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CCFTV Safety In Care Homes Roundtable - 30th May 2024

Care Campaign for the Vulnerable (CCFTV) is dedicated to improving the quality of care for vulnerable individuals in care homes across the UK. One of its key initiatives involves promoting independent safety monitoring technology to enhance resident safety and reduce unnecessary strain on the National Health Service (NHS). This article explores how safety monitoring can significantly reduce emergency call-outs and save the NHS millions of pounds annually, focusing on the groundbreaking research conducted by Shedfield Lodge Care Home in Hampshire.

The Role of Safety Monitoring in Care Homes:

Safety monitoring technology in care homes includes various systems designed to enhance the safety and wellbeing of residents. These technologies range from motion sensors and fall detection devices to advanced video monitoring systems. The primary aim is to provide real-time surveillance and immediate response capabilities, ensuring that incidents such as falls are promptly detected and addressed.

Falls are a significant concern in care homes, often leading to severe injuries, hospitalisations, and, in some cases, fatalities. The traditional response to a fall involves calling an ambulance, especially if the fall is unwitnessed, due to the potential risk of head injuries or other severe complications. This protocol, while necessary for resident safety, places a considerable burden on emergency services and healthcare facilities.

Reducing Unnecessary Emergency Call-Outs

Shedfield Lodge Care Home, under the management of Andrew Geach and his brother, care home owner, Stephen Geach, has pioneered the use of safety monitoring technology to address this issue. Their research highlights the potential of these systems to reduce unnecessary ambulance call-outs significantly. By accurately identifying the nature and severity of falls, safety monitoring allows care staff to make informed decisions about whether emergency medical intervention is required.

For instance, when a fall is detected by a monitoring system, staff can immediately review the incident, assess the resident's condition, and determine the appropriate response. If the monitoring system indicates that the fall was minor and the resident shows no signs of serious injury, staff can provide necessary first aid and continuous monitoring without the need to call an ambulance. This approach not only ensures the safety and wellbeing of residents but also reduces the number of non-critical ambulance dispatches.

Case Study: Shedfield Lodge Care Home.

Shedfield Lodge Care Home's implementation of safety monitoring has demonstrated tangible benefits. The care home integrated advanced monitoring systems capable of detecting falls and alerting staff in real time. Throughout their research, they collected data on the number of falls, the nature of these incidents, and the subsequent actions taken.

The results were remarkable. Shedfield Lodge Care Home reported a significant reduction in emergency call-outs, attributing this decline to their monitoring systems' precise fall detection and assessment capabilities. The care home could provide appropriate care without overburdening emergency services by differentiating between minor falls and more severe incidents.

Report by Andrew Geach. CEO Shedfield Lodge

“As proponents of safety monitoring since 2012, our commitment to enhancing resident security within care homes has been unwavering. The concept was initially inspired by discussions on ‘unwitnessed falls’ within the facility. It became apparent that the incidence of falls was influenced more by individual resident conditions than environmental factors. Despite efforts to mitigate risks, comprehensive monitoring remained a challenge without the provision of one-to-one care services.

Drawing on a decade of experience in the police service, where safety monitoring is ubiquitous across Portsmouth City, I recognised the potential benefits of such systems in a care home setting. Enhanced monitoring would allow for a detailed analysis of falls, identifying potential triggers and assessing the severity to inform appropriate medical responses. Additionally, it would enable us to evaluate staff response times and the overall handling of incidents.

After considering the day-to-day operations at Shedfield Lodge Care Home, the primary obstacle was the financial implications and the authorisation required for installation. The investment would significantly impact the bottom line, with a long-term return on investment. Collaborating with a local installer, we devised a phased implementation strategy to manage costs effectively, starting with a few cameras and expanding as funds permitted.

The expenditure for each camera was approximately £60.00, with the DVR recorder costing £250.00, excluding installation and cabling costs. Initially, we opted for second-hand TV monitors at £60.00 each, although live feeds could also be accessed via the office computer at no additional cost. The total expense for installing three cameras amounted to under £1000.00.

