In this blog, Jenn Garner and Ann Remmers report on our recent regional learning event, bringing together maternity and neonatal colleagues from across the region.
On Wednesday 30 April, we were delighted to welcome colleagues from trusts across the West of England to the regional learning event for our Maternity and Neonatal Safety Improvement Programmes at Gloucestershire County Cricket Club in Bristol.
With glorious spring sunshine setting the scene, the day was filled with inspiring talks, lively discussions and a shared commitment to providing safer, more equitable perinatal care.
The theme of the event, ‘Breaking Down Barriers for Safer Systems’, brought together a vibrant community of healthcare professionals united by a passion for improvement.
Ann Remmers (Maternity and Neonatal Clinical Lead for Health Innovation West of England) opened the day, encouraging attendees to take a step back from their busy roles to reflect, connect and learn from one another. Participants rose to the occasion with energy and engaged in interactive exercises to share the breadth of their work, captured creatively on our ‘tube maps’, which we’ll be sharing in the coming weeks.
We were gently grounded with a meditative breathing exercise led by Noshin Emamiannaeini-Menzies (Senior Project Manager at Health Innovation West of England), setting a calm and thoughtful tone for the day.
Jan Scott (Patient Safety Programme Manager) and Jenn Garner (Senior Project Manager) reflected on the maternity and neonatal collaborative’s achievements so far, including sustained improvements in neonatal outcomes through the PERIPrem programme, and shared exciting plans for the future.
Nikki Pattison (NHS England) and Gill Travers (Senior Project Manager, Health Innovation West of England) introduced the Perinatal Culture and Leadership programme, engaging the room with interactive exercises using the MOMENTS model to explore leadership behaviours and team culture.
Terri Gnani and Dr Sneha Basude (Bristol, North Somerset and South Gloucestershire Integrated Care Board) gave a powerful presentation on their work through the Race and Health Observatory’s Learning Action Network. Their project, ‘Anti-Racism in Preterm Optimisation’, has spotlighted disparities in preterm care and driven forward improvements in staff awareness and practice.
We were grateful to hear from Donna Butland, Service User Lead for South West Maternity and Neonatal Services, who delivered a moving talk on Listening Culture. Through the lens of a personal story, Donna highlighted the vital role of maternity and neonatal voices partnerships and made a compelling case for embedding them at every level of our systems.
Dr Lesley Jordan (Clinical Lead at Health Innovation West of England and Consultant Anaesthetist at Royal United Hospitals Bath) shared her insights into implementing the new national Maternal Early Warning Score (MEWS), reminding us all of the importance of nurturing a culture of curiosity.
The day concluded with Siobhan Lanigan (Senior Project Manager, Health Innovation West of England), who provided a valuable overview of Martha’s Rule and its links to MEWS. She left us looking ahead to the launch event in July – watch this space!
Thank you to everyone who attended, contributed, and made the day such a success. Your energy, openness and commitment to improving care for women, babies and families was truly inspiring.
Sean Hourigan is Development and Training Manager at The Peer Partnership and Brigstowe. We were delighted when Sean accepted our invitation to take part in a panel discussion at our conference last November, exploring how the NHS can partner more effectively with the VCSE sector to address health inequalities.
In this blog, Sean expands on some of his thoughts at the conference on how health and care services can develop more ‘grown up’ partnerships with the VCSE sector by stepping back and listening more.
In recent years, the concept of co-production has gained much-needed traction in the health and Voluntary, Community, and Social Enterprise (VCSE) sectors. This approach emphasises collaboration between service providers and the communities they serve, ensuring that services are designed and delivered in a way that truly meets people’s needs. However, the journey towards effective co-production is loaded with challenges and power dynamics that require a fundamental shift in mindset and practice.
One of the first steps in this journey is rethinking the language we use when talking about communities and inequalities in health and social support.
The term “hard-to-reach communities” is often used to describe groups that are perceived as difficult to engage with. However, this term is inherently victim-blaming, suggesting that these communities are deliberately avoiding engagement. Instead, the VCSE sector has moved towards the term “underserved communities”. This shift in terminology acknowledges that the failure lies with the service providers who have not effectively reached out to these communities, rather than with the communities themselves.
