Pimp my Zimmer - Mental Health Services for Older People - HPFT - HC - #MHAwards19

Please briefly describe your project, group, team or service, outlining What you do and why it makes a difference

`Pimp My Zimmer’ was a pilot project, inspired by Essex County Council, which aimed to reduce falls after a care home matron noticed people with dementia sometimes find it hard to recognise their own frame.

Hertfordshire Partnership University NHS Foundation Trust (HPFT), along with Hertfordshire Community NHS Trust (HCT), GPs, and social care services (the multi-partnership group) is supporting the residents of Watford and Three Rivers to stay well and live healthier, happier and more independent lives for longer.

Care home residents at Sunrise Residential Care Home, Chorleywood in Hertfordshire had their Zimmer frames decorated, with help from local schoolchildren from The Russell School in Chorleywood.

Their dull grey walking aids were transformed into works of art by adorning them with bespoke playing cards, football scarves, tinsel and flowers.

Personalising the frames has really helped the residents to feel proud of their Zimmer and want to use them, increasing mobility and reducing the risk of falls and pressure ulcers.

By having easy to recognise frames, older people are less likely to choose the wrong frame which can be dangerous as all frames are adjusted to the user’s height. Having the wrong frame can lead to a much greater risk of falling.

The new look frames are also great for opening up a conversation about the design which can lead to longer conversations about their past. Since its launch, the project has resulted in

· 50% reduction in referrals to HPFT (depression)

• 86% improvement in resident wellbeing validated scores

• 66% increase in zimmer frame usage

• 50% improved mobility, 33% mobility remained constant despite deteriorating health (due to frame usage), 17% stable.

Feedback from the residents at Sunrise Residential Care Home has seen a huge improvement with participants saying they felt “active and vigorous”.

What makes your service stand out from others? Please provide an example of this.

This project is a great example of a simple idea with a very strong impact. The residents completed Interest questionnaires, so the children designed the frames in conjunction with these, so Life Story and Reminiscence work was also bought into the project. It is a fantastic example of multi-agency working to improve both the physical and mental health of people who use walking aids. It is also inter-generational as local school children have personalised the frames for the people in the care home. The children completed the Wellbeing scale with the residents before and after the activity. Now that this relationship has been established, the school and care home plan to have the school children visit again.

How do you ensure an effective, safe, compassionate and sustainable workforce?
The Pimp My Zimmer project was based within Sunrise of Chorleywood Care Home, with professionals joining the residents, children and staff. This assisted the care home staff with their development and confidence around mobility, falls prevention, wellbeing, and interactions with people who reside there. It also allowed a link to form between the school and the care home,that developed after the project into carol singing and other visits. At HPFT we are driven by our values of being respectful, kind, positive, welcoming and professional. HPFT looks after people from the moment they apply for a role and throughout their careers. We believe our staff are our most valuable asset – and we also believe that investing in colleagues is crucial if we want to enable everyone to reach their full potential. As a University Trust we recognise the importance of supporting our workforce to deliver the right care in the most effective way. That means making sure staff can access outstanding learning and development opportunities whilst pursuing their careers within the Trust. We offer: A structured leadership and management development programme Core skills statutory and mandatory training programmes A ‘one-stop’ induction programme for all new staff – introducing you to the Trust, our values and our services A structured programme of learning for trainee doctors, student nurses and students across psychological services, social work and allied health professions A coaching network where trained coaches throughout the Trust are matched with staff of all disciplines to provide a powerful development opportunity A wide range of Continued Professional Develop (CPD) opportunities, working with partners – such as University of Hertfordshire, University of Bedfordshire, Anglia Ruskin University and University of Essex – to deliver training and development programmes and support. We also want to make it easy for people to return to work after a break, to come back to work after they’ve retired and to move around the Trust easily so they can explore new roles and take on new challenges. We also have a number of options for flexible working available. We offer a Health Hub which helps improve staff health and wellbeing across the Trust – encouraging staff to step away from their work and think about their own health. This includes: Workshops, challenges and social events throughout the year Confidential and safe forums where staff can talk about the emotional impact of their work An equality and diversity staff network providing support to all staff Mindfulness bite size taster sessions Mini health checks Free, confidential counselling services 24/7 Reduced gym rates at a number of local health clubs/gyms PAM life: our online personal health management resource which allows staff to set goals, track progress and develop specific, tailored programmes A quarterly staff magazine where staff can share stories and inspire others. Along with the staff magazine and national NHS Staff Survey we also engage with staff using a weekly e newsletter, quarterly Pulse Survey and Big Listen events. The Chief Executive holds breakfast meetings, approximately bi-monthly, inviting different groups of staff (including Consultants, Student Nurses, Social Workers and HCAs). We have a robust system for ensuring appropriate supervision is taking place at the correct times.
Who is in your team?	Band/grade	Number	Whole-time equivalent
Caroline Finch	7	1	0.6WTE
Nicola Kemp	GP	1	0.2WTE
Tracy Coots	3	1	1WTE

School Teachers and the Care Home activity coordinator also helped with the project. The team above put some hours into the project (wasn’t a full time role)

How do you work with the wider system?

