Ocean apart: Connected together: insights series

Impact 3: Improved patient safety through earlier detection of clinical deterioration

Authors:

Zainab Almukhtar

Tara Marshall

In care homes and other community settings, the people providing day-to-day care will often notice subtle changes in a resident before an acute clinical event occurs. Someone may be eating less, behaving differently, becoming more confused or simply appear “not quite right”.

The challenge is not only recognising those changes. It is ensuring that concern can be measured, communicated and acted upon early enough to make a difference.

Evidence from the Connected Care Programme, led by These Hands Academy, demonstrates how structured monitoring can help move care from reactive intervention towards proactive care.

The programme brings together Soft Signs, physiological observations, NEWS2, telehealth, workforce development and structured escalation. Routine observations become standardised clinical information that can sit alongside the care worker's knowledge of the individual.

That creates something particularly important for patient safety: an earlier decision point.

A care worker who feels somebody is “just not right” can support that concern with objective clinical information. That information can strengthen conversations with clinicians, support earlier assessment and allow an appropriate response before deterioration becomes a crisis.

The purpose is not to prevent hospital admission at all costs. Hospital is exactly where someone should be when they need hospital care. The opportunity is to reduce the risk of deterioration going unnoticed until an emergency pathway becomes the only remaining option.

Oceans apart, but a shared safety challenge

This question becomes particularly interesting when we look across the Atlantic.

Canada, like the UK, is considering how to support an ageing population with increasingly complex needs while strengthening care closer to home, but there is an important difference in how Canadian long-term care is organised.

Long-term care is primarily a provincial and territorial responsibility, meaning that provision, funding, regulation and models of delivery can vary between jurisdictions. At the same time, Canada has developed national ambitions for safer and higher-quality long-term care, including standards focused on resident-centred care, workforce capability, quality improvement and safer systems of care.

Significant investment is also being made. Through Canada's Ageing with Dignity agreements, federal funding includes $3 billion over five years for long-term care and $2.4 billion over four years for home and community care, delivered through agreements with provinces and territories.

This creates an interesting patient-safety question.

How do you turn national ambition and investment into something consistently meaningful at the point where a resident begins to deteriorate?

There may be an opportunity to explore whether the principles of a common approach to recognising deterioration could provide greater consistency within different systems.

A common language, not simply another score

This is where the experience from Leicester, Leicestershire and Rutland becomes relevant.

The lesson from Connected Care is not that NEWS2 alone transforms care.

A score without a confident workforce, an escalation pathway or somebody able to respond to it has limited value.

The opportunity comes from connecting the components:

recognise change → measure it → communicate it → respond to it.

The Care England and These Hands Academy paper, Managing deterioration in care homes: integrating NEWS2, explores this further, highlighting the potential for a shared clinical language to strengthen communication between social care and NHS services and support earlier recognition and escalation.

For Canada and the UK, the question therefore isn't simply:

“Should all long-term care adopt NEWS2?”

A more useful question may be:

“Could a more consistent approach to recognising and communicating deterioration become part of the infrastructure for safer long-term care?”

It brings together patient safety, workforce capability, technology, clinical pathways, quality improvement and system design while keeping the person receiving care at its centre.

That is where Oceans Apart, Connected Together becomes particularly relevant. Our systems are different, but many of the problems we are trying to solve are remarkably familiar.

Earlier recognition creates time for clinical assessment. It creates time to involve families. It creates time to intervene appropriately and, where clinically safe, to support someone in the place they call home.

Most importantly, it reduces the risk that the first clear indication of deterioration is a crisis.

Early recognition creates time. Time enables safer intervention. And safer intervention preserves choice.

At These Hands Academy, we are interested in continuing this conversation with Canadian long-term care providers, provincial health systems, researchers and partners: not to export a UK solution, but to explore what the evidence could look like when adapted, tested and evaluated within the Canadian context.

References

Care England and These Hands Academy (2026) Managing deterioration in care homes: integrating NEWS2. Care England.

Government of Canada (2024–2026) Working Together to Improve Health Care for Canadians: Ageing with Dignity bilateral agreements. Health Canada.

Health Canada (2024) Safe Long-Term Care Act: Consultation document. Government of Canada.

These Hands Academy (2026) Connected Care Programme Evaluation: Leicester, Leicestershire and Rutland.