To truly engage underserved communities, it is essential to change the way we think about service delivery. These communities are often ready and willing to work with service providers, but they need to see themselves and their concerns represented in the services being offered. This means moving away from short-term pilot projects that are frequently cancelled or don’t progress onto anything else, and instead focusing on sustainable, long-term initiatives in which communities see themselves as significant stakeholders rather than as passive recipients of care.
When these “here today, gone tomorrow” projects end abruptly, it not only disrupts the lives of those who value or have come to rely on them but also further erodes trust in the system as a whole. Rebooting these services later can often be met with cynicism and resistance, as the community members have moved on and are reluctant to re-engage with “yet another” initiative that they are assured wants to “take their issues seriously”.
The VCSE bridge
The VCSE sector has come to play a crucial role in bridging the gap between health services and underserved communities.
However, there are significant challenges that need to be addressed if we are to learn from this experience and if the NHS and social care are to successfully work in partnership with VCSE colleagues as part of a truly effective integrated care system.
Often when approaching VCSE organisations to deliver work with them, health services have already pre-written programmes and specific solutions in mind. This approach forces the VCSE sector to fit and tender for pre-defined programmes, rather than leveraging its unique strengths and expertise to co-design alternative and potentially more appropriate approaches and solutions to achieve the same outcomes.
The VCSE sector is inherently skilled at working with communities because its work is always reflective of the communities it serves.
Creating round pegs for round holes
Instead of dictating how the VCSE sector should fit in with plans designed by health services, I’d suggest we turn this on its head: health services should communicate their intended goals and allow the VCSE sector and the community to co-design and co-produce the programmes to achieve these. This approach not only ensures that the services are more effective but also fosters a sense of ownership and buy-in from the community.
Our Common Ambition Bristol programme, an approach that was co-produced by and for African and Caribbean heritage communities in Bristol to support HIV and sexual health awareness, has been an award-winning example of how to create services for a community previously considered “hard to reach” on sexual health matters.
It turns out that they are not hard to reach. It’s just that nobody was talking with or listening to them.
The challenges
Integrated care systems are supposed to be a partnership between healthcare, local authorities, and the VCSE sector. However, in practice, this partnership is often unequal. Healthcare and local authorities have been working together for years, while voluntary sector alliances are a relatively new addition. This disparity can lead to feelings of frustration and bitterness within the VCSE sector, as it is often treated as a junior partner rather than an equal.
Despite these challenges, VCSE colleagues remain hopeful and we continue to engage with the integrated care process. However, our counterparts in health and care services need to recognise the pressures we face. Just like health and care, the VCSE sector is experiencing increased demand for its services. Often, people turn to us after exhausting all other options, seeking support at their lowest point.
Therefore the VCSE sector, especially those providing longer-term support to the communities they serve, plays a critical role in re-engaging these individuals with health services.
The importance of co-production
Co-production is not just a buzzword; it is a vital approach to service delivery that can lead to more effective and inclusive care.
In the VCSE sector we are often better positioned to lead co-production efforts because we are already trusted by the community. Trust is a crucial factor, as many community members may have had actual or perceived negative experiences with health and care services in the past.
The VCSE sector can act as a bridge, helping to rebuild trust and facilitate engagement.
At The Peer Partnership, efforts are being made to build capacity for co-production through training and support. Workshops on best practices, group dynamics, facilitation, and responding to challenging behaviour are offered to help both VCSE and health sector staff. Additionally, we have developed action learning sets to support NHS staff who want to engage in co-production but may lack the time, capacity, knowledge or confidence to instigate such programmes.
Final thoughts
Co-production between health and charity services is a powerful approach that can lead to more effective and inclusive care.
By rethinking our language, changing our thought processes, and leveraging the strengths of the VCSE sector, we can create services that truly meet the needs of underserved communities.
While there are challenges to overcome, the potential benefits make it a journey worth undertaking. Through collaboration, trust-building, and capacity-building, we can move towards a future where co-production is the norm, not the exception.
