Author: Vanesther Hamer

Getting the balance right on polypharmacy

Posted on by Vanesther Hamer

The AHSN Network recently launched the new national polypharmacy programme: getting the balance right. Here national Programme Manager, Amy Semple and Clinical Lead, Clare Howard discuss why we need to take action to address problematic polypharmacy and how the AHSN Network is supporting this important area of work.

“As we live longer with more long-term conditions medicines can help but we know that people are sometimes exposed to more medicines than they can manage and some medicines, in combination with others, may cause them harm. The AHSN polypharmacy programme aims to help ensure clinicians, patients and the public understand how to get the balance right.”

Why is polypharmacy an important topic?

Polypharmacy is one of the key themes of the World Health Organisation’s Global Patient Safety Challenge, aiming to reduce severe avoidable medication related harm by 50% globally over five years.

In England, we prescribe and dispense over one billion items each year in primary care. In April 2022 alone, there were almost one million people in England taking 10 or more medicines and 370,000 of those people we aged 75 or over. We know a person taking 10 or more medicines is 300% more likely to be admitted to hospital.

Medicines do so much good but as more people live longer with multiple long-term conditions, the number of medicines they take increases, and this can sometimes expose them to harm. They may increase their risk of a fall or being admitted to hospital, or generally reduce their quality of life. Of course, no doctor, pharmacist or nurse wants this for their patients but sometimes the system that we work in can result in people being on too many medicines.

Our polypharmacy programme aims to support the national effort redressing the balance. We want to ensure that patients can access what is appropriate for them but not take so many medicines that they can’t manage them all or take combinations of medicines that we know increase their risk of harm.

Why do people end up on too many medicines?

This isn’t anyone’s fault. We have a medical model of care that doesn’t always take adequate notice of the situation a person is in or what is important to them. The AHSN polypharmacy programme is supporting GP practices to identify patients who might be at increased risk of harm. We’re helping clinicians carry out high-quality medication consultations based on shared-decision-making and we’re also helping the public understand that it’s important that they ask about their medicines and share their questions, concerns and expectations.

Just as the causes of polypharmacy are complex, so too are the solutions. That is why each AHSN is establishing a polypharmacy community of practice to bring people together to share ideas and best practice and work on local solutions.

What has been done already?

The AHSN Network, working with the NHS Business Service Authority, created the first national data set of polypharmacy comparators for England. This shows GPs and pharmacists which of their patients are deemed to be at greatest risk of harm. This work has been used by many practices since 2017 and we are now running training sessions to ensure that ALL practices access and use the tools as they’ve been designed to be used.  We know that where primary care does this, it can have a real impact on polypharmacy and lowering some of the risks of harm that patients can be exposed to.

What part do patients and the public play in this work?

Pillar 3 of our work is a more experimental phase where we’ll be considering how we can best support patients to be more open about their medication issues. Each AHSN will be testing available patient information resources and the impact these can have on conversations between clinicians and patients. And nationally we’ll be engaging with public, patients and carers, as well as organisations like Age UK, to ensure there is a strong patient voice throughout our work.

Where do you hope to see this programme in three years’ time?

I hope that in three years we’ll have deployed a comprehensive training programme to thousands of clinicians, and as result they’ll be much more confident in stopping medicines safely that are no longer needed or appropriate. I hope that the general public comes to demand a medication review every year and expects to have a meaningful conversation with their prescriber about what is important to them and how their medicines can help with their goals in life, especially in later life.  It is an honour to be leading this programme and I am committed to making taking medicines safer and easier.

How can people get involved?

Each AHSN is setting up a community of practice to bring together clinicians, charities and the voluntary sector and importantly patients and carers to explore and take action on how to address this locally.

We are encouraging GPs and prescribers to join local or national action learning sets. These will ramp up next year and are a practical way to start having conversations with patients about stopping medicines safely.

And if you are a member of the public managing multiple medicines, we want to hear from you – and your carer – to join our local focus groups and help test the patient resources.

So there are lots of ways to get involved. If you have any questions about the West of England Polypharmacy programme, or would like to join our community of practice, please contact Chris Learoyd, Senior Project Manager. You can also contact the national programme team for more information.

Shining a light on bladder and bowel health

Posted on by Vanesther Hamer

Ahead of World Continence Week 2022, Professor Nikki Cotterill talks about her experience of working in partnership with us to identify the needs of people affected by bladder & bowel conditions – and calls for change for those affected.

I have worked in the field of continence research for almost twenty years now and, since the very beginning, I have always been struck by how difficult bladder and bowel leakage is to talk about. And yet we know that being able to talk about these experiences is so vital to helping people who are affected by the conditions to understand that they are definitely not alone, and that things can be done to try to improve symptoms.

