Author: Vanesther Hamer

Meet the innovator – Tommy Parker

Posted on by Vanesther Hamer

In the first of our Meet the Innovator blog series, which spotlights the Founders and CEO’s making a difference to the lives of others, we meet Tommy Parker, CEO of KiActiv® – a clinically proven digital therapy designed to improve the self-management of long-term health conditions. Here he reflects how support from the West of England AHSN helped him to navigate the health innovation eco-system, accelerate the spread of his technology and steer his strategy to success.

At the beginning of our journey into Digital Health people would say that trying to establish our innovation in the NHS would be the end of us. The common perception, even from those within the system, was that you would run out of money before you were able to see people benefit from your innovation. You might think this was hyperbole, but I’m sure for plenty of people it was the truth.

Since then there has been a dramatic shift in the understanding of, and approach to, innovation within healthcare. The NHS as a whole has undergone a significant cultural change, with digital services and the ability of patients to look after themselves being central to the future vision, and frameworks in place to support innovation to achieve these long-term goals.

Early work with the West of England AHSN:

In 2015, the West of England AHSN launched a ‘diabetes mobile health challenge’ (self-management in a digital world), which was developed jointly with Diabetes UK and the regional health and care community. The purpose of this challenge was to identify established digital solutions locally to support and promote self-management of both type 1 and 2 diabetes. KiActiv® was one of five successful services selected to pilot our innovation in the West of England region, and subsequently became a partner in the national Diabetes Digital Coach Test Bed, one of the seven wave one NHS Test Beds.

Working with the West of England Academic Health Science Network on these projects provided us with introductions to regional clinicians and commissioners, enabled us to evaluate our digital service in a real-world NHS environment, and raised our company profile through speaking opportunities at regional and national events.

The collaboration with the West of England AHSN and NHS Gloucestershire CCG has enabled us to continually refine the service offering and provided evidence to demonstrate efficacy and positive user experiences for people using their programme. As a result, KiActiv® Health was commissioned by NHS Gloucestershire CCG for self-care and prevention, and our impact was recognised as a finalist at the 2018 Health Service Journal Awards in the ‘patient digital participation’ category. Since then, we have continued to deliver measurable health benefit by supporting people with self-care using their personal everyday physical activity, and access to the service has been expanded to multiple other long-term conditions.

Keeping Healthy at Home:

Our experience with the West of England AHSN on both regional and national projects gave us first-hand knowledge of their role within the health innovation eco-system, and helped steer our strategy with respect to accelerating the spread of our technology. This included maintaining an awareness of AHSN programmes, knowing that they represented the challenges being faced locally, which were often mirrored nationally.

The Keeping Healthy at Home Future Challenge posed two key questions, which both resonated strongly with our vision of how an effective and sustainable healthcare system should look. These were:

  • “what if we had technology, knowledge and the confidence to manage our own condition as an expert?”
  • “what if we could improve health literacy and fully support self-management?”

At this point, it’s worth me explaining a little more about our innovation.

Put simply, we make peoples’ personal everyday physical activity a medicine for improving their health, managing long term conditions, and for rehabilitation. Our mentor-guided digital service empowers people to make sustainable behaviour change in the context of their health, capacity and environment, without the need to visit gyms or clinics. We expand the therapy window, from just one to two hours of exercise per week, to include all ~112 hours of a waking week, and provide a personalised understanding of the value of movement in our daily routines and how to find the opportunities to move more. Our approach has no barriers to age or mobility and it increases patient access to deliver measurable health benefit.

KiActiv® met the needs of the West of England AHSN’s Future Challenge programme and our application was successful. We were subsequently matched with organisations looking at two very different conditions, to demonstrate how we could improve health outcomes by integrating our solution into existing pathways. Replenish-ME focused on augmenting existing services for patients with Chronic Fatigue Syndrome and evaluating our benefit to patients, whilst Moving to Better Health sought to provide a digital alternative to face-to-face pulmonary rehabilitation for those patients with COPD who were either unable or unwilling to take part in existing services.

COVID-19:

Both of these projects, and their evaluations, were designed prior to the impact of Covid-19. We had barely started before the pathways we were integrating with changed, as did the needs of the providers and most importantly the patients. However, it was clear that the vision of the Keeping Healthy at Home projects was now more important than ever and, as a technology-enabled service with remote mentor support, we were perfectly placed to continue delivering services to patients. It is a credit to all project partners, with the coordination of the West of England AHSN (and the unflappable project management team), that we were able to adapt to the changing needs and future outlook of services, and continue to support patients through a turbulent time for mental and physical health.

We had always held the belief that we could provide new, cost-effective, digital pathways for long-term condition management and rehabilitation services where physical activity is a key component, but none of us were expecting a global pandemic to be the trigger that accelerated our delivery of this vision. Alongside managing the impact of Covid-19 on our existing programmes, we knew that we would have to shout louder and work harder to make people aware of KiActiv® and our ability to support patients to self-care at home. This was reinforced every time we had an internal conversation about the potential impacts of physical inactivity during lockdown on the at-risk populations, and when witnessing the astonishing resilience of our users during this time. The adaptation to the Moving to Better Health project served as an example of what could be delivered digitally to provide a continuation of care, and with the West of England AHSN we were able to respond to local needs – rapidly setting up a small project in Wiltshire to support patients who no longer had access to face to face Pulmonary Rehabilitation, due to the lockdown.

