Archives: Case studies

Case study

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.

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.
  • 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.
  • Sponsoring the company to exhibit at the HETT show in London ExCel (2021), in order to generate national exposure of the app amongst healthcare decision makers.
  • 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).
  • Acting as a critical friend around commissioning and procurement.

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%.

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.

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 2,299 premature babies have been cared for using the PERIPrem bundle (to August 2023).

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.

Create Open Health: Voices for Change

Voices for Change was a partnership project between the Health Innovation West of England, the Bladder and Bowel Health Integration Team (BABCON HIT) at Bristol Health Partners and Disruptive Thinking, as part of our Create Open Health open innovation programme.

Its purpose was to give a voice to those affected by bladder and bowel conditions, with the long-term aim of initiating positive change for those living with the condition (or caring for someone who does), by suggesting improvements to existing information, services and pathways and guiding thinking around developing or identifying innovative healthcare solutions.

In November 2022, the project’s final output – the Voices for Change report – was presented at the House of Commons at the bi-annual meeting of the All-Party Parliamentary Group (APPG) for Bladder and Bowel Continence Care, at which there was strong consensus and support for the themes and priorities moving forwards.

The challenge

Bladder and bowel conditions are very common in the UK, affecting one in every five of us, and yet it is not a subject openly talked about due to the embarrassment that surrounds the symptoms. This means that many people suffer in silence and do not get the treatment and support they need.

As a long-term health condition, bladder and bowel continence can seriously affect the quality of life for those living with the condition directly or caring for somebody who does – often causing or worsening other health and social problems, with a significant impact on mental health.

Bladder and bowel leakage can affect anyone at any age, but there are also a number of groups of people who are disproportionately affected and underrepresented, which can lead to an increase in health inequalities.

Our approach

Voices for Change was a partnership project between the Health Innovation West of England, BABCON HIT at Bristol Health Partners and Disruptive Thinking.

Its purpose was to give a voice to those living with bladder and bowel conditions (or caring for someone who does) in order to identify need and be able to share suggested improvements with the sector. Its long-term aim is to initiate positive change for those affected.

As with any healthcare challenge, the starting point is always understanding the problem, in order to articulate the need. The first phase of the Voices for Change project was therefore to outreach to and engage with those affected, inviting them to share their experiences with us, in order to gather valuable information and insight into the challenges faced.

We reached out to all those experiencing symptoms, including those from often under-represented groups, through multiple channels – engaging with existing contacts, partners and networks with links to these communities, as well as building new relationships with new relevant groups and networks.

In total, 83 individuals across the West of England region and beyond were recruited to have their voices heard, with contributions gathered between October and December 2021.

In order to give an equitable opportunity to all individuals to contribute in the simplest and most sensitive way, we developed an inclusive and accessible approach. This was achieved through a multi-channel methodology, in which we offered participants three channels through which to participate: group workshops, individual interview and an anonymous survey.

Following the discovery phase, all research outputs were gathered and, using a thematic analysis approach, we grouped similar ideas together in order to organically generate six key themes and priorities: perception, communication, environmental, wider health service, mental health and anxiety and participation. From these themes and priorities, we were able to develop problem statements, which we shared with our network of experts for their reflections and recommendations.

Finally, we pulled the insights, learnings, reflections and recommendations together into a report, highlighting six key action points for the sector to consider:

1. Address the taboo surrounding bladder and bowel leakage

2. Increase conversations around bladder and bowel leakage

3. Prioritisation for bladder and bowel provisions (by commissioners)

4. Increase access to public toilet facilities

5. Improve access to the right treatment / improve service pathways

6. Support the mental wellbeing of those affected.

The final report was published in May 2022 with an intense cross-sector outreach and engagement campaign to disseminate the report’s findings to more than 100 key organisations. This included academic and health research institutions, business incubators, voluntary, community and social enterprise organisations, voluntary sector infrastructure organisations, charities and campaigning organisations, innovation networks, allied health professionals, integrated care systems, care quality commissioners, health and social care commissioners and local authorities.

“Wow, this report is a real tour de force! It will be cited and used up and down the country, and beyond, by all of those advocating for improvements in this area, for a long, long time to come. It truly is an amazing and powerful piece of work. A rare contribution to this field that really enables the voices of people with symptoms to be heard and has such potential to drive real change.”