In this blog, our Chief Executive, Natasha Swinscoe, reflects on co-creating Health Innovation West of England’s new five-year strategy and explores some of our new priority areas of focus.
I am pleased to share with you our new Health Innovation West of England Strategy for the next five years, setting out our clear vision for all communities in the West of England to benefit faster from the best innovations in health and care.
We will achieve this by working in partnership with our local health and care systems and the life sciences sector to discover, develop and deploy proven innovation to drive better and fairer health outcomes for our local communities and enable wealth creation.
We co-created this strategy with our staff team, our health and care member organisations, innovation ecosystem partners and our Partnership Board, which includes the chief executives from across our three integrated care systems.
We started this work in the summer of 2023 when the 15 Health Innovation Networks were relicensed by NHS England and the Government’s Office for Life Sciences for a further five years. We wanted to ensure our programmes and support continues to meet the needs and priorities of all the people we work with and the populations we serve.
Building on our track record
We have a fabulous track record from our first 10 years as the West of England Academic Health Science Network (we had a name change in October 2023 too!) of working collaboratively with system partners and organisations to create the right opportunities to deliver projects targeted at meeting real needs. Our back catalogue of projects delivered and spread locally (and in many cases nationally) proves we do this well.
Last summer was the ideal time to pause and take stock. The health and care landscape has changed so much in the last decade, with the introduction of integrated care systems and boards who are now are key partners, combined of course with the huge impact Covid has had in changing how we work and deliver services. We felt it was important to review how we work and what we do to ensure we are still adding value to the work of our partners ‘on the ground’.
Co-creating our strategic approach
We started by having discussions with our staff team at Health Innovation West of England, looking back at what we believe has supported our success, practices we think are useful to retain and areas we want to expand or develop. We tested this with our Partnership Board in September and involved all Board Members in individual ‘deep dive’ conversations where we asked two key questions:
“What does your organisation value from the past ten years of working with Health Innovation West of England that you want us to keep doing?”
“How do you see innovation supporting your organisation’s priorities in the future?”
The answers led us directly to the strategy you see here.
Much of what we did in the past we will continue to do because it works. We are valued for our joined-up approach, and in particular our focus on collaborating across organisational, system and geographical boundaries, and creating and resourcing networks or communities of practice.
But there are some areas we want to focus on more deeply. We identified a couple of clear areas for development that support the changes in health and social care in recent years.
A shift left to prevention and early intervention
Our new strategy therefore has a greater focus on prevention and early intervention. To achieve this “shift left” coupled with a focus on reducing health inequalities, we will work with the wider system and not just health partners. And by engaging more directly with local communities, in particular the disadvantaged and seldom heard, we aim to better understand and respond to the broader social determinants of health.
Focus on the important – not the urgent
One of the comments from our Board that sticks in my head is: “Focus on the important not the urgent – systems are all focussed on the urgent and often don’t get to the important.”
This is the space that Health Innovation West of England needs to work in. Providing partners with the headspace and resources to consider the ‘important’, where we can be proactive and intentional, rather than responsive and firefighting. This means our work in areas such as maternal and neonatal health, cancer and cardiovascular disease remain key work areas for us.
Wealth is as important as health
We also heard that our partners recognise wealth is as important as health. Systems and organisations are keen to work more commercially with innovators but don’t always know how. Our role is to both support health and care services maximise the use of innovation, as well as support innovators to develop solutions that genuinely meet the needs of our health and care services.
To do this many innovators need to generate real world evidence and evaluation of their solutions “in use”, and so a major strand of our new strategy is to expand our evaluation function to support this area of activity.
Developing new networks
As we implement this new strategy into action, I’m looking forward to developing new networks and working relationships with people across the West of England, in particular with social care and local authority colleagues, VCSE organisations and community groups.
The world of innovation is vibrant and exciting in the West of England. We have an amazing health and life sciences ecosystem and a wide range of industry in place already. There are opportunities all around us to generate solutions to the issues our health and social care colleagues face every day.
We are also fortunate to have so many innovative colleagues and thinkers in our patch, people who really want to make a difference and think “outside the box” to find solutions to knotty problems.
