Archives: Case studies

Case study

PreCiSSIon – Preventing Caesarean Birth SSI across the region

From November 2022 to March 2025, the PreCiSSIon programme successfully supported five acute maternity units in the West of England to achieve a 25% reduction in surgical site infection (SSI) rates following caesarean births by testing and reliably implementing evidence-based interventions at the time of surgery.

As most SSIs occur after patient discharge from hospital, digital SSI surveillance was established at 30 days using the standard UKHSA questionnaire in all trusts. The programme partnered with Cemplicity to digitalise and validate the questionnaire, which also collected mothers feedback, ethnicity and health inequality data. A blueprint has been created for spread to other trusts and other types of surgery.

Once surveillance was established a PreCiSSIon bundle was implemented. This complements the existing World Health Organisation (WHO) SSI bundle, already reliably in use in the five trusts to reduce infections. This consists of:

  • antibiotics within an hour of skin incision
  • maintenance of patients’ temperature
  • glucose control in diabetics
  • shaving with clippers if required.

The PreCiSSIon bundle contains further evidenced-based, non-costly interventions:

  • Skin preparation with 2% chlorhexidine, allowing two minutes drying time
  • Abdominal wall sheath and skin closure with antimicrobial triclosan coated sutures
  • Use of a wound protector for mothers with a body mass index (BMI) over 40 at time of booking
  • Repeat dose of antibiotics if more than 1500ml blood loss.

The programme collected information on over 9,300 women and enabled quantification of specific risk factors, and the ability to add further interventions specifically targeted to the higher risk mothers.

The programme resulted in reduced SSI rates in all five trusts with reduced inter-trust variation. This has improved outcomes for mothers and resulted in financial and sustainability cost savings.

The challenge

Surgical site infection (SSI) is a wound infection following an invasive surgical procedure. SSIs are the third commonest healthcare associated infection (HCAI), accounting for 14.5% of all HCAI in the UK, with increased associated costs of up to 226%.

Caesarean birth is the commonest abdominal surgical procedure, with rates increasing globally and in the UK from 29% to 40% over the last 10 years, resulting in around ¼ million women having a caesarean in 2023/24.

SSIs can have a huge impact on the recovery of mothers after caesarean birth, causing pain and immobility, decreasing their ability to look after their child/ren, as well as occasionally requiring readmission and further surgery. The need for antibiotics can affect breastfeeding and bonding with their newborn. In addition, scarring following infection can increase complications of any future caesareans, often required in subsequent pregnancies. Increasing use of antibiotics is also a national issue in terms of antimicrobial resistance and considered a ‘major public health concern’. Preventing infection will result in decrease in antimicrobial use, supporting measures to improve antimicrobial stewardship.

However, as there is no national mandate for SSI surveillance, most hospitals are unaware of their caesarean SSI rates. In addition, most SSI occur between seven and 14 days after surgery and mothers only spend one or two days in hospital, so SSIs occur in the community, and the full impact is not seen without recording post discharge surveillance.

SSI rates of up to 20% have been reported, with local spot audits indicating SSI rates of up to 18%. A rate of 18% nationally would equate to over 40,000 women having an SSI across the UK. Health Innovation West of England identified the need for continuous 30-day surveillance, which would enable a collaborative preventative improvement programme.

Our approach

Health Innovation West of England developed and led the implementation of PreCiSSIon, supporting five maternity units to introduce the care bundle, using the IHI collaborative approach, underpinned by quality improvement (QI) methodology and coaching.

The national UKHSA questionnaire collecting 30-day patient reported measures is a validated standard measure for SSI. Due to the numbers of mothers having a caesarean birth it is challenging for trusts to collect 30-day infection rates without a digital solution. Health Innovation West of England partnered with Cemplicity to digitise the standard UKHSA tool, gradually introducing the digital solution over three months. This enabled trusts to send mothers a digital questionnaire, making it easier to provide feedback following surgery.

Cemplicity is used globally to capture, measure, and improve patient reported experience (PREMs) and outcome measures (PROMs). The system developed for PreCiSSIon delivered the questionnaire to patients 30 days post caesarean birth and was integrated with electronic health records. This required collaborative meetings between clinical, business intelligence and IT teams across five hospitals, coordinated by Health Innovation West of England, who provided support to complete information governance agreements.

Once surveillance was established and at least four months baseline SSI rates collected, each trust implemented the bundle. Regular meetings were held to share learning and support. Health Innovation West of England project leads met with trust leadership teams, increasing visibility and prioritisation of the work.

Health Innovation West of England supported ongoing data analysis, identifying risk factors so that specific interventions could be targeted and tracked.

The data showed that women with a higher BMI at booking have an increased risk of SSI, and so a specific dressing intervention was able to be tested in this group and its effect tracked due to the robust SSI monitoring.

Impacts to date

“Working on this project is an excellent opportunity to learn more about the multidisciplinary team’s role in introducing and sustaining change. Using Cemplicity has enabled us to gather previously unseen data on the clinical iceberg that is post-caesarean wound infections and shine a light on the morbidity they cause. The rich information gathered has been enormously motivating to the team.”

Obstetric Lead 

SSI surveillance was successfully established across the West of England from November 2022 to March 2025, allowing analysis of data from over 9,300 women.

Across the region, SSI rates following caesarean births fell from a baseline of 18.5% to 13.3% by March 2025.

The reduction in SSI can be equated to preventing 364 mothers from developing an SSI, the unpleasant side effects associated, and requiring antibiotics. This represents an estimated cost saving to the NHS of up to £1.3 million and supports antimicrobial stewardship and sustainability savings from dressing and care visits.

PreCiSSIon has been presented at the SSI Network in London, infection control conferences in Northumberland and Amsterdam and a specific webinar to over 100 people in 2024, as well as poster presentations at the Royal College of Obstetricians and Gynaecologists World Congress 2025.

PreCiSSIon leads have collaborated with a health economist and submitted a cost evaluation paper to the International Journal of Infection Control and are currently finalising a paper on the SSI surveillance and risk factor analysis and another on the preventative programme.

PReCiSSIon received a Bronze Award at the HSJ Partnership Awards in 2024 for the collaborative work with Cemplicity and was also a finalist in the HSJ Digital Awards 2025 in the Driving Change through Data and Analytics category. It has been shortlisted for the HSJ Awards 2025 in two categories: Data-driven Transformation and Patient Safety.

“It’s great to see how the PreCiSSIon programme is really making a positive impact. We’ve loved being part of this programme, helping to reduce SSIs after caesarean births and support safer experiences for mothers and families.”
Josh Farrell-Evans, Senior Account Manager, Cemplicity

Patient and Public Involvement and Engagement

The PreCiSSIon team collaborated with the local Maternity & Neonatal Voices Partnership to create the digital questionnaire, resulting in the addition of a specific ethnicity question. Ethnicity was also included in the data extract from hospital systems, and analysis showed that this information is poorly collected within hospital systems and was much more robust in the questionnaire responses.

The PreCiSSIon teams also collaborated with mothers and the Maternity & Neonatal Voices Partnership to develop a wound information leaflet before the PreCiSSIon implementation, but feedback through the SSI dashboard identified that this was still not enough. This feedback resulted in production of a simple video help improve patient experience.

Questions were also added to the questionnaire regarding the specific dressing for the higher BMI mothers, and this response from mothers provided reassurance that it was being used correctly, as it needs to remain on for seven days to be effective. This information would have been very difficult for teams to obtain themselves. Other feedback about the dressing enabled concerns and issues to be addressed in a timely manner.

The Maternity & Neonatal Voices Partnership were invited to collaborative meetings and results shared with them.

Spread and adoption

This is the second SSI bundle supported by Health Innovation West of England. A previous iteration of PreciSSIon had been developed at North Bristol NHS Trust and focused on reducing SSIs following elective colorectal surgery. This first version of PReciSSIon was a successful applicant to Health Innovation West of England’s ‘Evidence into Practice’ call back in 2019.

Health Innovation West of England supported the rollout of this care bundle to all hospital trusts across the region, which resulted in a 50% reduction in SSI rate after elective colorectal surgery.

The PreCiSSIon programme focusing on reducing SSIs following caesarean births built on and learned lessons from the success of the earlier SSI initiative. PreCiSSIon has been spread to five units in the West of England with the sixth unit planning implementation.

Developing a blueprint for a digital national 30-day SSI questionnaire will ease establishment of SSI surveillance following caesarean births in other trusts and following other surgical procedures.

The work has been presented nationally and internationally to support spread and publication is planned. Evidence into Practice has become a successful model for Health Innovation West of England to spread evidence-based innovations across the region. Other innovations supported by the Evidence into Practice approach to date include PReCePT, PERIPrem, SHarED and most recently HOME, with many of these going on to be spread more widely across the country.