Whilst we are breaking taboos in many areas of healthcare, the voices of people who experience bladder and bowel leakage are still struggling to be heard – and this needs to change. For a long time, my work has focussed on how we improve our ways of reaching out to people with these symptoms, so that they do not feel alone and can be helped to improve their symptoms where possible.

We don’t talk about bladder and bowel health nearly enough and this really needs to improve to bring about change and break down the barriers to helping people improve their situation instead of just putting up with it. Dame Deborah James (Bowelbabe) is such an amazing advocate for getting us all to talk about our bowel health, but it is such a shame it takes such a sad situation to shine a light on this area of healthcare, that we are all too embarrassed to speak about.

While incontinence itself isn’t life threatening – a factor which can make it easier to ignore rather than be taken seriously – the daily experience of living with these symptoms can be absolutely devastating and most definitely quality-of-life limiting. The avoidance of exercise, the avoidance of family and friends, and having to always think twice about every situation (due to the fear of a potentially significant and embarrassing accident) are very common impacts.

Such life-limiting conditions are worthy of healthcare discussion and deserve the recognition that improvements could – and should – be made.

The Voices for Change project that I was privileged to be involved in on behalf of the Bladder and Bowel Health Integration Team (BABCON HIT), and in partnership with the West of England Academic Health Science Network and Disruptive Thinking, provided a much-needed opportunity to really hear the voices of people who experience bladder and bowel leakage and what it is like to live with this day in, day out.

The people involved were incredibly humbling, talking so candidly about the difficulties they face and their desire to see things improve for themselves and the many other people also affected. There is a palpable need for progress in many areas of society – smashing the taboo, encouraging conversations, valuing bladder and bowel health and in so doing ensuring society provides for people with difficulties by making services easier to navigate and not limiting our local environments due to lack of toilet facilities. Closely associated with all of this was a strong message around the impact on mental health for people who experience these symptoms and the struggle of constantly managing these symptoms while they remain shrouded in secrecy.

My sincere hope for this report is that it is read and fully considered by all audiences who have the potential to make a difference. Any one of us, or a friend or family member, could experience these symptoms at some point in our lives – and so I am sure we would like to make a difference to improve the quality of life and ease the burden of bladder or bowel leakage for ourselves and our loved ones.

This is a heartfelt plea to decision makers, commissioners and those shaping services to recognise the importance of these so often overlooked symptoms and make a change where significant differences can be realised. Let’s invest in our bladder and bowel services and enable more people to access the right self-help advice and education at an earlier stage of their symptom journey, to make a difference before things decline.

To those with creative and innovative minds, how can we demystify bladder and bowel health and get people talking, reaching out to others in the same situation, and destigmatise these symptoms so that the barrier of secrecy is removed?

For those working clinically or in caring roles in all health and social care areas, are we doing enough to encourage conversations and identify incontinence to help people navigate a path to education, advice and treatments?

We now have such an enhanced focus on our wellbeing in everyday life, which is a refreshing advance in society and very much needed. I challenge this focus, however, to do better in regard to including bladder and bowel health wellbeing. Let’s give bladder and bowel health it’s time to shine.

 

Find out about the Voices for Change project here.

Sharing impact stories

Posted on by Vanesther Hamer

In her latest blog, Natasha Swinscoe, Chief Executive of the West of England AHSN celebrates the ever-growing community of innovators and improvers across the region who shape and drive our work and have shared their stories in our new online impact review for 2021-22.

Providing a simple ‘elevator pitch’ for our AHSN isn’t easy. Whenever I ask my communications team to come up with something short and succinct for me, they generally challenge back by saying it depends on who we’re talking to, which I must admit is a fair point.

Our AHSN works with so many different people, teams, organisations and sectors – how and what we collaborate on will vary depending on their need and starting point. That’s part of the beauty of the work we do and our approach.

I recently moved house and, when meeting our new neighbours and making new friends, I’ve been having to describe what we do a lot. My go-to phrase has been “we support the NHS to adopt proven innovations that improve safety, efficiency and make the services better for patients and if there isn’t a proven solution, we work with innovators to create and test one”. I think that’s a pretty good summary, and I’m sure my communications team will thank me for that later!

But while I’m rather proud of that description, I acknowledge there’s no way we can convey in a sentence the depth and breadth of the work we’re involved in and the vast range of people across the West of England that get involved in shaping, driving and delivering what we do together.

This is why creating and publishing our impact review each year is so important to me and why I take great pride in pointing people to it. In part, it’s a marvellous celebration of what our regional health and care community has achieved together. But it’s also a fantastic opportunity to share the many stories of what that work means for people from a wide spectrum of backgrounds and disciplines.