I’m proud that the team at Health Innovation West of England are an integral part of this community and I am excited about making the connections to find and create those opportunities with you over the next five years.
In this blog, Dr Ben Newton, Senior Research Evaluator at Health Innovation West of England, shares his reflections on a qualitative interview study among health and social care professionals on their experiences of digital service implementations.
Our survey sought to understand NHS staff views and feelings on a digital app being implemented across two NHS trusts and I was curious about how other researchers have understood the role of staff capability, opportunity and motivation (COM-B model1) in implementing digital tech.
What I liked about the article was its relevance to a broad church of staff working to deliver, implement and evaluate digital technology.
If you work, as I do, in the health innovation space, you will definitely want to read the full article. The future appears to be a digital world; one which Covid-19 has accelerated in the health sector – a point the authors make.
The article is a primary research piece set in the Finnish healthcare system. The researchers used group interviews of health and social care professionals working in primary care. One of the key inclusion criteria was that participants had recent experience of implementing digital services.
Some of you will be familiar with Normalisation Process Theory2 (NPT), a framework that helps us understand what helps interventions be successfully implemented AND integrated into routine work. Nadav and colleagues used the NPT framework as an analytical tool, which I felt was a novel approach to qualitative analysis.
Anyway, I’m sure you are keen to read the headline findings, so here goes. The authors identified 14 strategies that they embedded within the four key concepts of NPT – coherence (sense-making); cognitive participation (relational work); collective action (enacting work) and reflexive monitoring (appraisal work).
I’m not going to list all these strategies here – you can read the open-access paper yourself. However, here are key headline results that struck me:
People have had bad experiences of interventions being implemented (you might relate to this!), which led to losing faith and trust. Therefore, implementation processes must be consistent, whilst communication must be multi-channel and continuous. Alongside this, to motivate staff (I’m seeing the link with the COM-B here), they should be provided with a good justification of why the service is needed.
Staff need to have a positive attitude to using the digital service – or they won’t use it. The authors highlight the importance of giving voice to staff to influence (you could say co-design!) the implementation.
Thinking about support, this should be ‘close and readily available’. In some instances, this can be through a physical presence on site. Staff should have time to get familiar with the service and have opportunities to practice. Having sufficient knowledge of the intervention gives staff confidence to use it.
Some of you will have come across the UTAT3 (Unified Theory of Acceptance and Use of Technology) and I would recommend Marikyan and Papagiannidis’ easier explanation of it4. The UTAT seeks to explain a person’s intention to use technology. Two key concepts of this are performance expectancy (how the technology will help the individual perform at work) and effort expectancy (how easy the technology is to use). The final theme in Nadav’s paper contains clear links to the UTAT concepts (although Nadav et al. don’t make these links themselves).
Participants in Nadav’s study reported that having bad experiences of usability, where the technology is not easy to use, can jeopardise successful implementation. This is a clear echo of the effort expectancy concept in UTAT. Moreover, participants said the service should be useful to them; an echo of performance expectancy. Finally, participants said they should have opportunity to offer feedback; a point the authors relates to evaluation factors.
Concluding thoughts? For experienced staff in programme work, the factors identified in this article are unlikely to surprise you. They should, however, reinforce good practice points that, in the heat of project timelines being pressurised, can all too easily get lost.
For the novice (or as my son likes to say in relation to my Minecraft skills: the ‘newb’), you would do well to start with this article and reflect on some of the key pointers and models that can support successful implementation (and evaluation) of programme work.
References
1. Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42
2. Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O’Donnell, C., Ong, B. N., Rapley, T., Rogers, A., & May, C. (2010). Normalisation process theory: A framework for developing, evaluating and implementing complex interventions. BMC Medicine, 8(1), 63. https://doi.org/10.1186/1741-7015-8-63
3. Venkatesh, Morris, Davis, & Davis. (2003). User Acceptance of Information Technology: Toward a Unified View. MIS Quarterly, 27(3), 425. https://doi.org/10.2307/30036540
4. Marikyan, D., & Papagiannidis, S. (2021). Unified Theory of Acceptance and Use of Technology: A review. In TheoryHub Book. http://open.ncl.ac.uk.