Collaborating for a better health future:

Our work in response to Covid-19 has demonstrated a number of things to us both at a company level and also within the healthcare eco-system. We have proven our delivery model and remote-working to be robust in the face of the crisis, ensuring that the people who need our support are able to access it regardless of the situation. This emphasis on the patient is carried over to all of our interactions with healthcare partners, where there is a new sense of agility about how we approach designing a system which is fit for purpose and meets the changing need of everyone within it. This has further highlighted the importance of collaboration, with everyone pulling in the same direction for the same cause being crucial to success. Now, when we share how we’re working successfully in other areas or other conditions, people listen with a sense of shared responsibility, seeking to spread and scale the innovations having a measurable benefit to peoples’ health.

In the second of our Meet the Innovator blog series, we meet Carey McClellan, Founder and CEO of getUBetter – a digital self-management platform for all common musculoskeletal injuries and conditions.  In his blog, he talks about how the West of England AHSN helped him with early ownership of his idea and what our Health Innovation Programme (HIP) taught him about business strategy and planning. Read it here.

If, like Tommy, you are a healthcare innovator looking for business development support and tools, do get in touch with us at the West of England AHSN. We can help. You can visit our Innovation Exchange for expert advice, information about funding opportunities and to make contact with our team to access support.

COVID-19: adaptability and rapid response

Posted on by Vanesther Hamer

In the fourth of our series looking at our learning from Covid-19, Alex Leach, Deputy Director of Innovation and Growth, reflects on the huge opportunities and risks that Covid has presented to innovators.

I have always liked this quote from Charles Darwin, who famously wrote in the Origin of Species, published in 1859,

“It is not the most intellectual of the species that survives; it is not the strongest that survives; but the species that survives is the one that is able best to adapt and adjust to the changing environment in which it finds itself.”

This quote has never been more true that in 2020. It has been an extraordinary year for everyone and no industry has been unaffected as the world continues to cope with the COVID-19 pandemic. Certainly, in the 25 years I have worked in healthcare, both within and alongside the NHS, I have never experienced anything like this.

The Medical Technology industry is, however, perhaps in a unique position. It has needed to respond to the urgent demands of its customers – both in helping detect the virus and in supplying frontline healthcare workers with the means to fight it. But it’s not been easy – companies have had to adapt to a changing economic and NHS landscape, in which supply chains, face-to-face sales interactions, and elective surgeries have all been disrupted. For those medical technology companies not already focused on epidemiology, virology, immunology or PPE, the pandemic has resulted in many challenges. This is a time of huge opportunity combined with significant risk.

At the West of England AHSN, we worked closely with the other AHSNs to collate a list of verified suppliers and companies who could rapidly support NHS members with their needs. In the early months of the pandemic, we saw an outstanding response from industry, supplying ventilators, diagnostic tests and PPE at a record pace. Companies able to respond at speed and scale benefited from large contracts agreed within a matter of days. Companies offered to rapidly repurpose and redesign existing products and solutions, production was ramped up and new ways of working were employed to support a healthcare system under real pressure. The normal slow speed of NHS procurement changed overnight and national procurement frameworks were rapidly put in place. Quality control has remained critical, and companies have needed to work hard to stand by regulatory guidelines to ensure speed did not compromise quality.

Greater collaboration across the system

The AHSN Network halted existing programmes in the early weeks of lockdown to focus on identifying suitable suppliers and products able to respond and support rapid adoption. And together with NHSX launched TechForce19, which sought to identify innovators who could support the elderly, vulnerable and self-isolating during COVID-19 to apply for government funding of up to £25,000 to test their solution.

In our AHSN, we supported applications and provided mentoring support to successful companies, including Aperito and Surecert.

Regional and national blended teams from multiple NHS agencies worked together, alongside industry to identify solutions and facilitate adoption. Funding opportunities were launched to support companies to fund rapid development of urgent solutions needed across the system.

Hurdles to overcome

However, we have observed that this was not a level playing field and not all companies were able to capitalise on such rapid demand. Increasing production takes time and investment and smaller companies often lack the cash flow or the infrastructure to respond at scale. The whole economy has been impacted by the pandemic, which has led to a slowdown or freeze from some investors. There was a surge in investment in medical technology related to COVID-19, but many investors are hesitant to fund medtech that is not directly related to the virus. Some investors are simply waiting to make their investment decisions until the current economic position becomes less labile.

In addition, many technologies that are used in more routine care have experienced a significant drop in usage and the appetite to trial and evaluate products, not seen as pertinent to the COVID-19 response, disappeared overnight. Clinics and surgeries were cancelled and “non-urgent” activities were halted overnight. Many companies have needed to put their sales teams on furlough and seen a substantial drop in income or some remain at risk of insolvency.