Prior to installation, it was essential to develop comprehensive policies and procedures. With the assistance of our Employment Law Consultants, we compiled a complete policy and procedure manual at no charge. Communication with family members, staff, advocates, and residents about the impending safety monitoring installation encountered minimal resistance.

Staff concerns regarding intrusive surveillance were quickly alleviated with assurances that the system’s purpose was to safeguard both staff and residents. The consensus among the team was that safety monitoring would serve as a valuable tool for care provision.

A significant motivation for implementing safety monitoring was the peace of mind it offered to providers and management. With 24-hour access to live camera feeds, the management team could ensure that care was delivered appropriately and with verifiable evidence. The knowledge that all activities were recorded provided an additional layer of protection for staff and residents alike.

The installation process included setting up three monitors strategically placed throughout the home, allowing staff to observe all camera feeds. Monitors were installed in the manager’s office, the ground floor kitchen, and the staff smoking area, providing coverage of the main lounge, stairs, and front door.

This initiative underscores our dedication to fostering a secure environment for our residents and staff, leveraging technology to enhance care quality and accountability.

Following the installation of our Safety Monitoring system, we were subject to the Care Quality Commission’s (CQC) standard 18-month inspection. The CQC initially expressed concerns regarding the system, suggesting it was not in compliance with their regulations and privacy laws. I presented a robust defence, showcasing the detailed Policies and Procedures we had developed, along with the consent from our residents’ families, which ultimately persuaded the CQC to permit the continuation of our Safety Monitoring.

In the nine years since its inception, we have expanded the system to include 21 cameras, providing comprehensive coverage of all communal areas, exits, and external spaces. The benefits of this system have been manifold, as illustrated by several key incidents:

On one occasion, a resident was observed on the floor, seemingly after a fall. However, upon closer inspection through the Safety Monitoring, it was determined that no emergency services were required, thus conserving valuable resources and reducing undue stress for the resident.

In another case, a resident found on a stair landing claimed to have been pushed. A review of the Safety Monitoring footage clarified that the resident had simply lost their footing, allowing us to promptly address and resolve a family complaint.

Through our Safety Monitoring system, we were able to capture a critical moment seconds before a resident’s fall. Another resident had turned off the stairway light just before retiring for the night. Remarkably, even in low-light conditions, the camera recorded this event.

As a direct result of this incident, our maintenance team promptly adjusted the stairway lights to prevent them from being switched off, ensuring continuous illumination for safety.

Had we not implemented Safety Monitoring, we would have faced a complaint regarding a service user being pushed. In such a scenario, we would have been obligated to notify both Safeguarding and the Care Quality Commission (CQC), consuming valuable time and potentially requiring an ambulance response.

The cost implications of managing this incident without Safety Monitoring would have been substantial, likely exceeding thousands of pounds.

Recently, we encountered a situation where a resident was found on the corridor floor with two male residents standing nearby. A vigilant staff member, passing by, alerted the management team to review the Safety Monitoring footage. Upon examination, it became evident that the male resident had simply tripped while stepping backwards, and there was no visible injury. Swift assistance was provided, avoiding unnecessary medical intervention.

In the absence of our Safety Monitoring system, we would have been compelled to summon an ambulance following an unwitnessed fall, due to the uncertainty of a potential head injury. Additionally, it would have been necessary to alert our Safeguarding team, given the appearance that the individual had been pushed by two other residents. Such incidents would inevitably lead to difficult conversations with the families involved.

These examples underscore the invaluable role of Safety Monitoring in both preventing unnecessary emergency responses and providing clarity in situations that could otherwise lead to misunderstandings or unwarranted concerns. The system has not only enhanced the safety and well-being of our residents but also provided significant cost savings by reducing the need for external interventions.

Furthermore, the Safety Monitoring system has proven to be a valuable asset in conserving NHS resources by obviating the need for emergency services in certain situations.