The Evidence into Practice programme identifies innovations that have been developed in a single site, which demonstrate the potential for achieving significant health benefits if adopted across the wider region. Successful applicants to the programme receive free advice, project management, quality improvement, communications and evaluation support for the rollout of their innovation to multiple sites across the West of England.

Next steps

The PreCiSSIon programme ended in March 2025, and a final evaluation of the surveillance data is expected in December 2025.

Three trusts are continuing with SSI surveillance using Cemplicity, and are collaborating on further interventions to reduce SSI. Another trust is planning implementation of digital surveillance to support its infection control team and save valuable staff time, and another is reviewing implementation for colorectal surgery.

The dressing intervention for high BMI mothers was expensive, and agreement to test it was achieved due to the robust SSI surveillance in place, enabling tracking its effect, so the project has added to the real-world evidence for this expensive dressing. The dressing had less impact than expected for the expense, so use has paused in most hospitals, and the three trusts with continued SSI surveillance are testing another NICE recommended cheaper dressing for use in all mothers. Results should be available from February 2026.

A cost evaluation paper, written collaboratively with a health economist, has been submitted to the International Journal of Infection Control and two further papers are being prepared on PreCiSSIon for submission to journals by the end of December 2025.

Further analysis of the patient feedback is being reviewed with the Cemplicity analysis for other themes.

Analysis of the inequality data identified lower response rates in the lower socioeconomic groups, and using this data may enable further insights into this group and support further work in this area.

The Cemplicity lead has been in discussions with teams in New Zealand and Australia, and has asked for Health Innovation West of England support in sharing our work with these teams.

Anya

Anya is a pregnancy, parenting and breastfeeding support app which utilises cutting-edge 3D interactive technology and Artificial Intelligence (AI) to provide parents and parents-to-be with vital support on their parenting and breastfeeding journey.

With our support and expertise Anya has grown from an early-stage business idea to an NHS-ready product. Its founder, Dr Chen Mao Davies, was named as an NHS Innovation Accelerator Fellow in 2023 and as ‘one of the top 40 female innovators in the UK’ by Innovate UK in 2021.

Since 2019, Anya has secured £365,000 in grant funding, £510,000 in loans and £500,000 in equity investment – and has now grown to a team of eight employees. In 2022 the company won £100,000 of SBRI funding to tackle health inequalities in maternity care.

The app (iOS and Android) is now available to more than 4.3 million NHS service users.

Early user studies indicate that over 70% of mothers increased their breastfeeding confidence and skills in just four weeks of using the app. With a 100% increase of mothers breastfeeding their babies at six weeks postnatally, compared with the national average.

The challenge

The UK has the lowest breastfeeding rate in the world. Sadly, 90% of mothers give up before they want to, due to lack of support, pain/health issues, and feelings of isolation and depression. Difficulties in achieving a good latch can lead to breast infections, baby weight loss and postpartum depression. This costs the NHS £50 million a year on excess appointments for babies fed on formula milk, who are more prone to illness.

Our approach

Using smart technology, the Anya app provides parents and parents-to-be with vital support during the first 1,001 days of their parenting and breastfeeding journey. It delivers trusted, accurate and evidence-based information with two unique features:

  • LatchAid™, a 3D animation breastfeeding support tool, using cutting-edge interactive technology to learn skills intuitively.
  • Anya AI, the bespoke virtual supporter, providing information 24/7, for those times when it’s just not possible to get help or answers.

Developed alongside the country’s leading infant feeding experts, the app was originally designed to address issues associated with difficulties in breastfeeding, for parents who are having problems getting their baby to latch. An avatar provides visual demonstrations of vital breastfeeding skills, such as how the baby should take the mother’s areola into his / her mouth, achieving a ‘deep latch’ that prevents damage to the breast.

The app also allows users to join webinars and interact with Anya AI (the app’s chatbox) and lactation consultants to ask questions, as well as connect with other parents in a virtual peer-to-peer support group.

Developed by Dr Chen Mao Davies after experiencing huge breastfeeding challenges herself, Anya (originally launched as LatchAid) began its innovation journey on our Health Innovation Programme (HIP) in 2018. Here she was able to test the validity of her early-stage business proposition with experts and learn how to navigate a very complex healthcare landscape and pitch her ideas into the NHS.

In this short video, Anya’s Founder, Dr Chen Mao Davies, talks about why she created the app.  You can watch it here or below.

 

Since graduating from the HIP, we have continued to support Chen and the company on its healthcare innovation journey, in order to develop the app towards market-readiness.  Our support has included:

  • Providing ongoing insight and guidance into the NHS as a marketplace.
  • Acting as a critical friend around commissioning and procurement.
  • Brokering introductions to key contacts – connecting Chen to NHS maternity services and commissioners across the West of England region and beyond.
  • Funding an expediated ORCHA Review to assess the quality of the product for listing in the ORCHA digital library.
  • Identifying / presenting appropriate opportunities for funding and acceleration and reviewing and steering applications. Successful applications include:
    • Innovate UK Women in Innovation Award (2021), securing a £50,000 grant and support package.
    • SBRI Healthcare competition to address health inequalities in maternity care (2022), securing £100,000 of Phase 1 feasibility funding. This enabled a rebuild of the app, engaging service users in the co-design and co-creation of its features. The Gen 2.0 Anya app (available in both iOS and Android) was launched in December 2022, housing LatchAid as its upgraded, 3D breastfeeding tool – which now has additional skin tone capability for mother and baby.
    • NHS Innovation Accelerator (2023), securing fellowship to enhance credibility and help Anya achieve wide scale deployment across the NHS.
  • Supporting with the design of the evaluation framework for a four-month NHS pilot across 12 NHS Trusts and VirginCare (Health Innovation Wessex- 2021).
  • Supporting a real-world evaluation with Gloucestershire Local Maternity and Neonatal System.

In the following short video, Chen talks about the support she has received from the Health Innovation West of England. You can watch it here or below.

 

“I learned a huge amount in the HIP bootcamp training and was able to share my business ideas with fellow innovators, present my business proposition to a panel of experts and start building relationships with a network of experts and fellow entrepreneurs. Since then, I have continued to receive ongoing support from Health Innovation West of England with regards to funding opportunities, application reviews, pilot evaluations and connecting me to NHS maternity services and commissioners. I definitely would not be where I am now without the help of Health Innovation West of England.”

Dr Chen Mao Davies, Founder/CEO of Anya and HIP graduate 2018

Impacts to date

Economic impact

To date and with our support, Anya has been awarded over £365,000 grant funding from Innovate UK, EU, UnLtd, the NHS and SBRI, including three Innovate UK grants totaling over £190,000 and, most recently, £100,000 of SBRI funding to tackle health inequalities in maternity care.

Since 2019, the company has secured one Innovate UK loan totaling £510,000 and £500,000 in equity investment.

The team has now grown to a team of eight employees (an increase from two employees in early 2022).

Patient and health care provider impact

In partnership with 12 NHS trusts and VirginCare, a four-month pilot project from October 2021 saw the Anya app prescribed for free to 5,000 families, as part of their infant feeding support. Infant feeding experts, midwives and health visitors were able to prescribe Anya for free to all new parents (iOS users) in participating regions. Read more here.

In 2022, Anya secured four contracts from NHS and NHS Providers, covering a population of 2 million.

Early user studies indicate that over 70% of mothers increased their breastfeeding confidence and skills in just four weeks. 96% of mothers using the app are breastfeeding their babies at six weeks (compared with the national UK average of 48%) – an increase of 100%.

In May 2025 we published the findings of our real-world evaluation of Anya with Gloucestershire Local Maternity and Neonatal System, who piloted the app with 500 women in two of the county’s more deprived districts, the Forest of Dean and Gloucester, where breastfeeding rates were the lowest in the county. The real-world evaluation concluded that Anya is an acceptable and promising digital tool for breastfeeding support. While further research is needed to assess long-term outcomes and cost-effectiveness, early findings support the integration of smartphone apps like Anya into broader perinatal care pathways. Read the full evaluation report here.

The Anya app now has users in 95 countries.

The Anya app (iOS and Android) is now available to more than 4.3 million NHS service users.

“Put this app on your phone, it’s the closest thing you’re going to have to a Lactation Consultant or a peer supporter in your pocket.” 

Emma, a breastfeeding mother

“Just to have that instant support, all hours of the night. Amazing”.

Breastfeeding mother

“I have used the app with colleagues who have found it really useful. They enjoy the 3D effect and the ability to view things from different angles.”

Amanda, NHS Health Visitor

Other impacts

In 2021, Chen was recognised as a ‘42 under 42’ rising star by South West Business Insider magazine.