New ways to work

I have found it so inspiring to see how companies have been finding new ways to work. The move to home working and virtual meetings has resulted in the usual challenges, including the loss of those spontaneous serendipitous meetings that often create unexpected opportunities. On a large scale, though, we have seen how organisations can work more efficiently from a distance. Virtual meetings can now easily include attendees from across the globe, at short notice with no travelling required. The improvement in the functionality and accessibility of virtual tools allows for speedy data sharing, the development of highly functional virtual teams and created a whole raft of opportunities to deliver healthcare interventions remotely as well.

The pandemic has spurred changes to make the process of regulatory approval and validation more rapid and efficient. The Medicines and Healthcare Products Regulatory Agency (MHRA) started working more closely with industry, academic partners and other healthcare organizations to speed up the pace of testing and trial processes. The overall cooperation between public-private partnerships across healthcare has been a welcome change during COVID-19, and it is hoped that this won’t change after a vaccine is developed for this virus.

Life science business owners have a vital role to play in the industry. There are more than 700 life sciences companies in the UK, all with a growing opportunity to explore existing unmet medical needs, short-term COVID-19 solutions, or longer-term challenges as they come to light.

I believe that while the healthcare industry has uphill battles ahead, medical devices, in particular, will continue to play a critical role in defeating COVID-19. By establishing a collaborative and flexible approach, the medical device industry will find continued success and be integral in the ability of the UK healthcare system to navigate this pandemic and continue to provide improvements in patient care in the years to come.

The severity and unknowns associated with COVID-19 have pushed medical technology companies in new ways, but it has proven to be an integral time for companies to examine how they fit into the medical community’s role when it comes to fighting the virus.

While there have certainly been challenges in the short-term, it’s important to find opportunities where they exist and understand the value in long-term developments, whether they do indeed have the potential to aid in the fight against COVID-19 now or whether they will prove to be vital across the wider system in the future.

The whole AHSN network is committed to continue to work to support the medical technology industry to better navigate the COVID storm and continue to thrive, thereby enhancing patient care and delivering long-term impacts.  My team at the West of England AHSN offers a variety of business development support tools and advice to help health tech innovators get their ideas off the ground, evidence the benefits and grow their business.  Innovators can visit our Innovation Exchange for expert advice, information about funding opportunities and to make contact with our team to access support. Our door is always open.

In the first of this blog series, our Chief Executive Natasha Swinscoe explores how healthcare is changing to manage Covid-19, and considers the factors that helped those on the front-line respond quickly and effectively. Read it here.

In the second of this blog series, Kevin Hunter, Associate Director for Patient Safety & Programme Delivery, discusses how working across systems with multiple partners and the blending of resources, irrespective of organisational boundaries, was a key element of the work we undertook with care homes. Read it here.

In the third of our series looking at our learning from COVID-19, Kay Haughton, Director of Transformation at West of England AHSN, explains how the AHSN used its existing expertise to help healthcare systems during the pandemic. Read it here.

COVID-19: collaboration is key

Posted on by Vanesther Hamer

In the third of our series looking at our learning from COVID-19, Kay Haughton, Director of Transformation at West of England AHSN, explains how the AHSN used its existing expertise to help healthcare systems during the pandemic.

Covid blog badge

As COVID-19 took hold, we became very aware in the West of England AHSN just how busy our operational colleagues were, and that we needed to stop and refocus our work and our staff where possible to support front-line teams in local healthcare systems.

I was delighted to be able to respond when Gloucestershire Clinical Commissioning Group (CCG) asked if I could help them manage their Incident Control Centre. I loved my previous role as Deputy Director of Nursing and working with my colleagues at the CCG, so it was a privilege to help.

What did I learn? Well, a lot about PPE – and as I am a theatre nurse, I thought I knew all there was to know! I learnt how death rates are reported and worked more closely with Public Heath England than I ever have before. I also learnt a lot about testing for COVID-19 and marvelled at how quickly organisations across the county mobilised to respond together, including the military based locally.

Being exposed to this unprecedented situation and learning has really helped me to ground the work I was currently undertaking in the AHSN. I became involved with reporting on how care homes were managing and this resonated clearly with the enhanced care home project we had just got underway.

The work on the deteriorating patient we have been producing for the last couple of years had generated the perfect training programme for our colleagues in care homes on RESTORE2, a tool to recognise early deterioration in their residents. In the WEAHSN we are always proud to be ahead of the curve and the RESTORE2 training package is a good example of this.

I also became aware of the Gloucestershire CCG telephone service to support the most vulnerable people who are shielding and I am now part of an AHSN community of practice to share and learn what AHSN colleagues across England have piloted to support the vulnerable.

Clearly an important part of reset and recovery is to recognise the impact COVID-19 has had for the people affected by the pandemic, both physically and mentally. This applies to everyone in society and as such we are reworking our business plan to address the areas where we can add support. Some examples include support to increase the uptake of annual health checks for people with learning disabilities, medicines safety and suicide prevention work, supporting those with respiratory disease and women who go into premature labour, and help for people to make choices about their care at the end of life.

It is heartening to realise that we were already delivering on many of these programmes and we are working at pace to accelerate progress where we can.