This year’s online impact review is no exception. It is rich with impact stories, from a very personal level to a much more wide-reaching, system-changing level. Whilst I do love the year in numbers section, it’s the stories that best describe for me our approach to healthcare innovation and improvement.

There’s a GP talking about our support to establish a diabetes community of practice; a community activist explaining how our AHSN has opened doors for them in working with the NHS to tackle health inequalities facing Black mothers and their babies; a patient contributor who acknowledges being involved in one of our projects as a ‘great achievement’ in her life – so much so it has encouraged her to pursue a career in nursing; and several commercial innovators who say they have benefited from our continued support as a critical friend over the years to develop and get their products into the NHS.

Those are just a handful of examples. Time and time again the experiences of those we’ve featured in this year’s impact review combine to paint a clear picture of a responsive, dynamic, proactive organisation that listens, supports ideas, connects people together to make things more than the sum of their parts and really make things happen that make a difference.

I hope you enjoy reading this year’s impact review and feel inspired by what we’ve achieved and the stories of those involved. I hope you will also want to join our ever-growing community of passionate healthcare innovators and improvers.

There is still much work to do. With our three Integrated Care Systems driving through massive changes including the creation of new Integrated Care Boards, I look forward to working closely with our system partners in exploring together how the development, adoption and spread of innovation can play a significant part and where it can add most value to the work of teams across the region in addressing local priorities.

We have also just published our refreshed business plan for the coming year, which details many activities we have already identified to tackle some of these priorities, as well as opportunities for us to continue engaging, listening and learning from colleagues across health and care, researchers and academics, the voluntary sector, patients and the public in shaping this work and directing proven innovation to where it is most needed.

I look forward to continuing on this journey with you.

The power of language

Posted on by Vanesther Hamer

In response to the growing commitment in the region to work together to address inequality and inequity within maternity and neonatal services the Regional Perinatal Equity Network was launched in July 2021 by the West of England and South West Academic Health Science Networks. In this blog, Katie Donovan Adekanmbi, Inclusion and Cohesion Specialist from BCohCo talks about her experience of attending the Network to discuss the power of language…

Not knowing what to say and how to say it when discussing Diversity, Inclusion, Cohesion and Equity (DICE) can make for an uncomfortable conversation. Bumbling over our words revealing our lack of vocabulary and confusing schools of thought when discussing protected communities can provoke a level of anxiety high enough for some to justify avoiding ‘the conversation’ completely. However, I am here to tell you that ‘unless it feels uncomfortable you are probably not doing it right’.

One trait of an inclusive leader is an insatiable curiosity for difference. So, I’m inviting you, as I did with attendees of the April Regional Perinatal Equity Network (RPEN), to lean in rather than out when your discomfort is activated…

What I have found to be true – as a woman of dual heritage, thriving with neuro divergency and proud of her working-class roots – is that we aren’t going to build cohesive communities by avoiding the difficult conversations. We won’t swim in the sea of creativity and innovation should we choose our comfort over discomfort and vulnerability any longer.

In my experience, navigating the ambiguous states of mixed ethnicities, neuro-divergence and class has created a resilience I never knew possible. So here’s my confession, never have I achieved more learning than when putting my preverbal size nines in it.

Getting to work

The reality is we are always combating bias, prejudice and discrimination. Organisations dress it up in the positive packaging that is Diversity & Inclusivity or DICE but make no mistake the reason we are fighting for DICE is because the playing field is not even and bias shows up everywhere. I feel very assured by the fact that everyone has biases. No one has made it to a ‘perfect’ bias-free status. We all have work to do, and the work is continuous.

The Covid pandemic exasperated inequalities and left us no choice but to face some serious disparities and biases in our society. Those in care homes initially left out of contingency plans; people trapped in poverty without their support services; those facing domestic abuse. The exam results scandal revealing postcode and class bias. People of colour disproportionately affected by Covid19 and the Black Lives Matters protests erupting on the international stage.

Why focus on maternal inequity?

When focusing on maternity we now know that Black women are 4 times more likely to die during pregnancy or in the postnatal period than white women (Knight et al 2019 MBRRACE-UK). Stillbirth rates of Black and Black British babies are over twice those for White babies (Muglu et al 2019).

In addition, it is accepted that there are inevitable “near misses”, experiences of poor care and psychological impact that have not yet been a focus of research, further adding to the burden of trauma carried by Black women.

The reasons for the disparity are described as a “constellation of biases” (Knight 2020); systemic biases preventing women with complex / multiple problems receiving the care they need ante- and postnatally. What is clear is the diminishing tolerance to the impact of unconscious bias, stereotyping and lack of diversity competency that result in health services that are not safe for all.