Across England, NHS service providers have been working through the Patient Safety Incident Response Framework since it was published a year ago in preparation for the transition to a new approach in autumn 2023.
In this blog, Nathalie Delaney, Senior Programme Manager at the West of England AHSN, explores why understanding and creating a positive safety culture is such a critical part of the approach.
Patient Safety Collaboratives have been commissioned to support the implementation of the Patient Safety Incident Response Framework (PSIRF), working with their local integrated care systems (ICSs) and integrated care boards (ICBs), as well as NHS England regional teams.
One of the changes in approach through PSIRF includes a greater focus on taking a whole-system approach to exploring not only when things go wrong, but also how everyday work happens. Understanding and creating a positive safety culture is a vital part of this.
The new practical guide published by NHS England in association with the AHSN Network aims to support this. Improving Patient Safety Culture: a practical guide was developed out of Patient Safety Collaborative’s experience in exploring safety culture through various programmes.
Why is improving safety culture so important?
Again and again, investigations into where things go wrong in the NHS give recommendations to improve safety culture. But despite this, and lots of hard work from people across the health and care system, we sadly see the same issues and recommendations recurring.
This suggests that our approach isn’t working, and so this new practical guidance aims to give a clear definition of what safety culture is so that we can all work towards a shared understanding.
How does PSIRF fit into this?
PSIRF is a framework that sets out a new approach that not only looks at the systems and culture within which things happen but also gives a greater emphasis than before to compassionate engagement with those affected by an incident. This aligns with other recent guidance, such as the Being Fair report from NHS Resolution.
Is this about individual, team or organisational culture?
All of the above! But perhaps organisational culture is the most critical factor.
I often refer to the work of Mary Dixon-Woods describing a shift from comfort-seeking to problem-sensing cultures when talking about organisational culture, as that is the shift in mindset at an organisational level.
All of this is about learning and making sure that we put this learning into practice by developing learning systems.
How are Patient Safety Collaboratives supporting PSIRF and improving safety culture?
We’ve got strong connections with organisations across the system built up through our years of working on patient safety improvement together in a collaborative way. This means that within each of the 15 Patient Safety Collaboratives (each hosted by its local AHSN), we’ve got local networks and relationships in place.
Many areas are setting up collaborative events on a regional footprint or have held launch events to bring everyone together. Some meetings have been virtual, and we have been fortunate enough to meet face to face, which is exciting because there’s real power in getting people together in person to learn and share from each other.
That’s what we love doing in the Patient Safety Collaboratives, and what is needed to create learning systems to deliver improvements in safety that stick.
In this blog, Dr Mark Juniper, Respiratory Consultant at the Great Western Hospital, Swindon, and Medical Director at the West of England AHSN, gives a progress report on the collaborative to reduce mortality following acute non-invasive ventilation (NIV). He tells us how sharing the data collected for this project can help deliver the improvements needed…
As a new consultant in 2000, I helped to set up an acute non-invasive ventilation (NIV) service in my hospital. This was based on studies that showed it was possible to deliver this care on respiratory wards and to achieve a mortality rate of 10%.
Over the next decade, national audits showed that hospitals were not delivering the expected outcomes and mortality rates had more than doubled. The ‘Inspiring Change’ report published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in 2017 helped to identify how care needed to improve. As an author of that report, improving NIV care has been a priority of mine ever since.
I was really excited when the opportunity came up to organise a collaborative project to Improve NIV care, supported by the West of England AHSN and working with colleagues across all six of our acute hospitals locally. We had got together before to try to do this but we lacked the organisation and project management the AHSN has provided.
Together, we developed the NIV5 bundle based on the British Thoracic Society’s quality standards, and we are using quality improvement approaches and tools to ensure that the right support is given to clinicians implementing the bundle.
We set out to achieve a mortality rate of 10% (or better) that we know is possible. We are now halfway through the NIV5 project and it’s great to see the data coming in from all the hospitals, but we still need to do more work to reduce mortality rates.