COVID-19 has placed unprecedented pressure on our health and care system, particularly in primary care. Whilst immediate focus has been on supporting patients with or at risk of the virus, there is a large cohort of people living with long-term conditions that need ongoing, proactive management to prevent a wave of exacerbations in the months ahead.

We are keen to support primary care by offering support to roll out a risk stratification tool developed by UCL Partners, our AHSN colleagues in London. The package is based on new pathway development, virtual consultations, and the optimal use of the wider primary care team. Additionally, the package includes a selection of digital tools to support patient activation and help patients to manage their conditions at home. This is designed to help primary care teams deliver quality care to patients and meet Quality and Outcomes Framework and other contractual requirements, while releasing precious GP time. This is just one of many ways we are seeking to support front-line colleagues, for more information on this and other programmes please go to our COVID-19 resources page.

To finish on a personal note, I would like to thank my former colleagues at Gloucestershire CCG for welcoming me back so warmly and to my Service and System Transformation team for keeping up the good work in the AHSN. I look forward to working with and supporting you all in the months to come. Stay safe.

In the first of this blog series, our Chief Executive Natasha Swinscoe explores how healthcare is changing to manage Covid-19, and considers the factors that helped those on the front-line respond quickly and effectively. Read it here.

In the second of this blog series, Kevin Hunter, Associate Director for Patient Safety & Programme Delivery, discusses how working across systems with multiple partners and the blending of resources, irrespective of organisational boundaries, was a key element of the work we undertook with care homes. Read it here.

Coming up in the series next week, Alex Leach, Deputy Director of Innovation & Growth, reflects on the huge opportunities and risks that Covid-19 has presented to innovators.

Reflections on hosting virtual interactive workshops

Posted on by Vanesther Hamer

In this Q&A our West of England Academy Project Managers Kate Phillips and Vardeep Deogan share their reflections on the delivery of the Academy’s recent Quality Improvement (QI) Summer Series. They led 10 hours of online interactive workshops and delivery of QI theory by 12 different facilitators to around 60 delegates per session from across the West of England region and beyond. The Academy team have also compiled a series of slides with their top tips on hosting virtual learning.

Vardeep talks about virtual learning

  1. What did you enjoy about the QI Summer Series?

Vardeep: Every part of our workshops had a purpose, so being creative and thinking outside the box with activities without making them complicated was really important. Supporting our guest facilitators was a pleasure too. After our fifth session, we really felt a sense of achievement, and we cannot wait to deliver future online workshops.

Kate: An unanticipated pleasure was coaching our guest facilitators. Vardeep and I were the main hosts, but wanted the series to reflect the wealth of knowledge and range of experiences of working with QI across the West of England. We also figured that our voices might be a bit dull for two hours straight! Considering that online training was a fairly new concept, this meant that Vardeep and I mentored our guest facilitators to deliver their 25 minute activity. The feedback from the guest facilitators was lovely – they felt challenged by the experience but also supported. I think they were all very proud of themselves which was great to see.

The overwhelmingly positive response to the sessions has also been wonderful. Vardeep and I cooked these sessions up, combining our knowledge and experiences and we seemed to have stumbled upon a winning formula!

“Exceeded my expectations – I learnt so much.”

    2. What are the differences between online and face-to-face delivery?

Vardeep: When delivering face to face it’s much easier to ‘read the room’ for non-verbal communication and how people interact with each other, and as a facilitator you respond accordingly. We had to think differently about how to get this feedback during and throughout each workshop. This involved designing activities and including opportunities for feedback using functions like slido, the chat box and voting.

We also considered different learning styles and made certain to include activities that reflected these. Using liberating structures supported this.

Kate: The whole experience is different- quite often I’d be looking at only one or two faces in the corner of my screen, but knowing I was talking to 50+ delegates who had prioritised our training over other work, it’s a bit of a barmy experience really! I think delivering online sessions brings a different type of nervous energy…the adrenaline flows!

   3. Can you tell us about your biggest ‘aha’ moment?

Vardeep: As the series progressed, even though we may have been delivering our fourth or fifth session (and at times felt we were repeating ourselves with instructions for activities etc.) we kept in mind that this may be someone’s first experience on zoom or of virtual learning. I realised the value of clear instructions from the positive feedback we received where our clarity was praised. This was a key learning point.

Kate: For me, a lovely moment during our second session was when Vardeep asked a delegate to turn their mic on and share their experiences verbally with the entire group. We regularly asked delegates to share feedback via the Zoom chat box, but giving individuals the platform to voice their thoughts brought the session alive. It did mean having to relinquish some control, but it was worth it every time. Sharing the platform was important.

“I think I’ve learned more in this two-hour online session than any other face-to-face course I’ve attended!”

    4. Have you learnt any new skills with online facilitation/delivery?

Vardeep: I’ve learnt you have to be even more adaptable and fluid when delivering online. Anything can happen at any time (tech issues!) and you have to be able to step in and pick up anything, whether this is the delivery of a session or an aspect of facilitation. Every member of the team needs to be able to pick up any role and this really stretched me and took me out of my comfort zone – we survived a few hairy moments.

