Safer Provision and Caring Excellence (SPACE) Programme

Patient safety

Partner Organisations

  • Walsall Clinical Commissioning Group
  • Wolverhampton Clinical Commissioning Group


  • Mental health: recovery
  • crisis and prevention
  • Wellness and prevention of illness
  • Education and skills

Date Initiated

26 January 2017

Project Status

In Progress

The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (PSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.

Most research into safety culture improvement has focused on hospitals, and the concept has only recently emerged in other areas of health and social care provision such as the care home sector. This is surprising given the complex needs of care home residents who often have multiple physical, cognitive and sensory impairments. A recent UK care home census reported that 87% of residents have high support needs, defined as having one or more of dementia, confusion, challenging behaviour, dual incontinence, severe hearing/visual impairment or dependence in mobility. In this population, adverse safety events can quickly escalate and lead to hospital attendance or admission. The care home sector is also characterised by frequent policy and regulatory changes, heavy workloads, high staff turnover and difficulty recruiting and retaining competent staff. These factors make it challenging for positive safety practices to be cascaded to staff and to become embedded within care home organisational culture.

The nature of the care home resident population, coupled with workforce issues within the sector has meant that quality and safety in care homes is becoming an increasingly important concern for adult social care. The most common adverse safety events in care homes are accidental injuries involving residents and staff, pressure ulcers, falls, wounds and medication errors. A limited number of safety and quality improvement initiatives have been developed and tested in the care home sector, showing some evidence of effectiveness, especially with falls and pressure ulcer prevention. However, quality and safety improvement approaches in care homes are often small-scale and improvements may not persist in the longer term. 

The SPACE programme is a large-scale care home improvement programme being undertaken in the West Midlands which aims to strengthen safety culture and reduce the incidence of adverse safety events. There are two main elements to the SPACE programme:

  • Training events and workshops, which will help care home staff and managers develop relevant skills and enhance their understanding of safety-related service improvement. Training will explore clinical and human risk factors related to safety, alongside techniques for designing and implementing service improvements.
  • Facilitated sessions delivered in participating care homes will support staff to implement changes to practice relating to specific safety concerns such as falls prevention and pressure ulcer management.

Programme Outcomes

The planned outcomes of the SPACE programme are: 

  • Strengthening safety culture.
  • Reducing the incidence of adverse safety events.

The programme will be robustly evaluated to assess its effectiveness. The overall aim of the evaluation is to assess the extent to which safety climate in care homes can be improved and the incidence of adverse events reduced, by skilling-up care home staff in service improvement techniques and providing facilitation to enable care homes to implement changes to practice. It will take a longitudinal approach, using a before and after study design. The protocol outlining the evaluation has been published. 


Programme Lead

Helen Hunt
t: 0121 371 8061