Nikki Cotterill Professor in Continence Care, UWE

Impacts to date

  • Through collaborative working with an academic health research partner, a strong partnership has been formed with the potential to drive future innovation in bladder and bowel health forward.
  • The particular focus on under-represented groups and those disproportionately affected supports the sector in its need to address healthcare inequalities.
  • In November 2022, the Voices for Change report was presented at the House of Commons at the bi-annual meeting of the All-Party Parliamentary Group (APPG) for Bladder and Bowel Continence Care, at which there was strong consensus and support for the themes and priorities moving forwards. Read more here.

“I am so pleased that the issue of bladder and bowel continence is being talked about and solutions sought to help people affected cope with the issues in a practical sense. This will hopefully help these people to start living full lives again and avoid isolation and shame.”

Participant

“As clinicians we should create opportunities for sensitive conversations about bladder and bowel incontinence. By doing this we can work with our patients and other colleagues to find practical solutions to embarrassing situations, and so enable our patients to face life with greater confidence.”

Alison Tavaré, GP and Clinical Lead at the Health Innovation West of England

Next steps

The insights, learnings and recommendations presented in the Voices for Change report lay the groundwork to initiate positive change for those affected, by suggesting improvements to existing information, services and pathways and guiding thinking around developing or identifying innovative healthcare solutions.

We continue to explore opportunities to support our partners in responding to the report’s recommendations.

Find out more about the Voices for Change project here.

For further information, email us at healthinnowest.innovation@nhs.net.

Find out more about the Bladder and Bowel Health Integration Team (BABCON HIT) at Bristol Health Partners here.

Find out more about Disruptive Thinking here.

FeNO testing in Primary Care

The FeNO testing programme aims to improve the speed and accuracy of asthma diagnosis and prescribing, therefore reducing the risks of exacerbations and admissions to hospital.  FeNO devices measure fractional exhaled nitric oxide in the breath of patients. This provides an indication of the level of inflammation in the lungs, a marker which helps make the diagnosis of asthma and also helps to define the best initial treatment.

Health Innovation West of England has been working collaboratively with all three Integrated Care Systems (ICSs) in the region to support the implementation of FeNO testing in primary care.  Two projects were awarded Pathway Transformation Funding.  The South West Respiratory Clinical Network has supported the programme with additional funding for devices and mouthpieces.

There has been high uptake of FeNO testing; 143 GP practices across the region now offer this service to their patients.  More than 2,500 patients have accessed FeNO testing since October 2021, resulting in improved care and outcomes.

“It is very useful.  I’ve never had this test before and had not been taking my treatment.  I do have symptoms and the test made me realise that I need to be better with taking inhalers and other treatment”  Anonymous

The challenge

Respiratory disease is identified as a clinical priority in the NHS Long Term Plan, with a commitment to do more to detect and diagnose respiratory problems earlier.

Over 5.4 million people in the UK suffer from asthma with the NHS spending £1.1 billion on asthma annually1.  90% of this cost goes directly on asthma medication including the excessive prescription of steroid inhalers2.

Statistics released from Asthma UK3 show that over 120,000 asthma sufferers in the UK are at risk from wrongly prescribed medication and NICE findings on studies of adults diagnosed with asthma suggest that up to 30% do not have clear evidence of asthma with other studies suggesting that asthma may be underdiagnosed . As a consequence, people could potentially be on medications that they do not need or not receiving medication they require to control their symptoms.

NICE recommends objective testing with FeNO (and spirometry) for most people with suspected asthma, but the infrastructure and training needed in primary care, along with the cost of devices, has been a barrier to implementing this.

Our approach

FeNO testing was included in the national Rapid Uptake Products Programme in 2021.

The benefits of FeNO testing include:

  • Improved accuracy of diagnosis for patients with suspected asthma
  • Improved effectiveness of patient care through better understanding of an individual’s condition
  • Improved patient outcomes, reducing the risk of exacerbations and admissions to hospital
  • Reduction in inappropriate prescribing
  • Reduction in the number of inappropriate referrals to secondary care clinics.

Health Innovation West of England worked collaboratively to spread FeNO testing to GP practices in Bath, Swindon and Wiltshire (BSW) ICS and Gloucestershire ICS, who were successful in bidding for Pathway Transformation Funding.  Health Innovation West of England also developed an implementation checklist, delivered education webinars, coordinated device training and managed staff and patient experience surveys.