Kate: I had delivered a few online webinars before, but they were very much ‘chalk and talk’ style. I’ve loved learning about, and using, Liberating Structures to keep delegates engaged and to facilitate interaction between them. I’ve also enjoyed thinking creatively to convert traditional face-to-face QI training for online delivery.

   5. Have you learnt anything about yourselves during this project?

Vardeep: Working alongside Kate to plan every session in detail, really enabled me to be fluid and agile to the needs of others, particularly guest facilitators. I’ve learnt that with the right team around you, you can adapt to any last minute change and for it to still feel under control and most importantly – fun.

Kate: I’ve learnt that my happy place is extremely organised and where I’m in control. Fortunately Vardeep is very good at making me feel safe enough to step outside of that and allow space for spontaneity and discussion, and that’s where the magic happens! On the flip-side, I’ve learnt to value the skill of organisation and I don’t think we could have pulled off this series without it.

“Really good workshop today – best I’ve attended during this whole pandemic, so thanks to you and your colleagues”.

  6. What has been the biggest challenge?

Vardeep: You never truly know how you’re being received online until you read the feedback.  Over the five sessions I got used to smiling and talking to a camera instead of being able to make eye contact and responding to non-verbal cues. That often felt odd but it’s vital to the person the other side of the screen.

Kate: At the start I was overwhelmed with the task that lay ahead of us, thinking about all the details. Fortunately I work with brilliant colleagues who made this series a true team effort. I was able to focus on planning and delivering the sessions in a step-by-step way, knowing that the event logistics and marketing of the series were being expertly handled. Breaking down the roles, tasks and working as a team was crucial.

 7. Do you have any top tips for online delivery?

Vardeep: Plenty….

  • As a facilitation team agree a way of communicating with each other behind the scenes (such as Whatsapp). This allows you to adapt, adjust or abandon as you go along.
  • Plan your sessions with timings in mind. This is invaluable and is a skill – things often take longer virtually. This also includes prepping any guests.
  • Allow time for a team pre-brief and de-brief after each session. Kate, Shomais and I always spent time reflecting on what went well, what didn’t go so well and we also captured new ideas to incorporate for the next session on ideaz boards or jamboards.

Kate: I think one of my favourite phrases from this series was “team work makes the dream work”. We couldn’t have delivered such a slick series without the designated online technical support that our colleague Shomais provided. Having clear roles and responsibilities in the team was important, e.g. being clear on who is responding to questions in the chat box, who is co-ordinating break-out rooms and who is introducing facilitators and welcoming delegates back from breaks. I think the clarity of roles and knowing we could depend on each other, created a safe space to do each of our jobs really well.

Thanks to Kate and Vardeep for sharing their experiences.

Further information about the West of England Academy’s online resources and future events can be found here.

Civility can save lives

Posted on by Vanesther Hamer

Aless Glover Williams, Neonatal GRID Trainee ST7, St Michael’s Neonatal Unit and Neonatal QI Fellow supporting the PERIPrem Project on how knowing your team will help ensure Patient Safety.

On World Patient Safety Day, especially as this year highlights ‘Health Worker Safety’, I’m reflecting on the importance of knowing and valuing the individual members of the teams I work with.

Nearly everything we do as doctors centres around Patient Safety. It is in the morning safety brief, the staffing, the clinical decision making, the team-management, the drug checks, the Matching Michigan or WHO checklists, the governance and the documentation. Patient Safety underpins every outcome that we strive to achieve for our patients and awareness of how to make a difference as a professional is essential for every member of the team.

Quality improvement is but one string to this bow as it can not only directly but also indirectly effect change. Through building strong multi-disciplinary relationships and trust we will work better as teams, avoid a blame culture and avoid incivility, which is well-recognised to impact personal performance and functioning for the rest of the day all from a single interaction.

The PERIPrem Project which I’m proud to be a part of has built an amazing, supportive team culture despite being largely put together in the virtual world we now spend so much more time in. I have some close valued colleagues I’ve not met face to face, but that hasn’t stopped us building a fabulous team culture. My colleague Noshin does a fantastic job of describing it here.

So on this World Patient Safety Day take some time to really get to know your team; what is going on in their lives that might effect their functioning? Care for each other, look after each other, look after yourself, take breaks, value sleep and after prioritising kindness to ourselves we will find that we have space to care for others and embark upon new projects. #Civilitysaveslives

Innovating for economic growth

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Steve West, Chair, West of England AHSN and Vice-Chancellor, University of the West of England and Chair, West of England Local Enterprise Partnership on the challenges and opportunities for health, care and the economy, and how the AHSN can help to meet them.

Who would have imagined six months ago that we would be in the middle of a global pandemic that requires us to reimagine our world, our relationships and our way of living, working and thinking? We are in a crisis and it will be human creativity, innovation and ingenuity that will help us through it.

There has been a lot of debate about the Health and Care Reset and how we can rebuild a system that capitalises on the positive changes we’ve had to make over the last few months, such as the rapid uptake of digital tools and the focus on patient safety. The economy is also in poor shape, and that is already having implications for disadvantaged groups and populations, such as people’s mental health.

