies any movement issues, as well as the severity of those issues. The GaitSmart report is shared with a remote physiotherapist who creates a personalised exercise plan to target the problem areas. The personalised exercise plan provides exercises and daily activities that can easily be performed by the patient in the everyday lives that can help strengthen the gait of the patient and reduce their risk of falling. The patient’s gait is then re-tested on a monthly basis so that they can see their improvement, receive progressive exercises and activities and are motivated to continue with their exercise treatment.

John Craig, Chief Executive, Care City commented “This new approach to reducing falls risk puts the tools to assess gait (the way in which you walk and run) in the hands of our primary care system, enabling them to find people with gait issues, and help them, quickly and affordably, before their mobility deteriorates. The long-term vision is to give citizens an understanding of their own mobility, enabling them to exercise cheaply and easily - independently or socially - while benefiting from expertly calibrated exercises. We hope to keep more people more mobile for longer, reducing their risk of falls.”

Steve Goode, Head of GaitSmart clinics and client development commented “Every year, three million people over the age of 65 will experience a fall costing the health service in excess of £2.3bn. The GaitSmart system allows us to identify these patients quickly and easily, ascertain any areas of concern and to provide personalised exercise plans, to help improve or rectify the problem.”

Feedback to date shows that patients value the experience of GaitSmart gait analysis. It is quick, easy and can be conducted locally by someone the patient may well already know and puts the tools to managing their own health, in their own hands.