ICS teams met with Health Innovation West of England monthly to share progress, challenges and lessons learned.

Different models of implementation were used in different localities. Gloucestershire ICS used a hospital-based referral clinic as a blueprint for primary care based FeNO testing with devices allocated at practice level. BSW ICS tested a mobile model within primary care with shared devices moving between multiple practices.

Patients with suspected asthma were invited for a FeNO test at their local GP practice to try and confirm a diagnosis, as per NICE guidelines. FeNO testing was also offered to patients with poorly controlled asthma for monitoring and treatment adherence purposes.

“It’s a valuable tool for aiding the diagnosis of asthma as well as monitoring existing patients who are uncontrolled and needing potential treatment change or can be informed that their current treatment is working.  It is easy to use and can be done in a 10-minute appointment if you are only performing FeNO.  Patients find holding and breathing into the device quick and easy and it proves to patients that there is inflammation that needs dealing with”.
Nicci Mawer, Practice Nurse, Combe Down Surgery

Impacts to date

Between January and June 2022, Health Innovation West of England delivered FeNO testing education webinars to 95 attendees.  There are currently 143 GP practices across the region offering FeNO testing to patients.

Patient stories have been developed, illustrating the benefits of FeNO testing.

Evaluation data from the two funded projects (in BSW and Gloucestershire) demonstrate the following impact on patients:

  • 2,374 patients were reviewed
  • 535 patients were diagnosed with asthma following a FeNO test
  • 62% of survey respondents4 feel more able to manage their symptoms following a FeNO test
  • Shorter waiting times than secondary care referrals – 70% of survey respondents waited less than 2 weeks for a FeNO test
  • Easier access to local testing – 64% of survey respondents travelled less than 3 miles for a FeNO test
  • Improved experience – 98% of survey respondents were satisfied or very satisfied with the service

“FeNO testing is improving the speed and accuracy of asthma diagnosis across the West of England region.  Patients are now able to access this service more easily at their local GP practice with shorter waiting times.  Networks for respiratory teams in primary care have been established to ensure ongoing support and sustainability of FeNO testing.”
Charlotte Hallett, Senior Project Manager, Health Innovation West of England

Feedback from staff experience surveys indicates:

  • Access to FeNO testing has supported diagnosis of asthma (90% out of 53 respondents)
  • Access to FeNO testing has influenced prescribing (57% out of 53 respondents)
  • Access to FeNO testing has improved confidence levels when diagnosing asthma (83% out of 47 respondents)

BSW ICS successfully submitted an abstract to the Primary Care Respiratory Society and the poster for their project was presented at the Annual Conference in September 2022.

We are also working with six individual PCNs in Bristol, North Somerset and South Gloucestershire (BNSSG) ICS that are implementing FeNO testing. To December 2022, in BNSSG, 27 practices are offering FeNO testing to patients with 775 tests performed thus far.

“Having previously offered FeNO testing following referral and seen the improvements in accurate diagnosis, patient education and confidence in self-management, we are now able to offer the test without the delays associated with referral, close to the patient in their GP practice with competent healthcare professionals in a way that is sustainable in the longer term.  We achieved the aims of our project and have also been able to roll out the model across the whole ICB.”
Carol Stonham, Senior Nurse Practitioner – Respiratory, Gloucestershire ICB

Next steps

The Pathway Transformation Funding projects in BSW and Gloucestershire are now complete and have been evaluated.  Teams at the Integrated Care Boards (ICBs) are working to secure ongoing support to continue the important work that has been started and one system has adopted a Local Enhanced Service for respiratory which includes FeNO testing.

Health Innovation West of England are continuing to support the national programme until March 2023.

“It’s really exciting to see the impact of this project. Many more patients can now benefit from a rapid and accurate diagnostic pathway. Watching everyone collaborate and develop solutions together to deliver the changes needed has also been a highlight of this work.”
Mark Juniper, Medical Director, Health Innovation West of England

Find out more about FeNO or email: healthinnowest.transformation@nhs.net

  1. Mukherjee M, Stoddart A, Gupta RP et al. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases. BMC Med. 2016 The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases | BMC Medicine | Full Text (biomedcentral.com)
  2. NHS Long Term Plan
  3. Asthma UK. Patient Safety Failures in Asthma Care: the scale of unsafe prescribing in the UK. 2014. Patient Safety Failures in Asthma Care
  4. 73 patient survey respondents.