It’s clear to me that health and wealth are entwined. There are massive opportunities for us to rethink our health and social care system. We need to embrace technology to enhance and free up what we do best – delivering care, human to human. The NHS and care sectors are also huge employers, with significant influence over the prosperity of their local communities.

AHSNs are of course designed to straddle these interfaces of industry, the NHS, social care and academia. The beauty of our board is its wide representation from chief executives and decision-makers across all these organisations, including the West of England Local Enterprise Partnership (LEP), which shares our values of innovation and economic growth.

In our first five years as an AHSN, we developed a great track record supporting innovations and helping them spread nationally. We now have the headroom and flexibility to step back as an organisation and so when COVID-19 hit, we were able to respond quickly. This has included supporting the development of a Nightingale Hospital in Bristol with training and resources, and reaching out to care homes and other community settings to ensure environments were safe and able to care for patients.

As well as being fleet of foot, AHSNs also have the ability to take a ‘helicopter view’ and look at where we need to get to in three or five years’ time. I think there is a danger that we don’t learn from COVID-19 and miss an opportunity to take a step forward, embracing artificial intelligence and technologies that support self-care and promote prevention.

The challenge is how we can shift the focus from illness and put the ‘health’ back into the National Health Service.

The care sector is one area where we are likely to see growth in employment, as we rethink the sorts of jobs we want people to do. Despite being a major employer, until COVID-19 it had been pretty invisible in most economic discourse. We also need to build resilience in communities and see a big effort to reduce obesity; the system will fall over if we don’t.

COVID-19: a common purpose

Posted on by Vanesther Hamer

Covid blog badgeIn the first of our series looking at how healthcare is changing to manage COVID-19, our Chief Executive Natasha Swinscoe considers the factors that helped those on the front-line respond quickly and effectively.

There has already been a lot written on the lessons learned from dealing with the pandemic. Many have commented on the positive impact of the sudden removal of barriers they previously experienced. It feels that during the last four months, clinicians have been empowered to make decisions closer to the action, with more licence to just get on with things.

This was certainly the message Secretary of State for Health Matt Hancock gave in his address to the Royal College of Physicians’ Future of Healthcare event in July. He was reflecting on what he’d witnessed during COVID-19, and espoused the benefits of unshackling health and care staff from the ‘barnacles of bureaucracy’. Coupled with doubling down on tech solutions, this speaks to the innovation world of the Academic Health Science Networks (AHSNs).

Here at the West of England AHSN, we have been supporting our local systems since the beginning of COVID-19, as the initial response to the pandemic was forming. We were able to ‘swivel on a sixpence’, pausing many of our existing programmes and creating new, COVID-specific offers to our systems for immediate delivery. Like everyone else, we also felt empowered to just get on with the job in hand.

Four months on, we are taking stock and trying to distil what we’ve learnt from our experience, to identify what we want to keep doing, but also what worked less well. We surveyed our teams locally and many of the answers will probably resonate with what you’ve already read about in other research: faster decision-making, flatter hierarchies, more collaboration between organisations, the massive uptake of remote working platforms, and the power of coalescing around one single common issue that focuses people’s minds and energies: a shared purpose trumps all.

Not all of this is new or specific to COVID, but it certainly underscores its importance. At the West of England AHSN, we often call this the ‘call to action’ phase, or winning hearts and minds. In the past this phase might have taken more time and was generally achieved through face-to-face contact and workshops. In the last few months though, we’ve launched our new PERIPrem bundle virtually and despite the circumstances, it has been very well received. Senior Project Manager Noshin Menzies shares her experiences of how it went in this blog post.

We’ve also seen the power of unlocking people’s potential to make decisions and activate great ideas, and Twitter has been a great way to share those ideas. Early on in the pandemic, the suggestions to help patients to see who you really are when in full PPE were fantastic examples of people spotting a problem, solving it and sharing it rapidly so others can do the same.

We’ve seen that if you give good people a good reason to do something and the tools to do it, they can respond at an amazing speed. A large number of our AHSN colleagues joined a blended team for three months to roll out digital triage and monitoring platforms across primary care. By putting more ‘boots on the ground’ (figuratively as we did it via Microsoft Teams!) we achieved in three months what might otherwise have taken years.

We’ve also met many new people during this phase, expanding our networks across the West of England, the South West and further afield. The relationship and trust we’ve built with industry and the commercial sector particularly has improved as they have came to the aid of the NHS. I hope this open-borders approach remains, as we have so much to learn from each other.

So, going forwards there are key things we want to retain, and in our Covid-19 blog series, some of my colleagues at the West of England AHSN discuss these further:

  • Working across systems with multiple partners and the blending our resources, irrespective of organisational boundaries, was a key element of the work we undertook with care homes. This work is ongoing and is discussed in more detail by Kevin Hunter, Associate Director for Patient Safety & Programme Delivery. Read it here.
  • Collaboration is key and this really works when focussed around common aims. Director of Service and System Transformation Kay Haughton explains more about our offer to help spread a stratification tool to support shielded patients with long-term conditions. Read it here.
  • Deputy Director of Innovation and Growth Alex Leach reflects on the huge opportunities and risks that Covid-19 has presented to innovators. Read it here.
  • Releasing the power of teams to solve problems is something Janina Cross, our Chief Digital Transformation Officer, has first-hand experience of working with three AHSNs, the NHS SW regional team and seven STPs to support the digitisation of primary care.
  • And Senior Programme Manager Jo Bangoura will be reflecting on the importance of working in a structured way with our systems to capture the learning from COVID-19.