She was also named as ‘one of the top 40 female innovators in the UK’ by Innovate UK and awarded a ‘Women in Innovation Award 2021’ with £50,000 of funding. You can read more about this here.

In August 2021, Anya launched its LatchAid iOS app in the Apple App store, which was followed by the launch of its Android app in the Google Play Store in November 2022.  In January 2023 the app rebranded from LatchAid to Anya. The Anya app (iOS and Android) now has users in 95 countries.

Anya is the number one best breastfeeding support app in the ORCHA digital library.

With a growing media presence, Chen and her innovation have been featured in more than 70 press articles and interviews to date, including BBC News and Sky News.  Watch the BBC News video here or below:

Next steps

We will continue to work with the Anya team to:

  • Review outcomes/outputs from pilots
  • Understand any gaps in evidence base (and explore further evidence generation support)
  • Review and provide feedback on NHS business case
  • Continue to broker NHS relationships within the region.

We are now also working with Gloucestershire’s Local Maternity and Neonatal System (LMNS) on a ‘proof of value’ project to address healthcare inequalities in the region – implementing and evaluating the use of the Anya app to support communities who would not normally take up breastfeeding. You can read more about this work here.

Find out more about our Health Innovation Programme here.

Find out more about Anya here. For further information you can email hello@latchaid.com or Alex Leach, Deputy Director, Health Innovation West of England at alex.leach@nhs.net.

Black Maternity Matters

The Black Maternity Matters programme is a collaboration aimed at reducing inequitable maternity outcomes faced by Black mothers and their babies, supporting perinatal teams to offer safer, equitable care.

The six-month programme delivers in-depth, anti-racist training to multidisciplinary clinicians and senior leaders within the West of England. This training is delivered through in-person sessions and is supplemented by book clubs to embed learning.

A key component involves encouraging participants to develop quality improvement (QI) projects to transform perinatal services. The programme also fosters an ongoing community for continued learning and support.

On-going evaluation of the programme demonstrates increased awareness, knowledge, and skills associated with anti-racist competency among maternity and neonatal staff. Participants report feeling more confident in talking about racism and its impacts and demonstrate a greater willingness to intervene against discriminatory behaviour.

The programme’s approach is described as transformational, focusing on anti-racist action to address racism within NHS systems.

By the end of 2025, 10 perinatal cohorts across the three local maternity and neonatal systems in the West of England and three cohorts of senior leaders will have completed the Black Maternity Matters programme. That’s 300+ graduates – and counting.

Ann Remmers, Maternity and Neonatal Clinical Lead, Health Innovation West of England, said: “Everybody that comes on the Black Maternity Matters programme… I’m doing it myself at the moment. I’m currently one of the participants and it is a total transformation. You are learning so much and you’re unlearning a lot as well.”

The challenge

Black Maternity Matters has been designed to help tackle the significant and unacceptable disparities in maternal health outcomes faced by Black mothers and their babies in the UK.

Specifically, the programme addresses the fact that Black women are four times more likely to die during pregnancy or in the postnatal period than White women, while stillbirth rates for Black babies are over twice those for White babies. This is a major patient safety issue.

These poor outcomes, including higher mortality, stillbirth rates, traumatic births, and poor perinatal mental health, are linked to a “constellation of biases” and systemic racism within NHS systems.

Black Maternity Matters aims to confront these inequalities by providing anti-racist training and support to perinatal staff, empowering them to deliver safer, more equitable care and ultimately reduce these life-threatening disparities.

Our approach

Health Innovation West of England (HIWE) has played a vital role in both the development and delivery of the Black Maternity Matters programme.

In 2021, Health Innovation West of England established the Black Maternity Matters collaborative with Representation Matters, BCohCo and Black Mothers Matter.

Through engagement with community-based organisations and activists in Bristol, HIWE identified the shocking inequity of outcomes faced by Black families as an urgent patient safety issue, requiring a strategic and sustained response.

HIWE recognised the opportunity to take advantage of its privileged position to broker relationships across different sectors, bringing together the experts with lived experience to design a solution with health and care professionals.

The collaborative has coproduced the Black Maternity Matters training and education programme, with HIWE leading on the quality improvement aspects, as well as providing project management, organisational and communications expertise.

Furthermore, HIWE is responsible for evaluating the programme’s impact and progress. They also secured funding for the initial pilot from the Health Foundation and are now working to formalise the programme’s work into an actionable framework with the NHS Race and Health Observatory.

Hear Sonah Paton of Black Mothers Matter talk about the support from HIWE.

Impacts to date

Black Maternity Matters’ unique anti-racist approach is demonstrating a significant impact in several areas.

Evaluation of the pilot phase showed a successful increase in the cultural competency of maternity staff, evidenced by participant feedback and resulting actions. Participants increased their understanding of how racism impacts health inequalities and were able to transfer this knowledge to their work context. The programme has been described as ground-breaking and influencing real behaviour change.

The evaluation of the second cohort further supports these findings, demonstrating increased knowledge, skills, and confidence for maternity and neonatal staff to understand the impacts of racism.

Staff reported an increased ability to implement anti-racist practice and felt more motivated and psychologically able to do so. The training has empowered staff to have better conversations about racism with colleagues and patients and to initiate change within their practice. There is also evidence of an increase in staff reporting they would intervene if they saw racist or discriminatory behaviour and being actively involved in anti-racist initiatives.

Each cohort undergoes thorough evaluation, with improvements implemented in subsequent rollouts. In 2025, the evaluation focus is being expanded to include a rigorous analysis of clinical indicators for women and babies racialised as Black.

Maria Kane, Joint Chief Executive of North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust, commented: “This course turned my life upside down. I was overwhelmed but engaged.”

Health and care system success

The Black Maternity Matters programme has evolved iteratively in response to learning and insights gathered from participants and course leaders during each phase.

In 2024 a specific cohort for senior leaders was introduced, recognising that healthcare professionals are limited to how much change they can activate without senior leadership advocacy. This includes but is not limited to chief executives, chief nursing officers, medical directors, heads of midwifery, and integrated care board (ICB) leads.

This element of the programme has been a gamechanger for Black Maternity Matters in catalysing wider cultural ‘acceptance’ and a broader understanding of the need for an anti-racist approach and methodology to achieving long-term change.

As a result of senior leaders attending the programme, a bespoke version of the Black Maternity Matters model is now being delivered by the collaborative for all staff at North Bristol NHS Trust as part of a wider package of commitments to tackling institutional racism with their organisations.

Listen to senior NHS leaders’ talk about how Black Maternity Matters has impacted them both personally and professionally, and how they are taking this learning back to their organisations and networks.

Steve Hams, Chief Nursing Officer, North Bristol NHS Trust, said: “This has been the most transformative six months. It’s an immersive programme where you truly get to experience what it’s like.”

Patient and Public Involvement and Engagement 

Patient and public involvement and engagement is integral to Black Maternity Matters. It is not just a token gesture but is embedded through active partnerships with community organisations like Black Mothers Matter and Maternity Voices Partnerships, a commitment to centring lived experiences, and a reliance on the expertise and insights of people racialised as Black to inform the programme’s development and delivery.

The programme’s foundation is rooted in the lived experiences and concerns of the Black community, inspired by the vision of one its founding members that one day Black mothers will no longer be disproportionately in danger during pregnancy and the first year after birth.

The Black Maternity Matters collaborative includes community organisations, whose leadership and active involvement ensures that the programme is informed by the perspectives and needs of Black mothers.

Recognition of the need for a sustained, anti-racist approach came from an understanding articulated by community partners that traditional approaches to equity, diversity, and inclusion training are insufficient and do not translate into tangible improvements. This is why Black Maternity Matters actively seeks and values the expertise and insights of organisations representing Black mothers in shaping its approach.

Aisha Thomas, Educator, Representation Matters, commented: “It hasn’t been about tick box exercises. It hasn’t been about painting by numbers and putting people in front of a computer screen. It’s been about holding people. It’s been about honesty. It’s been about connection and it’s been about changing people’s lives.”

Spread and adoption methodology used

There has been a great interest in the work of the Black Maternity Matters collaborative from outside of the West of England and avenues for wider spread and adoption are currently being explored.

HIWE is currently working with the NHS Race and Health Observatory to formalise the wide range of work into key themes and an actionable framework. This formalisation could create a structure and guidance that would facilitate adoption by other regions or organisations.

How to spread and adopt the Black Maternity Matters model so as not to lose its essential components is likely to prove one of the most innovative aspects of this programme, and it is likely that further pilots in other parts of the country will be required as a series of tests of change.

The success of the programme to date is largely attributable to its collaborative approach, with the Health Innovation Network working in close partnership with local community organisations and anti-racist educational experts. This partnership model, where different organisations bring their expertise, as well as an understanding of local geographies and communities, will need to be considered as a transferable element for wider adoption.