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)

The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. ReSPECT was developed by the Resuscitation Council, working alongside NHS stakeholders, patients, and families.

The roll-out of ReSPECT in the West of England is one part of a national Patient Safety Collaborative strategy to improve the care of patients at risk of deterioration. Health Innovation West of England worked to ensure three local systems aligned to use and spread the same process. ReSPECT was implemented in Bristol, North Somerset and South Gloucestershire (BNSSG) and Gloucestershire Integrated Care Systems (ICS) at the end of 2019, and is now well embedded in services across both regions, with Bath and North East Somerset, Swindon and Wiltshire (BSW) ICS implementing ReSPECT in October 2021.

Our programme to support the use of ReSPECT evolved from insights gained through the ED Collaborative, and roll out of the ED Safety Checklist and NEWS2, around inappropriate end of life ED attendance and conveyance, alongside our wider work around Structured Mortality Reviews.

Ensuring there are high-quality advance care plans, accessible to the clinicians who need them, enables better care for patients, peace of mind for their carers and reassurance for staff who can be confident they are following their patients’ wishes.

Watch our Journey of a ReSPECT form video. 

The challenge

Before the start of this project, frail and complex patients might have a do not resuscitate form or treatment escalation plan but few had advance care plans describing what should happen in an emergency. This meant that clinicians and carers had to make decisions about a person’s best interests and preferences and rarely very frail patients were resuscitated against their wishes.

In 2018, there was a mixed picture across the region for managing end of life and emergency care. Health Innovation West of England aimed to create a unified system to make these challenging conversations easier and ensure a person’s wishes were recorded and easily accessible to health care workers in an emergency.

The aim of the project in the West of England was also to make sure the ReSPECT process offered confidence and an effective framework for encouraging and empowering staff when having these important conversations with their patients.

Our approach

Health Innovation West of England invited the Resuscitation Council to introduce ReSPECT to the region in June 2018. Delegates from 54 organisations attended the ‘Exploring approaches to end-of-life care’ event. Following the event Gloucestershire and BNSSG ICSs, agreed to implement ReSPECT together.

In October 2018 and March 2019, Health Innovation West of England held learning and sharing events to prepare for the joint launch in October 2019. The launch covered a population of 1.6 million people, including primary care, four acute trusts, four community healthcare providers, one mental health trust, the ambulance service, hospices and voluntary organisations.

The COVID-19 pandemic brought with it extra resonance for the ReSPECT programme. During the pandemic, registered nurses in nursing homes received online ReSPECT conversation training sessions and so they were able to have individualised ReSPECT conversations and complete forms for residents unable to see their GP. A training package was also created for RESTORE2 and developed for care homes which included awareness of ReSPECT. This package has so far been delivered to 2,375 care home workers from 255 care providers by Health Innovation West of England.

In September 2021, One Gloucestershire and Health Innovation West of England ran online learning sessions for paramedics in the West of England to help them to better use and understand the ReSPECT process.

Health Innovation West of England has continued advocacy of ReSPECT, with BSW ICS implementing ReSPECT in October 2021.

The ReSPECT process was amended to reflect use during the COVID-19 pandemic.

We created a suite of resources for healthcare systems including implementation and training toolkits. Health Innovation West of England  has also worked with the Resuscitation Council UK to produce two animations, one for patients and the public and one for healthcare professionals, telling the story of Joe and how his ReSPECT form improved communication and coordinated personalised, individualised care across the health and care system.

“What has been incredible is how the whole of the health and social care community within Gloucestershire have come together and driven this project. The cross boundary working, shared learning and respect literally for each other’s roles has been really fantastic to see.”

A social care provider in Gloucestershire

Impacts to date

Impacts for the project relate to quality of care and relationships built between organisations. The implementation standardised multiple processes reducing duplication, improved access to information, and encouraged earlier conversations with individuals and families. The project was not intended to save money, however it was cost effective as substituting one process with another required no financial investment; apart from events and project management funded by the Health Innovation West of England.

15,000 ReSPECT forms have been completed across the region (to September 2021).