Increasing support workers’ confidence to spot deterioration

Posted on by Vanesther Hamer

Mildred Mhlanga is a manager at Silva Care, which provides various care services across Bristol, including supported living, respite and outreach services. Silva Care’s support workers help service users with medical appointments, making referrals and signposting to relevant health professionals. Mildred felt a knowledge of NEWS2 could complement the skills of their support workers and their offer to service users. And so through the West of England Learning Disability Collaborative, Silva Care encouraged their support workers to sign up to our RESTORE2 training.

Here Mildred reflects on how the RESTORE2 training has helped increase her colleagues’ confidence in spotting deterioration and how they communicate this to healthcare professionals.

The training has enabled staff to check soft signs and seek appropriate medical attention before service users’  health declines. This can be extremely challenging when working with service users with a learning disability who may be unable to let you know how they are feeling, or service users’ whose pain threshold is very high as they self-harm for sensory purposes.

The training has also given staff the confidence to be able to communicate with health professionals in a concise way.

One point of feedback that struck me as very significant was one from our supported living placements in Stoke Gifford. The house has four service users, and they are the oldest service user group. RESTORE2 helped one service user who became unwell.

Gloria (name changed for confidentiality) had a slightly crackly chest, was very sleepy and the night before had been unsettled.

Staff checked her temperature and oxygen saturations and when they contacted the GP, they were able to give her this information and to receive intervention immediately. The GP prescribed antibiotics for Gloria, which meant she was able to be supported from home with staff who know her well, instead of going to hospital.

A week on, Gloria has made a full recovery and is grateful to have been allowed to be at home, especially during these difficult times.

The Senior at the supported living placement informed me that following the NEWS2 training, they purchased the equipment recommended, which was how they were able to record Gloria’s oxygen levels.

The training has really had a huge impact on how staff support service users in identifying health decline and seeking relevant medical help.

Do you support services in the West of England that could benefit from this training?

If so, you can sign up for free RESTORE2 training here.

Would you like to know more about the West of England Learning Disability Collaborative?

If so, visit our dedicated web pages.

Quality Improvement in the age of COVID – launching PERIPrem

Posted on by Vanesther Hamer

Noshin Menzies, Senior Project Manager, shares her experiences of launching a Quality Improvement programme during COVID.

If you’d told me 4 months ago we would be where we are today with PERIPRem, I’d have wondered what planet you were from. This exciting, ambitious care bundle, the vision of two extraordinary neonatologists, was going to launch in April and change the way that perinatal care is delivered across the entire South West region. It was a seed reliant on collaboration. However, 2020 had other plans…

The fundamentals of PERIPRem – nurturing a regional clinical community dedicated to improving outcomes for our most vulnerable babies and working side by side with women and their families – were, in an instant, stopped in their tracks.

Pre-COVID, I had been lucky enough to attend the Royal College of Obstetrics and Gynaecology’s “Let’s Talk about Race” event for International Women’s Day. The stories I heard further cemented the commitment we had to reducing inequalities.  We could not deliver a perinatal quality improvement project without ensuring that we were actively listening – and considering how to chip away at the barriers that result in Black and Minority Ethnic women being 5 times more likely to die in childbirth and their children to experience poorer outcomes. This was even before we knew the increased risk of COVID to people of colour and the raised chance of preterm labour for those women unfortunate enough to contract the virus whilst pregnant.

Just as we finalised plans for launch, and to get out into the communities and find every opportunity to involve those who lives are imprinted by the experience of preterm birth, COVID hit. Our PERIPRem teams were now on the battle lines, and we were nestled behind our laptop screens, shell shocked. Our ability to be agile and adapt to novel ways of working mattered now more than ever.

I’ll admit, I was sceptical how we could launch what was still a seedling of a programme to twelve units across the whole of the South West, when we were unable to leave our kitchens, let alone realise our plans to provide fertile ground for the creation of a regional PERIPRem clinical community. Without a physical launch, how could we provide space for those small but mighty moments, that when cultivated, have more of an impact than any toolkit or presentation?

I often struggle when I have to describe QI; in my experience it is much bigger than a framework or a process by which you can input your problem and wait for gold-standard results. For me, QI has its foundations in the people, the team and the culture. It is the introductions to new faces, teams huddled together around meeting tables, clinicians whispering to colleagues they had not seen for years and the camaraderie brewed alongside the substandard coffee.  We grow highly functioning teams, and the most exciting part of any QI project, on these blocks. It was boom or bust but I needn’t have worried.

We have formed strong bonds as a PERIPRem team; we have even managed a team social. My treasured counterpart in the South West AHSN and I have never met, we joke that we do not know what each other look like from the shoulders down. We have bonded over the many cameos from the PERIPRem teams’ children – or Assistant QI Coaches as they are now known.

