Impact review 2020-21: support for deteriorating patients

I am confident that the support provided by the AHSN at a time of crisis has positively contributed to the health and wellbeing of many of our citizens.

Susan Glanfield Ageing Well Programme Manager, NHS England and NHS Improvement - South West Region

Covid Oximetry@Home and virtual wards


patients supported by Covid Oximetry@home and virtual wards in the West

The future of this clinically led, digitally enabled programme has immense opportunity and we look forward to continuing to work with our AHSN colleagues in this very exciting space.

Emma Matthews Regional Community Development Lead, NHS England & NHS Improvement - South West

From November 2020, we supported our three integrated care systems with the rapid rollout of Covid Oximetry @home.

This ‘step-up’ pathway provides patients at risk with devices called pulse oximeters to safely self-monitor their condition at home. A decline in their condition can be quickly detected so that patients can be admitted to hospital where appropriate.

From January 2021, we also supported implementation of Covid virtual wards, ‘step-down’ pathways enabling people in hospital with Covid-related illness to return home safely as soon as possible.

By the end of March 2021 over 2,000 patients had been enrolled on these services across our region.

“The Covid Oximetry@Home and virtual wards programme was born out of the pandemic to assist people to be monitored at home who were Covid positive and were at risk of developing silent hypoxia,” explains Emma Matthews, Regional Community Development Lead for NHS England & NHS Improvement in the South West.

“The West of England AHSN clinical and programme leads enabled us to share learning and upscale the programme across the region at pace which supported frontline clinicians to work in new ways. This meant that people were empowered to stay at home and escalated to hospital only if needed. The future of this clinically led, digitally enabled programme has immense opportunity and we look forward to continuing to work with our AHSN colleagues in this very exciting space.”

Read more about Covid Oximetry@Home and virtual wards

 Training for care home staff

I cannot say how much I would recommend investing in this training. Staff will feel upskilled, more competent and I truly believe our use of RESTORE2 saved lives. I absolutely, 100% believe in RESTORE2 for all staff, residential and nursing.

Jacqui Croxford Care Home Manager, Darbyshire Care


care home staff attended our online RESTORE2 training


views of our short training videos for staff working in care homes supporting residents at risk of deterioration

Photo of Jamela

We were able to share our experiences, listening to what others have gone through. It really got you to think about what you would do.

Jamela Hoque Registered Manager, Victoria Court - talking about our RESTORE2 training for care homes

As part of the NHS response to Covid, we have been working to enhance the confidence of staff working in the community in detecting and responding to deterioration.

In collaboration with Health Education England and Wessex AHSN, we produced a series of short training videos to support staff working in care homes to care for residents who are at risk of deterioration. These have now been viewed over 250,000 times since launch in March 2020.

More than 1,600 staff from 215 care providers in the community have taken part in our free RESTORE2 online training programme. We offer this to all care homes in the West of England, including those for people with learning disabilities, domiciliary care and supported living providers. RESTORE2 is a tool that helps carers recognise signs of deterioration in health, measure physical observations and communicate their concerns to healthcare professionals.

Reflecting on our support for care homes during the last year, Susan Glanfield, Ageing Well Programme Manager for NHS England and NHS Improvement in the South West, said: “The AHSN responded quickly to our request to prioritise and scale up the support offer to care homes – with redevelopment of tools to suit the new virtual world, running training sessions on line instead of in person.

“This had significant impact in some of our vulnerable communities, such as homes supporting people with learning disabilities. I am confident that the support provided by the AHSN to this programme at a time of crisis has positively contributed to the health and wellbeing of many of our citizens.”

Erica Pryce, Rachel Baxter and Danielle Radcliffe all work for Wiltshire-based Whitehorse Care Trust, provider of residential and nursing care to adults with learning and physical disabilities, and have taken part in our RESTORE2 training. In the short video below, they share their experiences of how this training has supported the care they provide for their residents.

Find out more about our RESTORE2 training

Supporting emergency care planning with ReSPECT


ReSPECT forms on GP systems in the West


of our care home training delegates had used ReSPECT in an emergency situation

I can’t remember the last time I’ve had to flick through the notes of a deteriorating patient urgently searching for discussions about treatment escalation recommendations. Now I can just find the decisions easily at the front of the clinical records and give the patient the care that the team who knows them best, has agreed.

Hospital clinician

We have supported the adoption of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) across our three integrated care systems, providing a more standardised process of emergency care planning across the West of England.

ReSPECT is now fully embedded across Gloucestershire and Bristol, North Somerset and South Gloucestershire. Bath and North East Somerset, Swindon and Wiltshire plan to rollout ReSPECT from June 2021.

A key part of the region’s response to Covid-19, ReSPECT enabled our Network members to meet the demand for more end-of-life conversations and reduce the strain on staff.

Developed by the Resuscitation Council in collaboration with patients and their families, ReSPECT is a process to plan a person’s clinical care in the event of a future emergency when they might be unable to make or express choices. The personalised plan is created through conversations between a person and one or more health professionals involved in their care, as well as family members.

54% of people who attended our care homes training, which includes ReSPECT, said they had since used it in an emergency situation for a resident.

In March 2021, our ReSPECT programme was a finalist in the HSJ Awards in the System Leadership Initiative of the Year category.

The short animation below was co-designed by people involved in rolling out ReSPECT across our region. It tells the story of Joe and how his ReSPECT form improved communication and coordinated personalised, individualised care with different health and care professionals.

Find out more about ReSPECT

Scaling up remote monitoring across the South West

£3 million +

secured by the AHSNs in funding from NHSX to scale up use of remote monitoring

We partnered with the South West and Wessex AHSNs to support ambitious plans to work together as an entire health and care system to make best use of available technologies to support our most vulnerable residents.

Our Scaling Up Remote Monitoring programme is focused in particular on residents in care homes, those who live with frailty, and people with learning disabilities.

Find out more about our Remote Monitoring programme