Now professionals want to have the uncomfortable conversation, in fact they need to have the conversation. Whether regarding Race, LGBTQ+ or Disability to name a few. Professionals need to know how to better serve their colleagues, patients and team. Whatever your area of expertise we are fast realising that bias shows up everywhere.

So why focus on language?

‘Language is the mirror to our values and principals’ so ensuring that we are using the right language is essential. As this can reveal quite quickly where we stand on an issue, what our personal and private views, opinions or even politics are.

As individuals we need to get cross culturally literate as an essential core competency. Equal in importance to communication, negotiation and safeguarding skills.

If equality is treating everyone the same and equity is assessing individual need to socially prescribe, then there is permission in equity to ask the questions needed to better serve patients. Ask the necessary questions to serve patients effectively. However, know why you are avoiding awkward moments or questions. Marginalised groups have had information extracted for the comfort and convenience of professionals and the system for too long. The acronym BAME being an example of lumping the ‘global majority’ into a four-letter acronym for convenience despite it being reductive and damaging.

My work with the AHSN on projects such as Regional Perinatal Equity Network and Black Maternity Matters will continue, and as part of that we’ll continue to explore the power of language and why it is so important in starting and continuing the conversation to ultimately improve patient safety and care.

Join the next Regional Perinatal Equity Network on 14 July.

Find out more and book your space.

A conversation with Robert Woolley

Posted on by Vanesther Hamer

Robert Woolley was a founding board member of the West of England AHSN since our very earliest days when we were first licensed by NHS England back in 2013. With a distinguished career in the NHS spanning more than 30 years, he retired as Chief Executive of University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) at the end of March 2022. Before he stepped down from both roles, Robert took the time to share some of his thoughts and recollections with us.

You were involved in establishing the West of England AHSN right at the start. What were those early days like?

I think the shape of what was to become the AHSN was a bit uncertain in the beginning. We spent quite a lot of time in the early days talking through what it would mean to translate the thrust of national policy into what it would mean for us locally and how the partnership could work most effectively together.

One thing that was clear from the start was that we were all in it because we wanted to make a difference to patient care. However, there were all sorts of agendas then around, particularly around innovation.  There was discussion of creating innovation pipelines and gaining greater access to industry, which should not be novel and difficult, but can be in the NHS. Engaging with us is something the private sector still struggle with, so that was a big focus from the beginning.

How would you describe the landscape in which the AHSN operates?

It is a constantly changing landscape and that is undoubtedly a challenge. On the one hand you have the creation of Integrated Care Boards and Integrated Care Systems that do not mention much about clinical research in particular and innovation more generally. Their focus is on integration, which is fair enough. On the other hand there’s a constellation of applied research centres: the Biomedical Research Centres, the Clinical Research Network, the Academic Health Science Centre and Bristol Health Partners, as well as the AHSN.

I think this offers the AHSN an opportunity as we have the ability to shape the landscape in a way that is appropriate to all these partners.

How have UHBW and its clinicians benefited from being a part of the West of England AHSN?

It has been fantastic seeing work such the Emergency Department Checklist, PReCePT and PERIPrem initiated here in the West of England and then spread across the system. They are all brilliant examples of what can be achieved as part of the network the AHSN provides. AHSN staff have worked collaboratively and supportively with UHBW clinicians who alone would not have been able to drive the change and engage their clinical colleagues in making changes to practice. It is that support and collaboration that’s been the ingredient for success and I think it is something this AHSN has done from the start and that has really helped it to thrive.

What did you get from being on the West of England AHSN Board?

For me personally I got a huge amount out of being part of the AHSN Board. It widened my exposure to colleagues from around the region and also provided a real personal learning and development opportunity, and a chance to influence the AHSN’s approach.

Being at the heart of it we got see the results of the work around adoption and spread and what it meant to patients and staff. It meant improvement and innovation were not just empty words, abstract nouns. They make a real difference, something that was reinforced by the positive feedback I got from inside my organisation.

What do you think are the key challenges ahead for the local health and care system?

The challenge is a huge one and the complexity is growing with the development of Integrated Care Systems (ICSs). I believe the commitment to engage with local systems, which Tasha Swinscoe (chief executive) and the whole board hold close to their hearts, will help the AHSN navigate this. We also haven’t mentioned the pandemic. Taking account of and responding to its effects will shape our work. We have to respond, support the recovery, and ensure equality of access to services and health outcomes remains at the heart of what we do. There are opportunities, and some work has accelerated, but there is recovery work to do as well.