The data can help us to identify areas where care can be improved. The areas that can improve outcomes are: using NIV only where it is appropriate, starting treatment rapidly, increasing ventilator pressures to improve ventilation, and repeating blood gases to measure the effectiveness of ventilation (and acting on the results). In addition, escalation plans provide clarity about what to do if treatment does not work. If all these things happen reliably, more patients will survive.
Acute NIV is provided by teams that include medical, nursing and physiotherapy staff. It is most often started in emergency departments and acute medical units and is often continued on the respiratory wards.
Now that the NIV5 bundle is in place in all of our hospitals, and data on our performance is being shared, we can use this to identify where improvements are needed. I’m still excited that we are working together on the NIV5. I’m also looking forward to seeing how much we can reduce mortality rates and therefore how many lives we can save by working together!
As we celebrate the 75th birthday of the NHS this year, our Chief Executive Natasha Swinscoe and Chair Steve West reflect on another milestone we are also marking here at the West of England AHSN.
It is ten years since England’s 15 Academic Health Science Networks (AHSNs) were first licensed by NHS England and we are immensely proud of all we have achieved in bringing innovation into the NHS at pace and scale over the last decade to benefit thousands of patients.
For the last decade, our vision has remained constant – to create a dynamic ecosystem for innovation in the West of England, founded on a collective approach to benefiting our local people.
In our new impact review we share case studies, exploring how we collaborate with colleagues from health and care, industry, research and academia, the voluntary and community sector, and with patients and the public, to drive innovation and new approaches at every stage of the pipeline.
Discover
At the ‘Discover’ stage of our innovation pipeline, we support colleagues to be curious, ask questions and share their experiences to help us all better understand what we want innovation to achieve. We have nurtured active collaboratives and networks, bringing together all those who really understand health and care challenges to articulate the needs.
We help our local health and care community to foster an innovation culture, ready to embrace and develop new technologies and ways of working.
And of course we also work closely with healthcare innovators at this stage, acting as a critical friend through our business development support to equip them with the skills and insights to enter health and care as a market place. Our online Innovation Exchange is designed to help innovators understand health and care challenges and connect innovators to the support they need.
We’ve also supported many system partners to evaluate innovations in real world settings, from our Black Maternity Matters pilot (trying out new approaches to reducing health inequalities faced by Black mothers) to the Domiciliary Care Workforce Programme (testing the potential of AI to transform planning for providers of domiciliary social and health care).
Deploy
Finally comes the all-important ‘Deploy’ stage where we’ve achieved significant success in exporting innovations developed here in the West further afield, such as PReCePT and the PERIPrem care bundle for premature babies (which is now being implemented in Wales), as well as ‘importing’ solutions from other parts of the country and through national programmes.
There can never be single blueprint for deployment, and from our case studies you’ll see how we work closely with healthcare providers to help them adapt their care pathways and practices to adopt innovative solutions, often using quality improvement (QI) methodologies.
We hope you agree we have much to celebrate in our tenth year. These achievements are credit not only to the AHSN staff team, but also to all those across the West of England health and care innovation community who have seized the opportunity to work with us to achieve our shared ambitions. And so to all of you, we say a heartfelt thank you.
We remain committed to championing and scaling the best healthcare innovations and will continue to support the NHS with its most pressing issues, including helping to deliver a Net Zero NHS by 2040, addressing health inequalities and improving patient safety. NHS England recently announced the AHSNs (under the new name of Health Innovation Networks) will be relicensed for a further five years, and so we look forward to continuing this work, and continuing to learn and grow together, in the coming years.
In August 2020, four nurses completed the West of England AHSN’s free RESTORE2 Train-the-Trainer learning to implement and embed RESTORE2 into Mortimer House Nursing Home. In this case study, nursing Clinical Lead, Lorna Hewlett, describes her experience of using RESTORE2 and the impact the tool has had on the home’s ability to effectively manage deteriorating residents. Mortimer House has 13 beds, with a team of four nurses and 19 support staff looking after residents.
Lorna, how did you come to embed RESTORE2 within your care home?