Next steps

The collaborative is continuing to deliver Black Maternity Matters across the West of England. During 2025 they will carry out a comprehensive evaluation of the impact on women and families’ experiences and outcomes.

There has been a great interest in this work from other parts of the country and avenues for wider spread and adoption are being explored.

The success of Black Maternity Matters to date was recognised at the Black Maternal Health Awards in March 2025, where the collaborative won the award for community project impact.

Based on the success of the PERIPrem care bundle for preterm babies, Health Innovation West of England is now also developing a clinical perinatal anti-racism bundle to optimise outcomes and experiences for women and babies racialised as Black.

Managing high cholesterol in patients who have had a cardiac event

It is recognised that treating high cholesterol can reduce a patient’s chances of having a cardiac event such as a heart attack or stroke) by around 23%.

Health Innovation West of England worked with One Care, the GP federation for Bristol, North Somerset and South Gloucestershire (BNSSG), and five primary care networks (PCNs) in the wider Bristol area to deliver an innovative project focused on encouraging patients who have had a cardiac event to get their cholesterol reviewed.

Primary care practices were supported to use case finding tools developed by UCL Partners (UCLP) – to identify high risk patients and invite them for a review.  Most practices delivered this through their clinical pharmacists, while in one PCN it was delivered by GPs alongside their routine caseload.

Health Innovation West of England provided targeted training to support clinicians to manage patients in line with NICE lipid management pathway national guidance.

Findings show the project has had a positive impact for both patients and clinicians, and has identified useful insights and considerations for similar future projects.

Anil Singh, Senior PCN Pharmacist: “The collaborative lipid project really helped our Pharmacists and Pharmacy Technicians focus their efforts on reducing cardiovascular disease. As a result, not only do we have better patient care and medication compliance but a much greater understanding within our PCN”.

The challenge

Cardiovascular disease (CVD) is a general term for conditions affecting the heart and blood vessels and causes 25% of all deaths in England. CVD is also a health inequalities issue and is the largest contributor to unfair and avoidable differences in health across the population, with people living in the most deprived communities (areas of low income, employment, education etc) having poorer health outcomes than the least deprived communities.

High cholesterol (also known as high lipids) is when you have too much fatty substance called cholesterol in your blood and is recognised as a significant risk factor for developing CVD.  It is known that, for every 1mmol/L reduction in low density lipoprotein cholesterol (LDL-C), the risk of  patients having a cardiovascular event is reduced by around 23%.

Five PCNs across the wider Bristol area were identified by Health Innovation West of England, One Care and the BNSSG Integrated Care Board (ICB) as requiring targeted support. These were situated within deprived communities known to have poorer health outcomes and in need of improving cholesterol management for their patients.

Our approach

NHS England and Novartis Pharmaceuticals made the Collaborative Lipid Fund available to Health Innovation Networks in early 2023 to deliver projects that improve lipid management.

Health Innovation West of England used this funding to support GP practices within the five identified PCNs to run searches within their patient records to identify patients who had had a cardiac event (heart attack/stroke) and had high cholesterol.

These searches were undertaken using specific case finding tools known as UCLP proactive care frameworks, which also categorised patients into four priority groups:

  • 1.Patients not currently taking statins to manage high cholesterol
  • 2a. Patients taking a statin, but not the best one for their needs
  • 2b. Patients taking a statin, but not on the right dose for full effectiveness
  • 3. Patients with a non-high-density lipoprotein (HDL) blood test of higher than 2.5 even whilst on the strongest statin dose they can tolerate.

Groups 1 and 3 were targeted for this project and the overall target population was above 4,600 patients.

In four out of five PCNs, clinical pharmacists led and delivered this project by reviewing and managing patients. In the other PCN this was delivered by GPs alongside their routine caseload.

Health Innovation West of England worked with practices to provide targeted training webinars, supporting clinicians to manage patients in line with NICE lipid management pathway national guidance.

One Care collected data throughout OneCare CIC to assess the project impact.

Clinicians involved in the project received the following positive, patient feedback:

  • “Thank you so much for looking after me and making sure I stay healthy.”
  • “I didn’t realise how important this [diet & lifestyle] is at my age [40s]. Thank you for all the information and your help.”
  • “I had no idea my risks are so high. Thank you for keeping me safe.”

Impacts to date

  • Data demonstrated an increase in the number of patients who were reviewed as part of this project.

  • Throughout the course of the project over 56,000 contacts were made with these patients, including text messages, telephone calls and face-to-face appointments.
  • Key learning has been gained from this project that will help shape future projects in similar areas delivered by Health Innovation West of England.
  • Greater PCN understanding of lipid management.

The following longer-term impacts would be expected as a result of improved lipid management:

  • Reduced CVD events/complications.
  • Reduced hospital admissions.
  • Improved health outcome and life expectancy.
  • Reduced lipid health inequalities.

This project started in January 2024 and ended on the 31 October 2024. Evaluation started in November 2024 and the final report was submitted to our national colleagues at the end of December 2024, this will be published in due course.

To find out more, contact Amy Bowden, Senior Project Manager on Amy.bowden4@nhs.net or view our Cardiovascular Disease webpage.

Transforming how we monitor and diagnose health through in-ear innovation

Bristol-based EarSwitch is paving the way for a new era of healthcare with its groundbreaking EarMetrics technology. By leveraging the power of the ear canal, EarSwitch aims to enable accurate, inclusive, and accessible medical monitoring solutions.

Supported by Health Innovation West of England and  Invest Bristol & Bath, EarSwitch is harnessing the region’s life sciences ecosystem for growth.

Baroness Merron, Parliamentary Under-Secretary of State at the Department of Health and Social Care, at the Innovative Devices (IDAP) Expo 2024, said: “It is shameful that in modern Britain, the colour of your skin, or where you’re born can define the quality of healthcare you receive. So, I was delighted to find out about the Earmetrics Oximeter, which has been developed by Earswitch, and included on the IDAP pilot.

“Oximeters usually take oxygen readings from people’s fingertips. But higher levels of melanin can disrupt everyday oximeters, giving wrong readings to people with darker skin tones. The ear-oximeter takes the reading from inside the ear, so it removes this risk, and eliminates the disparity.

“I know that with every new technology comes a risk of exacerbating inequalities, as some people benefit from a postcode lottery of innovation, and others miss out. I’m interested in technologies that make our NHS fairer. Narrowing, not widening this gap.”

The challenge

Dr Nick Gompertz has had 30 years’ experience as an NHS doctor, achieving Membership of the Royal College of Physicians and subsequently spending 21 years as a GP. Using that experience, Nick developed EarMetrics to provide better medical monitoring for all; to resolve the racial inequity of finger oximetry and improve the accuracy and usability of all standard medical monitoring devices. EarMetrics evolved from Nick’s initial Communication EarSwitch earbuds which are currently starting clinical trials to help people with motor neurone disease (MND or ‘Locked in syndrome’), cerebral palsy and other neurological impairments better communicate.

Traditional finger pulse oximeters are life saving devices used across healthcare to provide vital information to support clinical decision making via the measurement of oxygen saturation in the blood. However, most pulse oximeters are accurate to within 2% to 4% of the actual blood oxygen saturation level. This means that a pulse oximeter reading may be anywhere from 2% to 4% higher or lower than the actual oxygen level in arterial blood.

A number of factors can impair the functioning or accuracy of a pulse oximeter. Nail polish and artificial nails may block the red and infrared light emitted by the device. Excessive motion—shivering, shaking, or other movement—can also cause erroneous readings

Pulse oximetry can be less accurate for people who have dark skin pigmentation. Evidence is also building that shows that pulse oximetry more frequently fails to detect hypoxemia—low blood oxygen levels—in people with darker skin tones as compared to white patients because of the way light interacts with melanin.

​This means that Black people are up to three times more likely to receive inadequate oxygen based on inaccurate readings from the very device that is meant to monitor their vitals. Traditional oximeters have been shown to overestimate oxygen saturation by up to 4% in black and brown skin, on top of the known inaccuracies of the devices more generally.

This discrepancy is the difference between staying in hospital on oxygen therapy or being discharged and sent home.

Aisha Alexander, Paediatric trainee and NHS Clinical Entrepreneur, said: “During a panel session Nick presented his innovation which aims to deliver accurate and equitable patient monitoring through ear metrics. We were shown data on how inequality is built into healthcare through the very technology we use on a daily basis and heard stories of the impact this has had on patients’ lives the world over. I thought about all the young black patients I watched dying in front of me on a daily basis in Intensive Care in the first wave of the pandemic, I still remember most of their names, and wondered “what if?”. I thought about every child with black and brown skin I’ve treated as a paediatric trainee with sickle cell, bronchiolitis or croup who deteriorated unexpectedly and wondered “could the bias and inaccuracy of the technology we treat as gospel adversely affect these patients?