The system also plays a pivotal role in internal management within the care home. For example, it was instrumental in resolving a situation where a staff member reported an alleged assault on a resident.

Upon review of the Safety Monitoring footage, it was observed that the staff member, while distributing drinks in the foyer, was lightly kicked on the shin by a resident who did not wish to accept their drink. The staff member’s immediate response was to reciprocate the action and depart from the area.

The initial report from the whistleblower did not include the full context of the incident, which was later clarified upon management’s review of the footage.

In the absence of Safety Monitoring, resolving disputes between staff members would have been challenging, relying solely on conflicting accounts.

The introduction of Safety Monitoring provided incontrovertible evidence, which was pivotal in the immediate dismissal of a staff member and their subsequent prohibition from working in the care sector, as evidenced by their inclusion on the Protection of Vulnerable Adults (POVA) list.

The advantages of Safety Monitoring extend beyond incident resolution. Remote access capabilities allow our management team to oversee operations from any global location with internet connectivity, ensuring continuous supervision and operational integrity.

Moreover, Safety Monitoring has proven to be an invaluable asset for staff development.

By reviewing recorded footage, we can conduct reflective training sessions with staff members, highlighting commendable actions or identifying areas for improvement. This approach not only reinforces positive behaviour but also fosters a culture of continuous learning and professional growth.

In our commitment to proactive risk management, we utilised Safety Monitoring to address a potential safety hazard within our facility.

A strategically placed camera and monitor system now provides visibility across a previously blind hallway entrance, significantly reducing the risk of accidents. This enhancement underscores our dedication to the safety and well-being of our residents and staff.

Our facility has recently expanded its Safety Monitoring capabilities to include a total of 32 cameras. This expansion necessitated the acquisition of a new Digital Video Recorder (DVR), representing an investment of £500.00. Additionally, we have upgraded our cameras to high-definition (HD) zoom lenses, enhancing the visual clarity for our staff, at a cost of £90.00 per camera.

The implementation of our comprehensive Safety Monitoring system has yielded significant benefits, notably in reducing the frequency of ambulance dispatches. This reduction has resulted in substantial annual savings for the National Health Service (NHS), estimated in the tens of thousands of pounds. Moreover, it has alleviated the distress that individuals may experience during prolonged waits for emergency services, as well as the subsequent time-consuming processes at the hospital. This efficiency also relieves our staff from the necessity of accompanying residents to the hospital, thereby preventing additional staffing pressures and associated costs.

Furthermore, the efficacy of our Safety Monitoring system has streamlined the Safeguarding process, allowing us to conclude investigations within days rather than the protracted durations of weeks or months previously experienced. It has also obviated the need for Safeguarding teams to conduct on-site visits, which were time-intensive for our management team. The teams are now satisfied with remotely reviewing the Safety Monitoring footage to determine if further evidence is required for their assessments

We searched the internet for a cost breakdown into callouts as a result of a 999 call

Service
Cost (£)
To answer a 999 call
7.00
Dispatch an ambulance
180.00
Dispatch an ambulance and transfer
253.00
Treatment in A&E
160.00
Bed for the night
303.00

(Source: Nottinghampost.com, “How much does it cost the NHS to call an ambulance,” Feb 2020. Note: These figures have not been updated to our knowledge).

In addition to the direct medical costs associated with hospital staff services, such as radiographic imaging and scans, there is a significant consideration for the emotional well-being of patients or residents. The experience of being admitted to the hospital, enduring lengthy wait times, and potentially being discharged during early hours can be distressing.

Furthermore, operational costs are impacted when care home staff are required to accompany patients in ambulances, as often requested by medical teams. This necessitates adjustments in staffing levels within the facility, sometimes requiring the employment of additional staff to maintain adequate care coverage.

Moreover, the involvement of family members, who may need to take time away from their employment to be present at the hospital, adds another layer of complexity to the situation."