A unique output from this project was a digital ReSPECT template created by a local GP and approved by the Resuscitation Council. The South West CIO network successfully lobbied for an opt-out policy for additional information  in the Summary Care Record , which was implemented during COVID-19 allowing ReSPECT decisions to be visible digitally to South West Ambulance Service first responders.

In October 2022 Age and Ageing published a study conducted in the West of England by NIHR ARC West on the use of ReSPECT in care homes. It found GPs and care home staff see ReSPECT as positive and empowering for residents. Read more about the study and its findings.

“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.”

A nurse practitioner

Next steps

ReSPECT continues to inform our patient safety work to manage deterioration and support care homes. For instance, the South West Learning Disabilities Collaborative continues to advocate use of ReSPECT and we now offer free training to care providers to detect and respond to the soft signs of deterioration alongside the importance of advance care planning.

Our involvement in the ReSPECT project started in 2018.

Find out more about ReSPECT or email: healthinnowest.transformation@nhs.net.

PreciSSIon (Preventing Surgical Site Infection across a region)

PreciSSIon (Preventing Surgical Site Infection across a region) is a double award-winning collaborative involving all hospitals in the West of England. The aim was to reduce incidence of surgical site infection after elective colorectal surgery by implementing a four-point evidence-based bundle of care developed at North Bristol NHS Trust in February 2013.

This became a Health Innovation West of England project in November 2019 and we supported adoption and spread to other hospital trusts (Royal United Hospital Bath, University Hospitals Bristol and Weston, Gloucestershire Hospitals Foundation Trust and Great Western Hospital Swindon) through project management, provision of resources, and funding of collaborative events.

The project almost halved SSI with a reduction of 47 % by March 2021. It is estimated that the project saved 115 patients from developing an SSI, with an associated cost saving of £566,720. This result was achieved despite the COVID response causing major disruption in hospitals.

Watch our PreciSSIon bundle video.

The challenge

Surgical site infection (SSI) refers to wound infections following invasive surgical procedures. SSI arises from contamination of the wound site during or after surgery. The development of SSI is complex with many contributing factors.

SSI is the third most common hospital acquired infection in the UK accounting for 14.5% of all HC AI affecting 250 000 people a year in England with an estimated 34-226% increase in associated costs.

SSI causes pain for patients, can increase hospital stay and readmission and increase antibiotic use. When severe it can lead to intensive care admission and rarely, death.

SSI is more common after colorectal surgery where wounds can be contaminated by bowel content, but most hospitals do not know their SSI rates. Rates of between 8-30% have been reported based on in-hospital SSI and readmissions. However, the prevalence is likely to be underestimated because SSI frequently presents after the patient has been discharged from hospital.

View the PreciSSIon implementation toolkit.

Our approach

The PreciSSIon project had 2 clear aims:
1. To establish reliable SSI measurement after elective colorectal surgery using a validated patient reported outcome questionnaire at 30 days.
2. To implement an evidence-based 4-point care bundle. The PreciSSIon bundle, includes: 2% chlorhexidine skin preparation; a second dose of antibiotics after 4 hours operating; use of dual ring wound protectors; antibacterial sutures for wound closure.

Health Innovation West of England supported the PreciSSIon collaborative using the IHI Breakthrough Collaborative model. We produced resources and materials to aid data collection and implementation of the PreciSSIon bundle. These included QI (quality improvement) resources, an implementation toolkit, posters, and videos. We also ran ‘learning and sharing’ events for the collaborative which were an opportunity to meet and share successes, challenges, and discuss data collection. One face to face meeting occurred before the pandemic but then all subsequent events were virtual.

“The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference.

“We had our challenges, including standardising measurement, procurement of antibacterial sutures and sustaining measurement during the pandemic, when staff were redeployed to other roles, but despite this we have demonstrated that a care bundle developed in a single hospital can be adopted and spread. Also that the original outcome of a 50% reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within just 18 months.”

Dr Lesley Jordan, Consultant Anaesthetist and Patient Safety Lead, Royal United Hospitals Bath NHS Foundation Trust

Impacts to date

The regional average baseline SSI rate was 18%. Implementation of the bundle in all trusts between November 2019 and May 2020 resulted in a 47% improvement in SSI rate, leading to a regional average of 9.5% by March 2021. This equates to saving 115 patients from an SSI, a significant improvement in patient experience. Compliance with bundle was 87% for chlorhexidine, 79% for antibacterial sutures, 68% for wound protectors and 92% for antibiotics.