We heard about the AHSN’s RESTORE2 learning sessions through the Milestones Trust who were encouraging all homes to take up the offer of free training. All nurses completed the Train-the-Trainer session, and we now deliver training for all new starters, aiming to keep the training at 100%, despite a high turnover of staff. We have adapted the session to suit our local needs, deliver annual refresher training and even deliver sessions during the evening shift to also ensure that night workers are captured.
As a nursing team, we have found short, on the spot, training sessions to be particularly helpful, focussing on smaller and specific elements of RESTORE2. We have found that support workers are confident taking observations, but less confident in documenting the observations on the New Early Warning Score 2 (NEWS2) chart, so we have spent more time focusing on this.
What is the process for escalation in your care home?
After taking observations, if staff have any concerns about residents showing signs of deterioration, the support workers will contact the nurse who is on shift, who will retake observations. The nurse will either continue to monitor more frequently or escalate through the GP or 999 as appropriate. If the nurse is not available, the home manager, also trained in taking observations, will support the care worker to escalate the care. The nurse will be available to provide support where necessary, but the support worker takes the lead. All residents have a nursing plan folder which includes their ReSPECT form, RESTORE2, GP contact details and protocols which we can refer to.
If the support worker is unable to get hold of the nurse, they are now more confident in taking the initiative and starting the escalation process to ensure residents get the right help at the right time.
Additionally, support workers take residents observations at the beginning of every month to ensure that their baseline is up to date. These are recorded on the NEWS2 chart and are used if the resident becomes unwell during the course of that month.
Can you describe a time where RESTORE2 has been particularly helpful?
There have been many occasions, but there was one resident recently who the support worker recognised as being unwell as they were not eating or drinking, were very sleepy and looked pale. The support worker took the observations, and despite these being lower than expected, they followed NEWS2 guidance to contact the out of hours GP. The GP asked what we thought was appropriate, as we know the residents well, and it was agreed to send the patient to hospital where he was admitted immediately.
This admission was in line with the resident’s ReSPECT form; however this has now changed following a review after this latest admission.
Has Restore2 implementation made any impact at Mortimer House?
Prior to the RESTORE2 training, the support workers would frequently rely on the nurses which created a heavier workload for us. The support workers now contact us with more appropriate concerns, as they feel empowered to start the process of getting the right help for the resident. The SBAR (Situation, Background, Assessment, Recommendation) tool has been particularly helpful in giving support workers the confidence to speak to the GP. Their conversations are calmer, and they share all the relevant information with the GP.
It’s also helped the support workers to understand the physiology of the signs of deterioration. They feel that their role is more meaningful and feel empowered to get the additional support when needed for residents. They know the residents best and are best placed to identify when they are deteriorating. The refresher training is important as it helps them to stay competent and confident in their abilities. The more that they practice with the SBAR tool, the more they realise that they’ve got everything across in an efficient way.
RESTORE2 has added a quick ‘go-to’ to our toolkit as it provides an initial response to someone being unwell, which has allowed the team to escalate care if needed. That’s proved really useful for staff and residents.
Chris Learoyd is Senior Project Manager at the West of England AHSN, overseeing our medicines optimisation programmes. In this blog, Chris explores some of the work we are currently involved in to help reduce harm from medicines.
Medicines safety and improvement work is complex: patients are prescribed medicines in different settings across the entire healthcare system, by different healthcare professionals.
Naturally, this can create challenges with continuity of care and ensuring treatment remains effective, all whilst reducing harmful side effects. Due to advances in medical care, people are living longer with long-term conditions. This can result in people taking multiple medicines regularly for many years. Taking multiple medicines is also known as polypharmacy.
Taking multiple medicines can help support patients with multiple conditions. However, when these are not regularly reviewed, with unnecessary medicines removed, it can lead to adverse drug reactions.
In England in February 2022, there were 876,317 people on 10 or more medicines and 349,653 of these were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital.
Improving the continuity of care and reducing harm through more preventative approaches to healthcare is a core aim of the NHS Long Term Plan. There have been a number of medicine-related initiatives and services implemented in recent years to provide added ‘safety nets’ and improve system collaboration, including the Discharge Medicines Service, New Medicine Service, and incentives and guidance for Structured Medication Reviews (SMR).