“I am genuinely so thankful to be on a programme that means I get to meet such incredible people who are changing the face of healthcare for the better through innovation and collaboration.”

Our approach

Watch our short video to find out how we have been working with Dr Nick Gompertz to develop EarSwitch.

Health Innovation West of England has supported EarSwitch over the last three years by brokering a three-year productive relationship with the Health Tech Hub at the University of West of England, Bristol, with additional access to smaller local grants by providing prototyping and CAD (Computer Aided Design) modelling for example, to match-making a local investor to successfully apply for and gain a UK Research and Innovation (UKRI) Healthy Aging grant – part of a five-year programme to help people remain active, productive, independent and socially connected across generations for as long as possible.

As the technology gets closer to launch, we will continue to support the company to refine its value proposition, seek funding and grants and gain evidence to support commercial licensing discussions and opportunities to collaborate with the wider healthcare community.

Nick is also supported by the Clinical Entrepreneur Programme, a workforce development programme for clinical and non-clinical NHS staff, run by NHS England’s Innovation, Research, Life Sciences and Strategy team and delivered jointly with Anglia Ruskin University. This programme has also supported Earswitch to develop the commercial skills, knowledge and experience needed to successfully develop and spread innovative solutions to the challenges facing the NHS for the benefit of patients, staff and the wider NHS.

Alex Leach, Deputy Director of Programmes, Health Innovation West of England, said: “We feel honoured to have been able to work with Nick and his team from the very beginning of his innovation journey. The need to drive innovations that deliver equitable, high-quality care is fundamental to the work of the Health Innovation Network and we are excited to continue to support the company in their mission to revolutionise how we monitor oximetry and save lives as a result.”

Impacts to date

EarSwitch stands out in the medical technology landscape due to its innovative use of the inner ear canal for monitoring vital signs. EarMetrics sensors are directed at the non-pigmented inner ear-canal and (at 1mm sq) are suitable for medical devices, audio earphones and hearing aids. EarMetrics aims to become the new global standard of medical monitoring, providing full sets of more accurate (core/central), real-world, synchronous, multi-parameter and racially inclusive data. EarMetrics-Oximetry is one of the eight Innovative Devices Access Pathway (IDAP) pilot innovations and in the future, EarMetrics-Cloud seeks to be the globally trusted and reliable source for artificial intelligence (AI) and machine learning (ML) driven health insights.

Today, EarSwitch™ is so much more than the initial vision. The company now has a team of 14 people turning ideas into reality from their headquarters in Bristol, with doctors, scientists, developers, engineers, and industry experts working together to build and market potentially life-saving technologies. The jump from four to 14 team members directly resulted from an investor introduction by Health Innovation West of England – for a successful match-funded UK Research and Innovation (UKRI) Healthy Ageing grant.

​They also have multiple academic and clinical partners helping to fund this development, take their products through clinical trials, and connect them to potential licensees – so that they can make the greatest positive impact on society.  This includes the NHS Clinical Entrepreneurs Programme, the Innovative Devices Access Pathway (IDAP), Praetura Ventures, and the NVIDIA Inception Program – to name a few. Locally, Royal United Hospital Bath NHS Foundation Trust has completed a protocol ready to run first in human studies in intensive care and acute respiratory care, pending funding from a national UK charity.

Nick Gompertz, founder of EarSwitch, said: “The involvement of Health Innovation West of England has allowed us to really accelerate our EarMetrics. Now we’ve been recognised nationally and we’re in a pilot of eight innovative devices to progress rapidly through regulatory approval through the NHSIDAP pilot – an initiative to bring new medical technologies to the NHS to help with medical needs that are currently unmet.

“Without Health Innovation West of England, we wouldn’t have accelerated to the stage where we’re aiming to be the global standard of medical monitoring device by 2025.”

The Domiciliary Care Workforce Programme

Significant pressures are impacting the home care sector, and providers are reportedly struggling with low workforce utilisation.

A three-year programme to trial the use of AI-based optimisation technology in home care has identified several opportunities for local authorities and care providers to improve the planning of home care, offering potentially significant benefits for care workers, service users and the social care sector as a whole.

Bristol City Council and Cornwall Council took part in a trial which sought to evaluate the impact of using Procomp’s Strategic Optimisation service, which provided data to support changes to how homecare was planned and delivered based on Procomp’s data modelling.

Specific benefits were identified in using optimisation software. These included improvements in the working conditions and retention of care workers and increases in provider revenue and efficiencies.

Care workers demonstrated increased satisfaction with their workload and the time available between home visits, as well as an increase in overall job satisfaction.

Christian Brailsford, Regional Lead for Nursing, Midwifery and Social Care with NHS England South West, said: “Integrated care plays a pivotal role in delivering high-quality services to the population of the South West. I’m genuinely enthusiastic about witnessing how AI technology can begin to positively influence the provision of domiciliary care, enhancing efficiency and enriching the experience for both care-providers and recipients within our communities.”

The challenge

State-funded domiciliary care (or home care) is provided at a local level by local authorities, generally via the commissioning of a range of contracts to multiple providers. Significant pressures are impacting care workers, service users and local authorities, and providers are reportedly struggling with capacity and sub-optimal workforce utilisation. Staff turnover in care is high with low morale and job satisfaction a common concern.

According to the King’s Fund, 818,000 people were using homecare in England in 2020/21, including some of the most vulnerable people in society, while the Care Quality Commission (CQC) has reported a further half a million people are on the waiting list, many with critical needs.

In the first three months of 2022, 2.2 million hours of homecare could not be delivered because of insufficient workforce capacity, leading to unmet and under-met needs.

Our approach

Exploring how technology could help tackle some of these challenges, the Domiciliary Care Workforce Programme was led and co-funded by Health Innovation West of England, Health Innovation South West, and NHS England Workforce, Training and Education South West.

We launched a nationwide call in 2021 to identify potential innovations. A panel of representatives from across the health and social care system assessed more than 30 applications, selecting Procomp’s Strategic Optimisation service as the appropriate solution to trial.

Procomp is a Finnish company with a background in logistics planning and optimisation. The company works with a third of the Finnish domiciliary care workforce. They use an AI-based solution to optimise planning, reduce mileage and improve carer utilisation, as well as to support key decision-makers identify and implement systemic changes.

Bristol City Council and Cornwall Councils successfully applied to take part in the trial, as part of a call to all local authorities in the South West.

Based on data modelling provided by Procomp’s Strategic Optimisation service, two rounds of changes to how homecare was planned and delivered were introduced in each locality between September 2022 and September 2023.
These changes included:

  • reviewing care assessment practices
  • introducing flexible start times
  • balancing demand by organising non-critical activity at off-peak times
  • discussions around care worker gender.

Mark Russell-Smith, Director of International Operations at Procomp, said: “We’re very proud to have been selected as the innovator in the Domiciliary Care Workforce Programme.

“An important aspect of the programme is that it’s enabled a more system-wide approach by both councils and providers. Positive improvements have already been achieved, and there is massive scope for further improvement. Not all problems will be solved overnight, and there isn’t one single solution, but these are important steps. They show how Strategic Optimisation can play a pivotal role in guiding and shaping the future of care, allowing new discussions and genuine solutions to be found to the problems facing the domiciliary care sector.”

Impacts to date

We commissioned Unity Insights to independently evaluate the Domiciliary Care Workforce Programme.

Unity Insights’ evaluation evidenced specific benefits in using optimisation software to improve the working conditions, job satisfaction and retention of care workers and to increase provider revenue and capacity.

Care workers who experienced the changes in working practices were surveyed. Their feedback was positive and demonstrated increased satisfaction with their workload and the time available between home visits, as well as an increase in overall job satisfaction.

The evaluation also evidenced a reduction in miles travelled by care workers during the first month after implementation, and several staff reported less need to cut appointments short due to reduced travel requirements.

Unity Insights’ cost-benefit analysis modelled the benefit of efficiency gains to homecare providers during the pilot. Results estimate the net present value and benefit-cost ratio between 2023/24 and 2027/28. The benefits were based on a reduction in travel distances, an increase in care packages delivered, and an improvement in staff retention. This demonstrated that the two pilot providers involved in the programme could potentially save a combined £3.58 for every £1 invested in the solution.

Procomp’s modelling of data from both local authorities, indicated potentially wider opportunities to improve care worker utilisation by 35%; reduce mileage by 65%, along with associated travel costs for providers and care workers; and improve the overall experience of service users.

Read the full evaluation findings here.