The CEO of English Oak Care Homes, Stephen Geach, manages three dementia-specialised care homes on the southern coast. Together with a fourth home, we have compiled data that underscores the efficacy of Safety Monitoring in supporting not only our facilities but also the National Health Service (NHS).

From January 2023 to January 2024, across the four homes, we recorded 219 unwitnessed falls. Among these, only 10 necessitated emergency services and hospital admission. This indicates that, due to our Safety Monitoring, we avoided 209 potential 999 calls, thereby conserving emergency service resources and sparing service users from unnecessary hospital visits, which often involve lengthy waits and discharges at inopportune hours.

Financially, the 2023 statistics reveal that each emergency callout, including transportation to A&E and initial treatment, costs approximately £420.00. By preventing 219 potential callouts through our Safety Monitoring, we estimate a savings of £91,980 for the NHS within this year alone. This substantial figure highlights the significant impact of our proactive safety measures on healthcare cost reduction. This is the maximum figure.

In consideration of the most severe scenarios, we anticipate instances where patients may require transport to Accident and Emergency (A&E) departments. However, there are occasions when paramedics, upon evaluation at the site, may advise against hospitalisation and instead recommend that our staff conduct ongoing observations as per their guidance. This protocol aims to alleviate any undue stress on the service user.

Financially, the assured savings to the National Health Service (NHS) stem from the avoidance of initial paramedic dispatch costs. Calculations indicate that, for our four care homes, this equates to an annual saving of £39,083, based on 209 instances where paramedic services were not required due to our proactive measures. This would be the very minimum saving.

On average, this represents a cost reduction of £63,431. We firmly believe that our Safety Monitoring systems significantly contribute to creating a secure living environment for our residents, a safe workplace for our staff, and a protected space for visitors. These systems facilitate prompt responses to incidents and, in most cases, enable us to pre-emptively address situations before they escalate, thereby proactively mitigating potential risks.

To conclude, it has been a protocol since late 2018 for paramedics to request access to our Safety Monitoring footage upon their arrival in response to an emergency call. This practice ensures that they can make informed decisions and administer appropriate care.

Annual Safety Monitoring Impact Report

Facility: Four Care Homes

Statistical Overview:

• 2021:
o Unwitnessed Falls: 250
o Hospital Admissions: 19
o NHS Savings (Cases Prevented): 241
o Estimated NHS Savings: £101,220 (Maximum), £45,067 (Minimum), £73,143 (Average)
• 2022:
o Unwitnessed Falls: 249
o Hospital Admissions: 8
o NHS Savings (Cases Prevented): 241
o Estimated NHS Savings: £101,220 (Maximum), £45,067 (Minimum), £73,143 (Average)
• 2023:
o Unwitnessed Falls: 219
o Hospital Admissions: 10
o NHS Savings (Cases Prevented): 209
o Estimated NHS Savings: £87,780 (Maximum), £39,083 (Minimum), £63,431 (Average)
Calculation Method:

• Savings are calculated based on the number of prevented cases multiplied by the average cost per case (£420).
The implementation of Safety Monitoring systems across all care homes in England could result in significant financial savings for the National Health Service (NHS). Given the current pressures on the NHS, this initiative could be a solution to many existing challenges.

With an estimated 16,000 care homes in England, the following are projected savings for the NHS, assuming all care homes adopt Safety Monitoring in communal areas and experience a similar number of falls as our care home. Please note that these figures are approximations:

• 2022 Savings:
o Maximum: £404,880,000
o Minimum: £180,268,000
o Average: £292,574,000
• 2023 Savings:
o Maximum: £351,120,000
o Minimum: £156,332,000
o Average: £253,724,000
These estimates highlight the potential for substantial cost reductions and emphasise the value of investing in preventative safety measures within care environments.

Financial Implications for the NHS

The financial impact of this reduction in emergency call-outs is substantial. The cost of an ambulance call-out and subsequent hospital visit can be significant, particularly when multiplied across numerous care homes and frequent incidents. By reducing unnecessary call-outs, safety monitoring technology can save the NHS millions of pounds annually.