 

Translating academic research ideas into health and care innovation

Posted on by Vanesther Hamer

Faiza Abdul Aziz is an impact administrator and master’s student at the University of Bath, who recently attended our Lunch with Impact event for University of Bath researchers, hosted by our Industry and Innovation team. In this blog, Faiza shares her insights and learnings from the session, including how the AHSN can support academic researchers and innovators to work with the NHS health and care system.

The virtual ‘Lunch with Impact’ on 30 March focused on the theme of translating research ideas into innovations that promise better health and care outcomes. We were joined by the team from the West of England Academic Health Science Network (AHSN), who gave us an insight into the role of the AHSN, how to navigate the NHS as a marketplace for innovations, and the support AHSN provides for researchers at the University of Bath.

Dr. Cheryl Scott (Industry and Innovation Lead, West of England AHSN) started with a beautiful childhood reminiscence of playing in the grounds of the University of Bath and finding innovative ways to hide from the security; linking this story with the role of AHSN in “finding solutions to problems.”  Dr Scott explained that the key to working on research and innovations for better NHS outcomes is identifying the market/demand pull, which addresses current needs of service-users, as opposed to a technology push, which looks for ‘a problem to the pre-conceived solution’.

Dr Scott outlined that England’s 15 AHSNs function as the innovation arm of the NHS, with a collective aim of transforming lives through healthcare innovation. Some of their priorities include improving the innovation pipeline, supporting digital transformation, and building capability and sharing knowledge, across NHS services including, but not limited to, mental health, maternity and neonatal, and medicines safety.

Professor Nigel Harris (Director of Innovation and Growth, West of England AHSN) further explained how the NHS is changing with the development of integrated care systems and this brings big opportunities to find the right solutions; ones which can transform outcomes through a product or service that addresses identified problems.

These priorities differ between systems within the NHS and also locally. Some of the current motivations include reducing burden on GPs, developing a prevention agenda, and facilitating early discharge from services. Research ideas and innovations that address recognised problems and priorities are more likely to gain traction within the NHS.

Finally, Dr. Richard Stevenson (Research Associate, Department for Health and Innovation Advisor, West of England AHSN) described the different ways in which the AHSN can support the researchers at our university.  Dr Stevenson outlined that he is available to support researchers through the process of requesting support from the AHSN including advising on the documentation that you will need to complete.

So, what support can the West of England AHSN provide researchers and innovators at the University of Bath?  There is a range of support on offer, including:

  • Understanding current health and care needs, through access to early-stage clinical input from lead clinicians, and connections to Patient and Public Involvement (PPI) and other subject matter experts
  • Developing a value proposition, with credible and coherent claims to demonstrate the value of your product or service to the NHS
  • Generating the evidence to support the real-world evaluation (proof of value) of the service or product
  • Signposting to resources including funding opportunities, medical regulation and support with commercialisation
  • Engagement with health and care organisations (including NHS) and industry
  • Advise on funding applications and provide letters of support for funding applications

The Health and Care system/NHS has huge opportunities for research ideas and innovations that can improve or increase the care provision. However, the landscape is competitive and selective, which is where the AHSN helps researchers in identifying current priorities, connecting with the experts in the field, and obtaining funding for their innovations. The AHSN provides catered support for the researchers at the University of Bath in planning and achieving research impact, allowing a massive opportunity to translate your research idea into an innovation that transforms patient and NHS outcomes.

As a master’s student myself, I can say that often, as students, we tend to get caught up in research in terms of addressing a gap and devising research questions and methodology; but rarely do we think beyond the final written research paper. Attending the ‘Lunch with Impact’ session gave me an insight into how a research output is not necessarily the endpoint, but rather should be the beginning of creating an impact; for which it is important that you address a relevant research question, understand whom this might be important to, and consider how to best engage and disseminate your research in order to create an impact.

If you are an academic researcher / innovator at the University of Bath, interested in translating your research ideas and insights into positive outcomes for patients and the NHS, then contact Dr Richard Stevenson at the West of England AHSN to discuss.

 

Visit our Innovation Exchange for industry and innovation news, guidance, opportunities and events.

 

The value of coming together with MatNeo colleagues

Posted on by Vanesther Hamer

Bea Chubb is a Midwife at Yeovil District Hospital and is currently on secondment to the West of England AHSN project managing local delivery of the Maternity and Neonatal Safety Improvement Programme (known as MatNeoSIP).

In this blog, Bea tells us what she’s learnt during her time at the AHSN and how valuable it is for MatNeo teams to join the AHSN and peers at MatNeo Patient Safety Network (PSN) meetings. Bea also tells us what’s on the agenda for the next meeting on 24 May…

I feel I am in a very fortunate position to be working clinically as a midwife alongside my secondment as a Senior Project Manager with the West of England AHSN. It has made me look with fresh perspective at the impact of Quality Improvement (QI) projects on Maternity and Neonatal care, such as with the hugely successful PERIPrem project. The data collected for PERIPrem has never been ‘just numbers’ to any of the team involved, there is always an acute awareness that these are vulnerable pre-term babies and their families. However, it has been a truly life changing and unique experience for me to provide care for ‘PERIPrem babies’ and meet their families on a clinical shift and the next day come to work in my AHSN role and analyse the data!