Pimp my Zimmer was a project that involved inter-agency and inter-generational working to improve the mental health and wellbeing of older people who rely on walking frames to support their mobilisation.

The original idea of Pimp my Zimmer was identified from literature following a successful project in Essex where they decorated the walking frames with items, colours and themes that are of interest to its owner.

HPFT’s Watford locality adopted the project as part of the integration approach. The primary partners being Direct Local Health (GP Federation for Watford), Hertfordshire Partnership Foundation Trust and Sunrise Senior Living. The project was adapted to an inter-generational one by involving Russell School of Chorleywood.

The school children did designs for the walking frames based on the resident’s interests, before visiting the home to decorate the walking frames with the residents. The visits were facilitated by a General Practitioner (Dr Nicki Kemp from the GP Federation)), an Occupational Therapist (Caroline Finch, HPFT), An Occupational Therapy Assistant (Tracy Coots, HPFT), Teaching Staff (Russell School) and care staff (Sunrise Senior Living) – who all worked with the children and residents in a way that was fun and engaging.

Do you use co-production approaches?

Prior to the makeover, residents were asked to fill in a questionnaire about themselves including their likes, dislikes and their favourite memories. These were then sent to the school and the children designed fun Zimmer frame transformations.

Do you share your work with others? If so, please tell us how.

Learning from the project was shared by the GP Federation within Herts Valley CCG, and within the Provider Delivery Board in Watford. It was shared internally within HPFT, and has subsequently been adopted by St Albans Provider Delivery Board in Harpenden and is being replicated in a residential home there with a local school and HPFT and HCT.

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

• 50% reduction in referrals to HPFT (depression)

• 86% improvement in resident wellbeing validated scores

• 66% increase in zimmer frame usage

• 50% improved mobility, 33% mobility remained constant despite deteriorating health (due to frame usage), 17% stable

• The project has formed a local link between Russell School and Sunrise Senior Living, which is hoped will continue as the school plan to visit at Christmas time to sing carols. They are also planning to re-run the Pimp my Zimmer project periodically as a school/ care home partnership.

• As part of the project the school held an assembly to talk about dementia to raise awareness and support the children in advance of visiting Sunrise. This also set the scene to explain to the children that by decorating a walking frame the person may be proud to use it, or it may make it easier to recognise. By using it more it may reduce falls. A decorated walking frame also provides a focus for residents to start a conversation, and talk about their interests/ why their frame is decorated in the way that it is. Thus, improving their social interactions as well.

• The project feedback is very positive, in that Sunrise report a ‘buzz’ amongst the residents following the project. The wellbeing scores completed pre and post project show an increase in wellbeing of an average of 86%. One resident has seen a dramatic fall in anxiety as he now knows which walking frame is his because it has a bike on it (before the project he was anxious about where his frame was, or which one was his). As well as the residents, care home staff report that it is easier for them to identify which frame belongs to which resident – which means the risk of using an incorrectly sized frame is reduced.

Has your service been evaluated (by peer or academic review)?

The Trust was reviewed by the CQC and was rated Outstanding overall. The report mentions the Pimp My Zimmer initiative in its summary of findings as an example of staff at all levels taking responsibility for innovation and implementing new ways of doing things, fully supported by their leaders.

Our Early Memory Diagnosis and Support Service (EMDASS) is accredited by the Memory Service Network Accreditation Programme.

How will you ensure that your service continues to deliver good mental health care?

The project is now planning for scalability, and taking this approach to other homes and schools in Watford locality, as well as the other three in Herts Valley CCG area.

What aspects of your service would you share with people who want to learn from you?

We have shared the forms that were devised by the Watford Locality group and have adapted them for the project in Harpenden. We also have focussed this next project on people who have a higher level of falls, so see if by Pimping their Zimmer can actually reduce the falls rate if it is targeted for those people who have a high rate of falls.

The Watford project did not show an overall reduction in falls over the 3 month period, however there were particular residents who did have a reduction in falls. The project displayed many other benefits which were not necessarily expected, for example, 86% improvement in resident wellbeing validated scores and 66% increase in zimmer frame usage.

One of the challenges of the project was coordinating the work between the Care Home, different organisations and the school. This took perseverance and required someone to lead in the communication.

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Co-Production

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