Councillor Andy Virr, Portfolio Holder for Adults Social Care and Health, Cornwall Council, said: “Procomp’s strategic optimisation service delivered a depth of insight and evidence that exceeded our expectations, empowering us to make evidence-based decisions that incentivised transformation at a strategic level.

“If successful, this new approach will enable us to improve the day-to-day experience of people who use our homecare services and their care workers. It will also enable us to enhance the pay received by our local care workforce, increase the profitability of our homecare providers and ultimately help to secure the financial sustainability of our local care market.”

Start and end dates

March 2021 to May 2024.

Next steps

The findings from the Domiciliary Care Workforce Programme present a strong argument for both commissioners and providers to explore the opportunities offered by the use of optimisation software in planning home care, as well as identifying and implementing much-needed systemic changes.

To support this, Health Innovation West of England is sharing these findings with key stakeholders, including policy makers and influencers, to explore how we best take advantage of these opportunities and overcome the identified barriers to change.

Find out more

To find out more about the Domiciliary Care Workforce Programme, email healthinnowest.innovation@nhs.net.

To find out more about Procomp, visit procompglobal.com.

RESTORE2 training for care providers

Building on our leadership of national projects to support the management of deterioration including New Early Warning Score (NEWS2) and ED Safety Checklist, we have delivered free RESTORE2 training to thousands of care staff across the region.

Originally created by Hampshire, Southampton and Isle of Wight CCG, RESTORE2 is an escalation tool for use in care settings to enable early recognition of deterioration. Training in RESTORE2 supports more effective communication, efficient workflow and improves patient safety at the handovers of care between care staff, primary care and the urgent care system.  Calculating a NEWS2 is an important part of the RESTORE2 tool.

Prior to the use of NEWS2 across healthcare systems there was no standardised response to deterioration or common language used at handovers of care for acutely unwell patients.

Supported by Health Innovation West of England, NEWS was adopted across all elements of the region’s healthcare system. NEWS2 was subsequently rolled out nationally through our Network’s Patient Safety Collaboratives in 2018-20.

To build on this work and cement the importance of managing deterioration in care homes, we provided a programme of free RESTORE2 training for care providers from December 2019 to October 2023. Whilst initially delivered face-to-face, learning moved online in spring 2020 due to the COVID pandemic and this then remained virtual.

“We also have a better relationship with our GP now we use RESTORE2. We can now speak a common language with the clinicians; we are now able to clearly communicate our observations and concerns when we ask for a GP home visit, and the GP better appreciates the complexity of needs of residents living in the home.” Ella Redler, Care Home Team Leader, Brandon Trust

Watch our short video on RESTORE2 training:

The challenge

Prior to the use of NEWS2, health care settings did not use the same common language or set of measurements at the handovers of care, or where different parts of the health and social care systems met.  This resulted in a lack of consistency in identification and response to acute illness. Equally there was no standardised training or process for the management of deterioration in care settings.

NEWS2 is a simple scoring system, based on the six physiological measurements that make up the routine vital signs of an adult patient. By monitoring scores over time, NEWS2 can demonstrate a positive response to treatment, or more importantly, allow early detection of patient deterioration. Early recognition and management of deterioration leads to improved outcomes for patients. Whilst NEWS2 was rolled out across healthcare services it was vital that a similar approach was adopted in care settings where many of the most vulnerable patients are supported. The COVID pandemic brought an increased emphasis on the value of managing deterioration in care settings.

Calculating NEWS2 is an important part of the RESTORE2 tool alongside building the confidence of care staff to communicate concerns about patients with primary care and urgent care systems through the development of a common language. The RESTORE2 Mini tool is suitable for use in domiciliary care and acts as an important development opportunity for non-registered care staff.

“Soft signs” training is particularly valuable where individuals have difficulties in communicating when they are feeling unwell or in pain including in care homes for people with learning disabilities or dementia.

Our approach

In March 2015, the West of England Patient Safety Collaborative became the first region to implement NEWS. National adoption and spread of NEWS2 took place from 2018-2020.

During this time, Health Innovation West of England also created Primary Care, ED and Community Collaboratives to enable sectors to meet and share best practice on improving patient safety through the effective management of deterioration.  Identifying that many of the most vulnerable patients reside in care homes, or receive domiciliary care, we launched care homes training in late 2019.

Prior to and during the pandemic – and in line with the British Geriatrics Society paper offering key recommendations to help care home staff support residents through the pandemic – Health Innovation West of England recognised the importance of supporting care staff in managing deterioration through the observation and escalation of ‘softs signs’.

Initially training was offered face-to-face but the pandemic required a pivot to virtual learning which presented an opportunity for greater attendance and representation at sessions. Health Innovation West of England offered a choice of workshops tailored to the different needs of care staff: RESTORE2 Mini, RESTORE2 and Train the Trainer.

We also developed supporting materials including posters, videos and case studies.

Impact to date

“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

To illustrate how RESTORE2 has improved patient outcomes and care staff confidence in communicating at the handovers of care a series of ‘in our words’ case studies have been collated. These illustrate the positive personal impact training has had on care staff, their patients and teams.

By the end of the programme in October 2023, we had trained 84% of nursing homes in RESTORE2 or RESTORE2mini across the West of England region, well exceeding our target of 60%.

We have trained 3,217 care staff with 553 West of England care providers participating.

Building on our RESTORE2 training, free videos were produced by Health Innovation West of England and partners to help staff working in care homes spot and respond to the soft signs of deterioration. The videos have now been viewed more than 2 million times (as of July 2024) and were shortlisted for a 2021 HSJ Patient Safety Award.

Our South West Learning Disabilities Collaborative continues to advocate use of NEWS2 and soft-signs tools including RESTORE2 to support early identification of physical deterioration in patients who may be less able to communicate feeling unwell. In February 2021 Health Innovation West of England staff delivered a ‘Super Trainer’ RESTORE2 model to 167 experienced trainers, who by the end of May 2021 had trained over 7,000 paid and unpaid carers. Training continues to be delivered across the country.

Our programme to support the use of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), evolved from insights gained through our NEWS2 project, inappropriate end-of-life ED attendance and conveyance, alongside our wider work on Structured Mortality Reviews. RESTORE2 training in the West of England showcases ReSPECT and the importance of care planning for emergencies and end-of-life care.

“As a GP I can clearly see how RESTORE2 would benefit patients through the earlier identification of deterioration and treatment commencing earlier. When I am triaging home visits, having a NEWS2 score and soft signs available allows me to ensure that a visit is prioritised within an appropriate timescale.” Chris Turner, GP, Swindon Community Health Services

Next steps

Our RESTORE2 training programme finished in October 2023. By offering a train-the-trainer approach as part of our training package, we have been able to promote the sustainability of this model. This was increasingly a focus in the last few months of the programme and 364 care colleagues were trained using the train-the-trainer model.

The ongoing impact of our adoption of NEWS2 and related collaboratives continues to be felt today in the work of Health Innovation West of England and our Patient Safety Collaborative.

Find out more

Find out more about the resources available to care home staff or email healthinnowest.transformation@nhs.net.

getUBetter

getUBetter is an evidence-based, CE marked, digital self-management support platform for all common musculoskeletal (MSK) conditions and women’s pelvic health. It is now available across 17 integrated care systems (ICSs) to a total eligible population of over 20 million people.

getUBetter helps integrated care systems to provide digital-self-management support across their whole care pathway. It supports patients 24 hours a day, 365 days a year, taking them through their recovery day-by-day and providing them with the knowledge, skills, and confidence to self-manage. Support is provided through triage, advice, exercises, outcome measures, safety netting and referral when necessary.

The getUBetter digital self-management pathways are locally configured to each place within a health system and are made available to people wherever they connect with the system – in the community, primary or secondary care, for example GP practice, urgent care, pharmacy, or physiotherapy. The digital self-management support is suitable for 80% of all new, recurrent, or long-term conditions, including people on waiting lists.

The platform has been proven to reduce the need for prescriptions, follow-up appointments, referrals, and physiotherapy waiting lists, therefore helping to reduce inefficiencies and costs to the healthcare system.

Developed by Dr Carey McClellan, the getUBetter app launched in 2016, following support from the Health Innovation West of England through our popular Health Innovation Programme, run in partnership with SETSquared.

getUBetter has been demonstrated to offer a 4:1 return on investment for providers – for every £1 spent, getUBetter saves £4.20. getUBetter self-management support has also been recommended by NICE for use in the NHS.

In the last two years, getUBetter has grown from supporting two ICSs to 17, enhanced the scope of their MSK offering and developed a new digital self-management support package for women’s pelvic health.

getUBetter is now available across 38% of the country to a total eligible population of over 20 million.

The challenge

Common MSK conditions such as back pain have a massive impact on patients, the NHS, the workplace and the economy.