This balance between clinical and AHSN roles has also opened my eyes to the benefits of MatNeo PSN events. Despite working clinically as a midwife for ten years, it was only when I began my secondment that I discovered them – and I am so glad I have. I now talk about them to my clinical colleagues all the time – they offer so much in a few hours! These events are for all health care professionals (neonatal nurses, midwives, doctors etc) and students but also for women, birthing people and their families. The patient/parent voice is considered throughout and sharing a training/education space with parents is so important.

During a time where we have been unable to come together physically for conferences, and even if we could staffing doesn’t often allow for it, the virtual PSN events are a great resource and networking opportunity. Being able to register for them even if you cannot join on the day and receive the videos after the event is a brilliant resource for busy front-line staff.

I see the role of the PSN becoming more important in light of the latest Ockenden report, which, amongst its devastating findings, discusses the importance of teamworking, culture and staff development. While PSN’s are not strictly staff training, they do provide a platform for shared learning, address topics like culture and escalation and create a safe space for staff to have important discussions.

As we move forwards, exploring ways to improve maternity care after Ockenden, I see the PSN being able to play an ever-growing part in improving not just patient safety but also helping to address the psychological safety of staff. The topics covered very much reflect elements of Ockenden and as a team, when we are organising these events, we very much have at the forefront of our mind ‘what is useful for busy staff’, I ask myself ‘what topics do I want to hear about’ in my usual day job. Hopefully this is reflected in the exciting agenda that we have for our next morning event on the 24 May . We’ll be sharing innovation around managing maternity emergencies, updates on PERIPrem, we look at escalation and also feature discussions about Ockenden and how the MatNeoSIP can help support trusts implementing the Immediate and Essential Actions.

When I started my secondment with the AHSN I thought that being a midwife would help me meet the objectives of the post, I had not envisaged how much working with the AHSN – and what I would learn – would make me a better midwife, and now I want to share to make sure all midwives have the chance to get involved. As I enter the last couple of months of my secondment, I am grateful to my amazing colleagues for the learning and experiences. I am really excited for our last event together and to take all that I have learnt back into clinical practice and continue to spread the word about the PSN events.

Book your space at the 24 May Maternity and Neonatal Patient Safety Network.

 

Patient and public involvement (PPI) to initiate positive change for people affected by bladder and bowel conditions

Posted on by Vanesther Hamer

In this blog by Project Support Officer, Cathy Geary, we hear about the public engagement work the West of England AHSN’s Innovation and Growth team has been doing to gather insight into bladder and bowel continence.

The Voices for Change bladder and bowel continence project is part of the West of England AHSN’s Create Open Health programme, which we are running in partnership with Bristol Health Partner’s Bladder and Bowel Confidence Health Integration Team (BABCON HIT).

One in five people in the UK live with bladder and bowel conditions, which is huge. It affects people of all ages, across all life stages and is a challenging and sometimes ignored, somewhat taboo, health issue.

This was one of my first projects at the AHSN and one that I feel passionately about, due to personal experience. Personally, my problems started after the difficult forceps delivery of my first child. Continence was something I had previously taken for granted, when suddenly I began experiencing symptoms. I was exhausted and had a new born to look after. I was lucky that things did improve for me (with the support of an app that provides pelvic floor muscle exercise programmes), but this piece of work has given me such an insight into how difficult life can be for people living with these conditions.

One of the aspects that I have most enjoyed has been working in partnership with Amy and Yiuwin from Disruptive Thinking Ltd and Nikki from BABCON and also members of the team at the AHSN.  It was clear from the start that we all feel passionately about this cause and want to make positive changes for those affected.

Our objective was to enable people with lived experience of bladder and bowel conditions to share their experiences with us, in order to generate insights which can be used to inspire new innovations and future awareness campaigns. Involving people with lived experience is known as patient and public involvement (PPI) and is an important aspect of health care – but is not always easy to achieve, often because it can be hard to reach certain groups of the population.

Throughout the process, the team worked with a friendly rapport to solve challenges, apportion tasks and give feedback with professionalism and gentle humour; online team meetings were a pleasure to attend and minute. Sadly, real life meetings weren’t possible due to the Covid situation.

We began by planning a series of online group sessions/workshops and the challenge was to promote these to a range of groups of people who commonly suffer incontinence conditions.  It was really rewarding when we started to see people registering to attend the sessions, as this showed that there is an appetite to share and be heard.