Shedfield Lodge Care Home's research provides a concrete example. Over a year, they reported saving tens of thousands of pounds through reduced ambulance call-outs. Extrapolating these savings across the entire care home sector, the potential for cost savings is immense. With thousands of care homes across the UK, widespread adoption of safety monitoring could lead to multi-million-pound savings for the NHS.

Enhancing Resident Safety and Quality of Care

Beyond the financial benefits, safety monitoring technology also enhances the quality of care provided to residents. Prompt detection of falls and other incidents ensures that residents receive immediate attention, reducing the risk of complications and improving overall outcomes. Additionally, the presence of monitoring systems can provide peace of mind for residents and their families, knowing that their loved ones are under continuous supervision and care.

The use of safety monitoring also supports care staff by providing them with precise information about incidents. This data can be used to identify patterns, implement preventive measures, and continuously improve care practices. For example, if the monitoring system identifies a specific area where falls frequently occur, the care home can take steps to modify the environment and reduce the risk of future incidents.

Overcoming Challenges and Barriers

Despite the clear benefits, the adoption of safety monitoring technology in care homes faces several challenges. Initial costs, technological barriers, and concerns about privacy and consent are significant hurdles that need to be addressed.

Cost Considerations:

The initial investment in safety monitoring technology can be substantial. Care homes must allocate funds for purchasing, installing, and maintaining these systems. However, the long-term savings in reduced emergency call-outs and improved efficiency can offset these initial costs. Moreover, financial support and incentives from government bodies and healthcare organizations could facilitate wider adoption.

Technological Barriers:

Implementing and maintaining safety monitoring systems require technical expertise and ongoing support. Care homes need to ensure that staff are adequately trained to use these systems effectively. Partnerships with technology providers can help address these challenges by offering training, support, and maintenance services.

Privacy and Consent:

The use of monitoring systems, particularly those involving video surveillance, raises concerns about resident privacy and consent. It is essential to establish clear guidelines and protocols to ensure that monitoring is conducted ethically and with respect for residents' privacy. Informed consent from residents and their families is crucial, and monitoring should be used primarily for safety purposes.

The Future of Safety Monitoring in Care Homes

The successful implementation of safety monitoring technology at Shedfield Lodge Care Home provides a compelling case for its wider adoption across the care home sector. As technology continues to advance, these systems will become more sophisticated, reliable, and accessible.

Future developments in safety monitoring could include integration with other healthcare technologies, such as electronic health records and telemedicine platforms. This integration could create a comprehensive care ecosystem, enabling seamless communication and coordination between care homes, healthcare providers, and emergency services.

Moreover, advancements in artificial intelligence and machine learning could enhance the capabilities of safety monitoring systems. These technologies could enable predictive analytics, identifying residents at higher risk of falls and other incidents, and allowing for proactive interventions. This proactive approach could further reduce the incidence of falls and emergency call-outs, improving resident safety and quality of life.”

Care Campaign for the Vulnerable's advocacy for safety monitoring technology in care homes represents a significant step towards improving the quality of care for vulnerable individuals and reducing the financial burden on the NHS. The research conducted by Shedfield Lodge Care Home demonstrates the potential of these systems to enhance resident safety, reduce unnecessary emergency call-outs, and save millions of pounds annually.

CCFTV exclusively advocates for independent (professional, third party oversight ) safety monitoring technology. However, if care providers choose to implement in-house monitoring, CCFTV expects that they have conducted thorough due diligence. Safety monitoring is not merely a tool for improving present-day care; it is an investment in the future of care for vulnerable individuals. Through ongoing advocacy, research, and collaboration, we can ensure that every resident receives the care and protection they deserve, while also preserving the resources of our healthcare system for future generations.As the care home sector continues to evolve, the adoption of safety monitoring technology will be crucial in meeting the challenges of an aging population and increasing demand for high-quality care. By investing in these technologies, care homes can provide safer environments for residents, support care staff, and contribute to the sustainability of the healthcare system.