  • 20 – 30% of population will visit a GP every year for an MSK complaint.
  • MSK injuries and conditions account for 18-30% of all GP appointments.
  • A growing number of people on waiting lists remain unsupported .
  • The NHS spends £5 billion treating these conditions every year – 20% of this is overtreatment.
  • MSK complaints account for half of all days off work and cost the economy £7 billion every year.

There is an absolute need to provide digital solutions to enable MSK support and safety netting, increase capacity, reduce costs, enable MSK support whilst waiting and promote self-management.

As most MSK problems can be managed without specialist treatment, NICE, the NHS, and the Department of Health all recommend self-management support.

Digital health technology such as getUBetter can help to deliver a better service, by providing instant and constant access to a local care pathway, connecting people to support services available to them in their local environment.

Our approach

getUBetter is a digital self-management platform for all common MSK conditions and women’s pelvic health support that integrates with entire local care pathways and is provided to support patients alongside their routine care.

getUBetter transforms digital self-management at scale by supporting integrated care systems and health boards to provide digital self-management for their whole population. getUBetter educates and empowers people to trust their recovery, have the confidence to self manage, and utilise healthcare resources appropriately. This releases healthcare professionals’ capacity and cost pressure on the health system.

Carey McClellan, CEO getUBetter

getUBetter is safe and evidence-based – the platform promotes self-management but safety nets at scale, automating referrals to appropriate parts of the health system when needed. The support can be accessed wherever a patient connects with the health service, in traditional and non-traditional settings.

The app, developed by Dr Carey McClellan and launched in 2016, has been developed and deployed with our support.

Health Innovation West of England first supported Carey in 2013, very early on in his innovation journey, with support around ownership of his intellectual property. Then in 2015, he secured a place on our Health Innovation Programme (HIP).

We have continued to support Carey from development through to deployment and scale – connecting him to relevant organisations and helping him to write funding bids, including successful bids for SBRI phase one and two funding.

Health Innovation Network South London has also supported Carey with deployment across the South and South West London.

In 2021, getUBetter secured a place on DigitalHealth.London’s accelerator programme, supported by the three London health innovation networks, and was named Alumni company of the year 2022.

Dr Carey McLellan is one of the 2022 cohort of NHS Innovation Accelerator Fellows, to receive three years of support to scale getUBetter up across England’s NHS, for the benefit of patients and staff.

getUBetter’s ongoing work with South West London ICS to better understand and minimise digital exclusion we were awarded funding by NHS England as part of their Digital Inequalities Pioneer Programme.

getUBetter’s innovative collaboration with South West London and South West London Integrated Care System won the HealthTech Partnership of the Year category at the HSJ Partnership Awards 2023, recognising their outstanding dedication to improving healthcare and effective collaboration with the NHS.

“getUBetter’s whole pathway approach to self-management means it can be locally configured to suit the target population. Condition pathways can be modified to suit the unique requirements of an individual service. This adaptability ensures that the platform remains relevant and applicable to patients, enhancing their engagement and overall experience.”

Jack Grodon, Clinical Specialist Physiotherapist, South East London ICS

Impacts to date

Patient impact

getUBetter is now available across 38% of the country, covering an eligible population of 20+ million people, including 80% of London.

  • 79,000 patients have been supported by getUBetter to date.
  • 86% of patients would recommend to others.
  • 100% of patients feel the app helps recovery.

Economic impact

Independent economic evaluation has demonstrated a potential cost saving of up to £1.96 million per year per integrated care system for use of getUBetter with back pain alone.

getUBetter has been demonstrated to offer a 4:1 return on investment for providers – for every £1 spent, getUBetter saves £4.20 (NHS MSK Digital Playbook case study).

In the last three years, getUBetter has grown from supporting two ICSs to 17 and has seen a five-fold increase in the size of its team.

In 2019, getUBetter successfully secured £99,420 of SBRI Healthcare funding through phase one of its Musculoskeletal Disorders competition, and a further £860,897 in phase two.

The company has enhanced the scope of their offering, further personalising their MSK digital self-management support for users, as well as developing new core package: digital self-management support for women’s pelvic health.

Clinical impact

getUBetter has been recommended by NICE as one of the five digital health technologies to be used by the NHS to help manage non-specific low back pain in people 16 years and over. Read more here.

Evaluations have also demonstrated:

  • 20% fewer physiotherapy referrals
  • 13% fewer MSK GP appointments
  • 50% fewer MSK prescriptions
  • 66% less Urgent Care attendance
  • Supports behaviour change (Berry et al. 2020, 2022)
  • 50% of patients on a physio waiting list no longer needed an appointment (Somerset evaluation 2022)
  • 40% fewer physio appointments
  • Patients develop better understanding of their conditions and recovery journey (HIN report, 2021)

More information is available on the getUBetter website.

Awards

 In 2023, getUBetter’s innovative collaboration with South West London and South West London Integrated Care System won the HealthTech Partnership of the Year at the HSJ Partnership Awards 2023, recognising their outstanding dedication to improving healthcare and effective collaboration with the NHS.

In the following video, Dr McLellan talks about the getUBetter platform, its impact to date and the support received from Health Innovation West of England. You can watch it here or below.

 

“It gave me reassurance when I was worried about my pain and helped me manage my expectations about the speed of recovery”. Patient

“The app is a great complement to seeing a GP or as an alternative” Patient

“I think it is a fantastic resource on its own but also because patients can then be referred on through the Wandsworth pathway directly.” GP, Wandsworth

“We see the ever-expanding app as a major part of our service redesign going forward.” Jim Fenwick, CEO Battersea Healthcare

Next steps

The team are in talks with several care systems and will be expanding getUBetter’s reach, making it available to more people.

In terms of product development, getUBetter have recently enhanced the scope of offering for MSK digital self-management support by adding targeted support for patients on waiting lists, pain, work, and arthritis. They are currently working on foot, wrist, and hand pathways. Next steps include the launch of our MSK pain support add on, the development of additional women’s pelvic health pathways – menstruation and menopause support, as well as men’s pelvic health.

Find out more about getUBetter here.

For further information, email Alex Leach, Deputy Director of Programmes, Health Innovation West of England at alex.leach@nhs.net.

PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth)

Launched in April 2020, PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) is a unique perinatal care bundle that aims to improve the outcomes for premature babies across the West and South West regions.

PERIPrem reflects the NHS Long Term Plan ambition to reduce stillbirths, maternal and neonatal mortality and serious brain injury by 50% by 2025, with an increased focus on pre-term mortality.

The bundle, which now forms part of our Maternity and Neonatal Safety Improvement Programme, consists of 11 interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born earlier than 34 weeks.

“I truly believe that this package saved my boys’ lives, and without it I’m not quite sure where we’d be now. But because of PERIPrem I have two (17-week-old) beautiful little boys who are just starting to smile, and that is down to PERIPrem.”

Lauren, PERIPrem parent.

PERIPrem was developed as a model in the West of England with the project working collaboratively with Health Innovation South West and South West Neonatal Network.

Watch our introduction to PERIPrem animation. 

The challenge

Preterm birth is the main cause of neonatal mortality and morbidity in the UK. Survival rates are improving in preterm babies, but rates of severe disability have not followed the same trajectory and there is a growing population of children with neuro-disabilities due to prematurity.

The NHS Long Term Plan (2019) has committed to realising a 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025, with an increased focus on pre-term mortality. PERIPrem directly contributes to this ambition, as well as those of the national NHS Maternity and Neonatal Safety Improvement Programme.

“Perinatal services across the South West have worked with great passion to implement the PERIPRrem Project in order to support improved outcomes and experiences for infants and families who journey through neonatal services. We are so proud to be part of a team of such dedicated, caring professionals.”

Mary Leighton, Network Manager, South West Neonatal Network

Our approach

The PERIPrem bundle was co-created by clinicians, maternity and neonatal teams and parents. The interventions range from ensuring that mums give birth in the right place, to offering mothers magnesium sulphate, which has been shown to reduce the risk of the baby developing cerebral palsy later in life, and optimal cord clamping.

Quality Improvement (QI) methodology was at the heart of implementation alongside coaching and forging new ways of working, where clinicians from obstetrics, midwifery and neonatal, join together to drive forward and revolutionise care for pre term babies.

To enable units to focus on increasing rates of PERIPrem interventions, we provided funding to each trust to backfill two PERIPrem Leads, one neonatal nurse and one midwifery lead. In addition, units were encouraged to identify PERIPrem Champions to act as advocates for selected bundle interventions, with a focus on obstetrician and neonatologists.