A UK study demonstrated that the cost of a SSI after elective colorectal surgery is £4,928 equating to a regional cost saving of £566,720. 3 hospitals also implemented the bundle after emergency abdominal surgery leading to a reduction in SSI from 22.5% to 12.5%.

PreciSSIon was shortlisted for two 2021 HSJ Patient Safety Awards, winning the Infection Prevention and Control Award. PreciSSIon also won Quality Improvement Team of the Year at the BMJ Awards, both in September 2021.

In March 2022, the Journal of Hospital Infection published a study by surgeons and trainees who formed part of the PreciSSIon project team. This evidenced the value of SSI bundles to patients and the NHS. Read the journal article.

In September 2022 the Journal of Hospital Infection published PreciSSIon – a collaborative initiative to reduce surgical site infection after elective colorectal surgery. This concluded a care bundle developed in a single hospital can be adopted and spread and the reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within 18 months.

Next steps

In October 2022 we launched a new PreCiSSIon collaborative – focused on reducing SSI after caesarean birth – in six local acute hospital maternity units across the region. Read more in our launch blog.

The project results have been shared with the Royal College of Surgeons and the results have been presented at the Association of Surgeons of Great Britain and Ireland with the aim of sharing more widely.

The project launched in November 2019 and is ongoing, although Health Innovation West of England project management has ended.

Project leads:
Anne Pullyblank, Medical Director, Health Innovation West of England
Dr Lesley Jordan, Consultant Anaesthetist and Patient Safety Lead, Royal United Hospitals Bath NHS Foundation Trust

Find out more about PreciSSIon.

 

The West of England Learning Disabilities Collaborative

We established the West of England Learning Disabilities Collaborative (LDC) in early 2019 bringing together individuals and organisations from across the region interested in the care of people with a learning disability and experts by experience, with a focus on three priority areas:

  • Improving recognition of deterioration through use of soft-signs and National Early Warning Score (NEWS2).
  • Promoting the uptake of flu vaccinations (for both care staff and patients) and the use of reasonable adjustments such as the nasal vaccine.
  • Supporting increased uptake and quality of Annual Health Checks (AHC).

The LDC provides a space for collaboration, cross-system working and sharing of good practice in a way that did not previously exist in the region.

The overarching aim of the collaborative is to reduce the inequity in care for people with a learning disability that has been identified nationally through the LeDeR (Learning Disabilities Mortality Review) programme.

Read our blog on how the LDC was formed.

In October 2021 the LDC team presented to the West of England Patient Safety Collaborative Board. Watch their short presentation which gives an overview of the LDC’s work and why co-creation is vital to its effectiveness:

The challenge

It is estimated that approximately 2% of the adult population has a learning disability. On average, people with a learning disability die 20 years younger than their peers. Many of these deaths continue to be from avoidable causes, such as pneumonia and sepsis.

Whilst the healthcare needs of people with a learning disability have been considered throughout our project cycles at the Health Innovation West of England, we had never before undertaken a specific project for people with a learning disability. The collaborative aims to put people with a learning disability, their carers and the healthcare staff that support them at the centre of our work. Read our blog on the importance of co-creation to the LDC.

The LDC advocates use of NEWS2 and soft-signs tools including RESTORE2 to support early identification of physical deterioration in patients. “Soft signs” training (including RESTORE2 and RESTORE2 Mini) is particularly valuable in the management of deterioration where individuals have difficulties in communicating when they are feeling unwell or in pain including in care homes for people with a learning disability or developmental needs.

Our approach

The collaborative’s first priority is to build on the work across the region to implement NEWS2 and expand into the learning disability sector, incorporating the use of soft signs through RESTORE2 training. Based on the recommendation from the LeDeR programme to empower carers, and the success of our RESTORE2 training for care homes (including learning disability settings), and in collaboration with Wessex Patient Safety Collaborative (PSC), we were commissioned by NHS England to train 120 ‘Super Trainers’ to deliver training remotely to paid and unpaid carers across the UK. The training and resources were co-created with people with a learning disability, carers, and supporting organisations, and this has created the potential for the training to be delivered by people with lived experience. To accompany this training, we worked with partner organisations to develop a series of short, bitesize videos in plain English. These include measuring heart rate, oxygen levels, temperature, how to recognise soft signs, and how to tell someone if you are worried.