The workshops themselves were hugely inspiring.  My role was to listen and take notes, and hearing participants share their stories so bravely – often with candid humour – was very moving.  In the first online session, we had nine attendees of all different ages who, as they spoke, supported each other. Knowing that other people have also been through something that is often so taboo clearly provides some comfort.  We noticed how certain themes were emerging of how difficult everyday life is for people living with incontinence. Travelling, working, the lack of clean public toilets, dealing with the stigma and frustrations at times trying to navigate the health system. Some of the commonly used language and stereotypes are also unhelpful. I myself have felt the competitive pressure in society to ‘toilet train’ a child who wasn’t ready before they started nursery.  There are many children who take longer to gain full control and it is very difficult for parents and schools to deal with this, which can lead to longer term challenges.  The effect of the condition on mental health was a common thread throughout the interviews.

After the third session, we had a rich picture of stories but still felt that voices of certain groups were missing, and so we added two further methods of engagement to our approach; a survey was devised, and one-to-one sessions were offered. The perspectives from this phase further added to the picture and provided new insights.

The project team is now working on the key learnings report, and I am excited to see what it will look like and what people will think of it. My hope is that this work will provide useful inspiration to solve some of the challenges in this area and will get people talking about this important matter.

To find out more about this project, and stay tuned for its soon-to-be-published key learnings report, visit the Create Open Health Voices for Change web page, here.

Additional Support

For information, signposting and confidential support, we would also like to highlight the national helplines provided by:

In addition, BABCON recently launched a free app which provides education and advice to help people to understand their symptoms and try out things that might help. The CONfidence app provides practical help at your fingertips. It brings together trusted and reliable information, informed by people with lived experience and national experts providing specialist bladder and bowel care.

You can find out more about the app and download it to your iPhone or Android phone here.

The Voices for Change project is the second run of the Create Open Health Programme. The programme first launched in 2019 and focused on building resilience in young people and supporting positive mental health. To read more about the first project, visit its web page here.

 

 

Why every healthcare professional or commissioner has a role to play on No Smoking Day and beyond.

Posted on by Vanesther Hamer

Mark Juniper is a consultant in respiratory medicine at the Great Western Hospital in Swindon. He also works as a clinical lead at the West of England AHSN. Over the last year, Mark has been working on our adoption and spread safety improvement programme. This is part of a national programme using a collaborative approach between acute hospitals helping to deliver improved care for patients with respiratory problems such as severe asthma and COPD.

In this blog, Mark reflects on how vital it remains, as the adoption and spread programme draws to a close and we mark No Smoking Day on 9 March, that colleagues across healthcare systems encourage patients to stop smoking…

As a doctor who sees people with lung disease, I have spent a lot of time encouraging people to stop smoking. Smoking tobacco is the single most important cause of preventable death and illness and services that support smokers to quit are very cost effective. Every healthcare contact represents an opportunity to help smokers to quit. This starts with very brief advice and continues with the provision of treatments that help patients to stop. Ideally all of these people should be referred to specialist smoking cessation services. Sadly, this doesn’t always happen and in some areas, there is limited service provision.

No Smoking Day gives us a great opportunity to highlight the impact of smoking on health and help our patients to improve their health by quitting. Every hospital admission represents a chance both to identify current smokers and to provide them with advice and support to stop. Hospital admission is a particularly good area to focus on as people are not able to smoke while on the hospital ward. A short period of enforced abstinence gives us a chance to offer treatment that will help patients to quit.

I have been involved in quality improvement work in the NHS for much of the last ten years. For me, variation in how things are done has become a ‘red flag’ that identifies an opportunity for improvement. Sadly, smoking cessation is one of these areas. We don’t always ask people if they smoke and even when we do, we aren’t consistent in offering advice and treatment. Sometimes it can feel as if we are too busy even to take the time to offer brief advice. What this actually does is add to our future workload!

Over the last two years, hospitals across the West of England have been working together to deliver a group of interventions that reduce readmission rates for patients admitted with chronic obstructive pulmonary disease (COPD). This is one of the diseases caused by smoking and also one of the most common reasons for hospital admission. During this time, we have increased the referral rate to smoking cessation services in our hospitals from 41 to 58%. There is clearly lots more to do but every patient who quits will experience less ill health – and that will help to make us all less busy in the future. Surely a win-win like that is a good reason to act!

No Smoking Day is a call to all of us to take action – and that should include personal reflection if we ourselves are smokers. Everyone can play a part in helping smokers to quit. That includes healthcare professionals working in primary and community care, acute hospitals, mental health and maternity services. It also includes those with responsibility for designing and commissioning local services. Don’t forget the influence we can have on friends and family too. To make the most of all opportunities that will help improve health – remember that every contact counts. All of us can make a difference!