These initiatives and services go some way to reducing the harm from medicines, but clinicians working with patients still face individual challenges addressing inappropriate polypharmacy, with clinicians often feeling isolated in their practice. This is where the national AHSN Network Polypharmacy programme and the West of England Polypharmacy Community of Practice aim to fill the gap.
Our Community of Practice (CoP) offers a safe space for clinicians to share their polypharmacy experiences, successes, and what they have learned from practice. It also highlights areas of common challenge: it’s inspiring to hear how a creative approach to problem-solving shared in a CoP can have a positive impact elsewhere.
The third CoP session held in February 2023 focused on ‘anti-cholinergic burden’. The discussions were fascinating, and they created a buzz amongst the attendees. I have been really inspired by the commitment and enthusiasm of the attendees and it’s been fantastic to see the CoP grow into a genuine space for learning.
A common challenge faced by CoP members is how to engage patients in meaningful and supportive conversations about reducing inappropriate polypharmacy.
Patient engagement in deprescribing is key to shared decision-making that supports the use of alternative treatment approaches and reduces over-reliance on medicines. This topic will be discussed in the next COP session on 15 June: if you’re interested, please do book your space and join us.
It’s recognised it will take time for patients and clinicians to fully adopt effective shared decision-making. To support clinicians gain confidence in carrying out structured medication reviews using shared decision-making processes, the AHSN Network has been delivering evidence-based Polypharmacy Action Learning Sets (known as ALS). Held over three morning sessions, these will continue regularly throughout 2023/24.
Aligning with this work, the West of England AHSN has been testing patient resources to support more open conversations about medicines. This cultural and behavioural change for patients and healthcare is fundamental in addressing polypharmacy, as recommended by the National Overprescribing Review Report, led by Dr Keith Ridge in September 2021.
Initial feedback from local testing has found it helped patients think about their medicines and what they needed to discuss during their medication review. This prompted a more meaningful conversation and increased patient confidence in discussing their medicines. Further testing is proposed for 2023/24, so watch this space for the findings.
Polypharmacy and the potential harm it can cause may not be new; however, working together is fundamental to address it.
To register an interest in the Polypharmacy Action Learning Set training or to discuss joining the region’s community of practice, please contact me at christopher.learoyd@nhs.net.
In this blog, project Clinical Lead and Respiratory Consultant at the Royal United Hospital Bath, Dr Rebecca Mason, looks forward to the launch of a new West of England collaborative to reduce mortality following non-invasive ventilation (NIV). A design and launch event is being held on 9 December. Here Rebecca explains more…
Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in type 2 (hypercapnic) respiratory failure. In 2000 a research study showed that effective NIV use reduced mortality in type 2 respiratory failure from 20 to 10% but by 2013 the British Thoracic Society (BTS) NIV audit had recorded that mortality rates had risen to 34% and change was needed.
These results prompted a 2017 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and ultimately the report entitled ‘Inspiring change’. This report focussed on patient selection and the standard of NIV care delivered in hospital trusts across the country and the results made for stark reading. In 2019, a BTS audit on adult NIV care reported the inpatient mortality rate was now 26%. This was an improvement on previous audits however mortality rates remained higher than in other countries.
The ‘Inspiring change’ report galvanized a group of South West Respiratory doctors, nurses and physiotherapists with a special interest in NIV to join together in October 2018 to establish a Quality Improvement (QI) network with the aim to drive change within their own trusts and across the region. Although enthusiastic and full of ideas, without the structure and support of a full QI team, and then with the arrival of the Covid pandemic, the group’s work halted.
However, I am extremely excited that with the fabulous support, structure and guidance of the West of England AHSN, and the enthusiasm of many NIV physicians, nurses, physiotherapists and AHPs across the South West, we have been able to reinvigorate this project.
This new pan-regional QI project will seek to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials.
I am really looking forward to working alongside my respiratory colleagues across the region and with the expert support of the AHSN to deliver this important and exciting QI project. With the hosting of our design and launch event on 9 December we’ll be stepping up activity, and as a first step gathering baseline data and agreeing our implementation plan.