To support our second priority during the 2019 flu vaccination season we collaborated with NHS England to produce a flu vaccination communications toolkit, including easy read information about the flu vaccine, for providers to use to promote uptake for people with a learning disability and their carers. We also had the NHSE website updated so that people with a learning disability were explicitly mentioned as being at risk. The toolkit is now updated and re-released each year. We also contributed to a letter for care workers to give to their GPs to obtain the vaccination for free, based on feedback from our members that they were being told they were not eligible for a flu vaccination and turned away.

Improving the uptake of annual health checks is the third aim of the collaborative and remains a high priority for systems and NHS England. Initially we were commissioned to increase the uptake of annual health checks through meetings and workshops. We were subsequently commissioned by NHS England South West to produce a series of videos that encouraged greater uptake of annual health checks for people with a learning disability. The videos were co-created and produced with Misfits who are a theatre and social group led by people with learning difficulties. We also collaborated with a number of experts by experience to produce these videos. The videos were published in October 2021 and cover a range of audiences including health professionals working in primary care, with a second playlist focusing on people with a learning disability and those that care for them. This project was selected by NHS England as an exemplar case study for the LeDeR 2021-22 Action from Learning Report (see pages 25 and 45).

In addition, we established a community of practice with over 300 members including representation from NHS England, our member organisations, Public Health England, Royal College of GPs, community learning disability providers, the local LeDer team and experts by experience. This is a hub for sharing best practice and information. A wide range of webinars have been held and members are sent a quarterly newsletter. We have also co-created videos and resources to support, amongst other campaigns, the uptake of covid boosters and oral healthcare.

Since March 2022, through Blue Stream Academy, RESTORE2 Mini is available as a free e-learning module to all carers (paid or unpaid).

Impact to date

  • In February 2021 we delivered the ‘Super Trainer’ RESTORE2 model to 167 experienced trainers, who by the end of May 2021 had trained over 7000 paid and unpaid carers, with training continuing to be delivered across the country.
  • The bitesize deterioration videos have had over 44,000 views and were 2021 finalists as part of a wider series on deterioration for a HSJ Patient Safety Award.
  • Our work was highlighted in the LeDeR Action from Learning report on sepsis
  • NHS England reported a 57% uptake of flu vaccinations in our region in November 2021 which is higher than the national average of 50%.
  • We campaigned for COVID vaccinations for people with a learning disability when this vulnerable group were not initially included on the priority list for vaccination. We contributed to a letter to the House of Lords which resulted in the list being updated in February 2021.
  • We presented our work to support the uptake of annual health checks at the September 2021 HSJ Patient Safety Congress with Andrew Bright, Head of Development for Thera Trust, an expert by experience.
  • Most recent data shows that 72% of people with a learning disability in the West of England accessed an annual health check.
  • We produce a regular newsletter to share best practice and resources which is sent to our collaborative of nearly 400 members.
  • We have run a series of seven webinars on topics such as advanced care planning, physical health, and mental capacity during Covid-19 which had more than 560 attendees.
  • To March 2022, over 2240 care staff have been trained in use of RESTORE2 or RESTORE2 Mini with 417 West of England care providers participating.

To illustrate how RESTORE2 training 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.

Key to developing the LDC’s soft signs videos and super-trainer model was co-creation, and working with us was one of our experts-by-experience Andrew Bright, who is Head of Development at Thera Trust:

“RESTORE2 will make such a difference and save lives. From my own personal experience of taking part in the training and watching the videos; I feel like they will make a huge difference, and from my own point of view I felt included in the work”.

Next Steps

The West of England collaborative ceased in its current format in March 2022. The collaborative has been relaunched to cover the entire South West region, and is funded and delivered in partnership with NHS England South West.

The reformed collaborative aims to share learning and best practice across the South West and focus on the adoption and spread of tested diagnostics, products and technology that supports both people with, and those who care for people with, a learning disability.

Find out more

Visit the South West Learning Disabilities Collaborative web page or email us at healthinnowest.swldc@nhs.net.