Most importantly, the PERIPRem perinatal teams have flourished. Whilst in the pressure cooker of the pandemic, we gave space and time to focus on delivering patient care – when they got a handle on what it meant for them as clinicians, they came back raring to go.  We have digitised all of our resources and are now holding webinars on each of the bundle elements – they are so well attended we cannot fit on a screen!

People have pushed through discomfort to record themselves sharing the clinical fundamentals and to provide the presence (all be it through a screen) we all miss. We are exploring new ways to engage with the women we were so keen to meet and listen to, and we are forever indebted to our patient representatives who are now pillars of our PERIPRem team.

The takeaway message from that tired trope of “these unprecedented times” is that we are stronger than we think. At the end of each exhausting day, when we have had our fill of fighting for bandwidth with Xboxing teenagers, with tired mouths from calmly saying, “you’re on mute”, we have been and will continue to be successful. More significantly, we have supported frazzled teammates, butted horns and laughed until we cried.

There is a sense of freedom this way of working has granted us. Whilst before, there was a tendency to stick to the tried and tested method of engaging and working with our clinical communities, COVID allowed us to think again. We used technology to enable hospital teams scattered across the entire southwest to meaningfully engage in PERIPRem without ever having to leave their wards. I was worried connecting through screens and keyboards would reinforce the distance between us all, but I am surprised to realise that it has in fact accelerated relationships and in turn progress.

Having to rely on the written word in email has meant that tone and intonation have been more carefully considered and the periods of chat offered through video calls means each sentence really counts. Of more significance, is a flattening of the hierarchy within our team. Each person no matter what their seniority is vital in keeping the PERIPRem wheel turning – be it because they know how to record a MS Teams meeting, or because they have the complex clinical knowledge of a perinatal intervention.  It is not that we did not appreciate this before, but the situation forced us to see beyond the limitations of a job description.

I have reflected on whether, upon return to ‘normality’, if we as a team will revert to the pre-COVID way of working. Whilst I would like to think there would be a time when we are able to sit in offices and meet with units, I do not think that is the whole question. I can honestly say I hope we do not – I do not want to forget our swift response to the restrictions placed on us, or our unwavering faith in our ability to make improvements.

I believe that we have fundamentally changed the way we will approach projects such as this in the future. We are braver in our ways of facilitating community, we have lived experience of delivering change programmes utilising technology rather than travel and we know that when needed, we can free ourselves of the legacy of traditional and more restrictive ways of working.

Reflections on working in a COVID-19 environment

Posted on by Vanesther Hamer

Dr. Mark Juniper shares his experiences of adjusting to and working in a COVID-19 environment.

I’ve recently done my first resident night on call for 25 years. For more than 20 years, I have been a consultant in respiratory and intensive care medicine.

Eight years ago I took on the role of clinical coordinator at the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). This led to an interest in quality improvement and several other roles in my trust. Last year I decided to make more time for improvement work. I resigned from my role in intensive care, finishing in December 2019. My new job plan included two days per week of improvement work outside my trust and two days of respiratory medicine. This arrangement lasted less than three months!

During the first week of March, while I was away on holiday, the WhatsApp chatter on various work groups picked up rapidly. There was talk of new protocols, reorganisation of services and new terms such as ‘donning’ and ‘doffing’ appeared. In anticipation of an increased pressure on the service, I was asked if I would be willing to return to the ICU.

My initial temptation was to retreat into QI work, but it rapidly became clear that the ICU was likely to experience considerable pressure. I felt it would be better to step forward quickly or I risked being ‘left behind’ on all the new developments. I stepped back into a unit that at first seemed difficult to recognise compared with the one I had left only three months previously. There had been changes to staffing, rotas, protocols and the fabric of the unit.

The new pattern of work involved 12-hour day or night shifts, often in full protective equipment and was exhausting. I was initially anxious about direct exposure to infected patients and doing simple things such as safely doffing protective equipment. This was not helped by problems with PPE supply, highlighted in the news, although access to protective equipment never became a problem in my hospital and the new routines slowly became familiar.

I also noticed that the mental energy involved in changing to a new system reduced my ‘mental bandwidth’: the ability to concentrate on work other than the clinical task in front of me. This has slowly returned over the last six weeks as the new systems have become more familiar and the peak of the first wave of admissions has reduced.

Now there has been some time to reflect on the experience of working in a COVID-19 environment, a number of positives stand out. The skill and professionalism of so many colleagues have been outstanding. From the detailed knowledge needed to redesign acute services to the compassion demonstrated by the team. The willingness to work flexibly to provide patients with what they need, and to implement new approaches to delivering care.

The importance of every member of the team that helps to deliver safe and effective healthcare has never been more apparent to me. Seeing the cleaners, porters, therapists, nurses and doctors all wearing protective equipment to keep themselves safe while providing essential care is an image that I will take with me as a reminder of the importance of everyone I have the privilege of working with over the last few weeks.

This article was originally published in the Royal College of Physicians Membership Magazine.