The PERIPrem Steering Group developed a toolkit of resources and materials for each element of the bundle. Units were encouraged to use and adapt these to meet their needs. PERIPrem clinical and parent passports were also created to offer advice and reassurance to families and many resources were made available in multiple languages. The PERIPrem team also ran virtual share and learn sessions and sent weekly newsletters to distribute resources, connect disparate teams kept apart by the COVID pandemic and celebrate success.

Watch our PERIPrem parent video.

Impacts to date

Over 2,749 premature babies have been cared for using the PERIPrem bundle (to March 2024).

The third update to the Saving Babies’ Lives Bundle, published in June 2023, encourages providers of maternity and neonatal care to draw upon the learning of PERIPrem to aid the optimisation of perinatal care (element five).

The National Neonatal Audit Programme’s (NNAP) 2022 report (published in November 2023) shows:

  • The South West Neonatal Operational Delivery Network (ODN) has the lowest rates of severe preterm white matter brain injury or death
  • The South West is the top ODN for early breastmilk feeding and delayed cord clamping
  • Optimal place of birth is above average across the South West (80.4%) and is the only ODN in England demonstrating consistent improvement in this area during 2020-2022.

“The South West units have led the way in many of the NNAP quality metrics in 2022. We have for the last three years improved continuously with optimal place of birth for extremely preterm infants and if we can continue on this trajectory, we can enable still more babies to survive free from brain injury.

“The NCMD data return for 2021/2022 ranks the South West as the English region with the lowest neonatal mortality rate, which reflects the impact of our PERIPrem QI collaborative and the stellar efforts of every one of our 12 perinatal teams.”

Dr Karen Luyt, Professor of Neonatal Medicine at the University of Bristol and is PERIPrem’s Clinical Strategic Lead.

Perinatal team culture has also improved, with an enhanced common language and situational monitoring, according to an independent evaluation of PERIPrem conducted by Health Innovation South West in 2022. Staff are empowered to increase their knowledge, skills and confidence in preterm birth and infant care, benefitting from strategic cues, protected time, and access to tailored resources and QI support.

In September 2022 PERIPrem was awarded best regional/national project at that year’s BAPM Gopi Menon Awards.

In August 2022, an independent evaluation was  published in the British Medical Journal Open Quality. It indicated 26% more mothers and babies born prematurely across the South West received the care interventions they were eligible for between July 2020 and June 2021, compared to before PERIPrem started. Explore a summary graphic of the PERIPrem evaluation.

Official PERIPrem resources have received Neonatal Nurses Association (NNA) endorsement.

In April 2022, PERIPrem featured as a case study in the latest NHS GIRFT Neonatology report with teams also being encouraged to access our resources (see pages 10 and 66). PERIPrem case studies were also published by NHS Confederation (April 2022) and the National Child Mortality Database thematic report (pages 21-22 – August 2022).

PERIPrem and PreCePT were highlighted as areas of good practice in November 2023 paper Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023.  Health Improvement Scotland referenced the PERIPrem evaluation in the in their patient safety perinatal change package launched in November 2023.

At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended as the Patient Safety Pilot of the Year. PERIPrem was also shortlisted for Provider Collaboration of the Year at the 2021 HSJ Awards.

There has been great interest in PERIPrem following the success of implementation across the South West region. PERIPrem Cymru launched in Wales early in 2023, and we have supported the adoption and spread of PERIPrem Cymru in Wales through sharing and adapting materials developed during the initial project. NHS Wales Executive have commissioned us to provide programme management and clinical leadership support during the initial set-up phases of PERIPrem Cymru.

Find out more about PERIPrem.

SHarED (Supporting High impact users in Emergency Departments)

The SHarED (Supporting High impact users in Emergency Departments) project aimed to improve outcomes for the most frequent users of Emergency Departments (EDs). High impact users (HIU) of EDs suffer some of the most severe health inequalities in the UK.

Through a collaborative case management approach, significant improvements have been recorded through project SHarED for both EDs and patients.

The evaluation of the SHarED project, undertaken by NIHR ARC West and published in April 2023, demonstrates:

  • 148 High Impact Users (HIU) were engaged across the six adopting EDs
  • 33% reduction in HIU ED attendance in six months before and after taking part in SHarED
  • 67% reduction in HIU hospital admissions in six months before and after taking part in SHarED.

Read our summary infographic which highlights key project information and evaluation findings and the full pre-print study of the SHarED evaluation.

The project was proposed by Dr Rebecca Thorpe and the team at University Hospitals Bristol as part of the Health Innovation West of England’s Evidence into Practice Challenge 2019. The model had been running successfully there for five years before being adopted and spread by the Health Innovation West of England throughout the region.

“Taking part in SHarED allowed our HIU Team the time, support and resource to really address the underlying issues which can drive patient requirement for large amounts of unscheduled care. By developing Personal Support Plans, in collaboration with patients and other professionals, we managed to reduce attendance rates, reduce admission rates to hospital and smooth the path of patients when they did attend the Department, thereby supporting our staff in dealing with these patients who often have complex health needs. Feedback from our ED staff was extremely positive. Looking to the future, with thanks to SHarED, we’re continuing to develop our HIU service.”

Dr Sarah Harper, Pain Consultant and HIU Team Lead, Gloucestershire Hospitals NHS Foundation Trust

Watch our SHarED project video.

The challenge

HIU of EDs suffer some of the most severe health inequalities in the UK. HIU are defined as those who attend the ED more than five each year. As a patient group, HIUs experience exceptionally high rates of mental health challenges; learning disability; homelessness; substance misuse; domestic abuse and safeguarding concerns. HIUs often attend the ED as they have nowhere else to go.

As well as the negative outcomes for HIUs attending ED when that service may be unsuitable for their needs, and the resulting strain on ED staff to manage high levels of repeat attendances, there is also a significant financial impact on the NHS. Some ‘super-users’ cost £30,000 per year in ED attendance and hospital admission.

Our approach

In 2019, Dr Rebecca Thorpe of University Hospitals Bristol put forward SHarED for Health Innovation West of England’s Evidence into Practice Challenge; an open call to healthcare professionals in the region with an evidence-based idea for an initiative or project that would improve healthcare. The initiative has been running at Dr Thorpe’s hospital for six years and had achieved great success in reducing attendances to the ED, as well as supporting users to seek healthcare and support in a more appropriate way. It was one of two programmes selected for adoption and spread across the West of England.

Health Innovation West of England worked collaboratively to spread SHarED to all six EDs in the region. Health Innovation West of England also developed a thorough SHarED Implementation Guide, run and managed ED staff surveys and created communications including videos .

All teams from across the region joined a monthly call to share progress, challenges and to discuss clinical case studies. They have since been supported in developing their business cases for ongoing service funding.

The HIU teams’ triage and prioritise patients based on multiple factors, including the number of attendances in the last 3 months, the impact on the department when they attend and a number of social factors. Once prioritised, patients are contacted and asked to contribute to a Personal Support Plan written by the HIU co-ordinator and the Multidisciplinary Team. The Personal Support Plan is then used by members of staff in the Emergency Department to provide a consistent approach to assessment and management. Additionally, the Multidisciplinary Team also seek to address any underlying issues through a holistic approach.

“The SHarED project has propelled our work to support some of the most vulnerable, marginalised patient groups in society, who access Emergency Departments frequently, for a variety of reasons. Working with teams from EDs all over the West of England, we’ve educated staff and supported patients to work towards safer patient care and an improved experience for patients and staff. It’s a fantastic example of cultural change across the whole patch.”

 Dr Rebecca Thorpe, Clinical Lead for SHarED and ED Consultant, University Hospitals Bristol and Weston NHS Foundation Trust

Impacts to date

The evaluation of the SHarED project, undertaken by NIHR ARC West and published in April 2023, demonstrates:

  • 148 High Impact Users (HIU) were engaged across the six adopting EDs
  • 33% reduction in HIU ED attendance in six months before and after taking part in SHarED
  • 67% reduction in HIU hospital admissions in six months before and after taking part in SHarED
  • over 360 staff trained to support HIUs
  • There were improvements in ED staff feelings of confidence, support and training, and a perception that HIUs were receiving more appropriate care.

Feedback from a 2021 staff experience survey included:

  • “Dedicated HIU teams are making a real difference to the appropriate management of these patients.”
  • “Our HIU team are brilliant and have made a huge impact on not only the number of attendances but patient outcome and reduction in violence and aggression cases.”

Read our news story and Plain English summary of the evaluation.

In September 2023, SHarED won the title ‘Urgent and Emergency Care Safety Initiative of the Year’ at the HSJ Patient Safety Awards.

Next steps

While the Health Innovation West of England funding has now ceased, the ED teams are working with their trusts to secure ongoing support. Each team are passionate about continuing the important work that has been started by the SHarED project. Support is also now provided by NHS England High Intensity User Programme.

Find out more about SHarED on our website.