Piloting child-parent screening to detect FH and save lives

Posted on by Vanesther Hamer

In this blog, Rachel Gibbons, Programme Manager, speaks to GP Dr Amy Howarth whose practice in Gloucestershire is participating in the Child-Parent Screening Service Programme. The Child-Parent Screening Programme is currently being piloted, initially for 24 months, across seven AHSN regions, including in the West of England.

The programme aims to identify families with Familial Hypercholesterolaemia (FH) through the use of a simple heel prick test undertaken at a child’s one year immunisation appointment. FH is an inherited condition which can lead to extremely high cholesterol levels. In those children with a reading of >95 percentile, further genetic testing can be undertaken for family members. FH affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed.

Without treatment, FH can lead to heart disease at a young age and significantly increases the incidence of fatal or non-fatal heart attacks. Early detection of FH is important as, if started early enough, treatment gives patients the same life expectancy as the general population.

Child-parent screening offers a population wide, low-cost solution to the management of CVD and is currently the best model for FH detection.

Dr Howarth, why was it important to you to be part of this new programme?

I have Familial Hypercholesterolaemia, so when I heard about this project, I was quite keen to get involved.  It’s a really interesting way to potentially increase the diagnosis rate and find more cases.

Apart from those times when there’s a very high cholesterol result, I’m not sure we’re (in primary care) considering FH as often as we could. This programme can help change that.

I was eleven when my dad had a heart attack, in fact it was on my 11th birthday.  He was 39 and he went off to work and then my mum had a phone call from his boss saying they had called an ambulance for him.

He was taken to the BRI in Bristol, made a recovery and came home five days later on Christmas Eve – people had longer inpatient stays for MIs (Myocardial Infarction) then. They said that his cholesterol was very, very high and that my sister and I both ought to have our cholesterol tested.

Mine was 6.8 I think at that time and hers was 8.8 so they made the diagnosis of Familial Hypercholesterolaemia. There was a great deal less in the way of diagnostics at that point, no genetic testing or anything, no lipid clinics that I remember.

My parents were advised that we should follow a low-fat diet. No medication was suggested at that time. It wasn’t until I was 17 that my GP prescribed statins and apart from four or five years off when I was trying to get pregnant, being pregnant and breastfeeding, I’ve been taking them ever since.

So, did you feel was there was much support for you as a patient at that time?  It was obviously a big shock what had happened to your father.

My father is 72 now and he still gets emotional thinking about that time. My mum was told that he might not make it to the next day. It was all touch and go.

They were also worried about me and my sister. And now I’m a parent, I can imagine how hard that was.

I was referred to a lipid clinic in my 20s. I’d been on statins for several years and my GP wanted to check I was on the right treatment, whether we should be doing anything else.

We know a great deal more about FH now and there’s a lot more support available.

My daughter has been tested and will continue to be monitored.

So, it’s still early days for your Practice, but now you have started to screen children, how have you found it?

We’ve been screening for six weeks and we’ve found that it’s been well received. Everyone who has brought children for their immunisations has wanted to take part in this screening.

And it’s been a straightforward procedure once we’ve gotten used to it and we’ve settled into a routine.

What would you like to see for the future for child-parent screening?

I’d love to see the pilot be successful and demonstrate an increase in case detection rates.

And if it then gets rolled out across the country then that would be amazing.

It would mean that as primary care nurses and doctors we’d be much more aware of FH and FH screening generally. If screening happened at everybody’s one year immunisation appointment, it’s bound to raise awareness amongst healthcare professionals.

I think if it was something that happened nationally, then my nurses would be quite pleased they were involved from the outset. It’s quite exciting to be involved in something that might lead to a national change in practice – and ultimately save lives.

It’s good to be able to talk to the parents about FH as well; people don’t always realise, that by identifying FH in their baby we’re potentially helping lots of other family members too.

I think it’s going to make a big difference.

What would you want other GPs to know if they were considering joining the pilot?

I would say “do it!”.  It’s been a good experience so far and it hasn’t taken lots of resources or time.

I’m also keen to know how else we could use the point of care testing machine and whether it’s something that might be a good asset to the practice in the future.

We don’t get all that many opportunities in general practice to be involved in research if you’re not a dedicated research practice, so it’s something exciting and valuable to be involved in.

Get involved

If your GP practice in the West of England and would like to get involved in this programme please contact Rachel Gibbons, Programme Manager – rachel.gibbons10@nhs.net.

Read more about our cardiovascular disease (CVD) programme, including the roll out of Inclisiran.