In April we held an event focusing on improving health outcomes for people with learning disabilities. Here Hannah Little, Patient Safety Improvement Lead and Senior Project Manager at the West of England AHSN reflects on the day and how it might have kick-started something big. Continue reading “A successful start for the West of England Learning Disabilities Collaborative”
Author: Vanesther Hamer
Getting it right: GPs and end of life care planning
Hein Le Roux is a GP in Gloucestershire as well as being a Clinical Lead for Patient Safety here at the West of England AHSN. In this blog, Hein reflects on his recent experience of guiding a couple through end of life care planning and how helpful ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) was in steering those conversations.
John and Sandra (not their real names) had been married for more than 50 years when I met them, almost by accident, earlier this year. My GP colleague was away on sabbatical and I was asked to do a home visit for a man in his 80s who was feeling unwell. He had cancer that had spread and was causing his kidneys to fail, and was becoming increasingly frail.
I had recently read the new GP contract with its focus on how ‘primary care networks’ might improve care for patients and their loved ones at the end of life.
In addition to being a GP, I am also a Clinical Lead with the West of England AHSN where we are doing a significant piece of work rolling out ReSPECT across our region, building on our ‘deteriorating patient’ work. I also work with our Gloucestershire CCG end of life team which has the vision of improving the end of life experience of patients and loved ones.
It goes without saying that we all care about our patients. However, it is nationally recognised that sometimes how we communicate with patients and between settings or professions can greatly impact the care we deliver to people at the end of their lives.
It struck me that we could do a mini quality improvement (QI) project to better understand how care is delivered and where improvements might occur bringing the various strands of my GP / CCG/ AHSN work together.
I asked John and Sandra if they would be interested in working with me on this as equal partners and they both said yes. Their lived experiences validated my clinical experiences that all the clinicians I have ever worked with do really care about their patients and yet care delivery can be ‘bitty’, with communication not always being as clear and joined up as it might be. John was under the excellent individual care of surgeons, cancer specialists, kidney specialists, palliative care team and different GPs but the system of care was not as integrated as it might be.
For me, the golden thread of great patient care that relies on team work is communication.
Most clinicians that I have spoken to about this feel frustrated by this gap in care, but how to bridge it? It can be hard to fly the aeroplane whilst you are building it and for me the antidote to this challenge is taking a QI approach.
We identified three key themes for learning and improving:
1. We need clearer communication between primary and secondary care about a patient’s prognosis, particularly when their condition is not responding to active treatment. These conversations should involve the patient and their loved ones.
2. We need to have open, anticipatory conversations around advance care planning and treatment escalation planning which includes the ReSPECT form and process.
3. We need to get anticipatory medications in place before a crisis. My fellow Gloucestershire GP colleague, Michelle Doidge, has done an excellent piece of QI work with ‘just in case’ boxes that hold key end of life medications.
Having ‘the conversation’
I could write a lot about each of these three themes, but I will focus on theme two. Filling out the ReSPECT form with John and Sandra prompted an incredibly powerful and emotive conversation which came as a bit of a surprise and I would like to share it with you.
In preparation, it made me go through the discipline of gathering some of the key letters from various specialists which would be helpful to have in John’s house. These are particularly useful for any out-of-hours clinicians, particularly an ambulance crew, who do not know him and need information to refer to at a time of crisis.
Whilst I have done my online Resuscitation Counsel training and been to several ReSPECT events, sitting down with John and Sandra for ‘the conversation’ made me feel apprehensive as it was the first time I had been through this process.
Reassuringly the form intuitively leads the discussion and crucially facilitates a conversation which is much more about ‘what matters to you?’ rather than the traditional medical approach of ‘what’s the matter with you?’ Sometimes it is more pleasant to avoid some of the difficult aspects of ‘the conversation’ but the ReSPECT process supported me to do this in a more structured yet compassionate way then I would otherwise have managed.
Explaining to John and Sandra how he was likely to die and ascertaining how he would like this to occur was an incredibly intimate and tearful experience for all of us.
Out of the ReSPECT conversation, we all realised that John did not have much time left and rather than attend an upcoming outpatient appointment he decided to attend an important family gathering in Devon. His family were concerned, but with John’s typical dry sense of humour he retorted with, ‘what is the worst that is going to happen to me?’
Some weeks later and on the day of him dying, John’s symptoms deteriorated in the early hours and Sandra felt understandably anxious and called an ambulance. The feedback I had from this was that the attending crew found the documents invaluable and this helped to keep John at home and fulfil his wishes.
Reflecting on ReSPECT
I have reflected on the attending crews’ comment and must admit that I feel slightly embarrassed that it has taken me this long in my career to leave a treatment escalation plan at a patient’s home to help guide out of hours colleagues’ decision making. How on earth would they previously have been informed about a person’s wishes and conditions particularly when they probably have never met the patient and don’t have access to their notes?
On a personal note, there have been several moments in my career as a doctor that have helped me to feel more human than clinician. This conversation with John and Sandra was one of those occasions. Thank you to John and Sandra for their bravery in working with me on this. I hope you find the ReSPECT process and the conversation it encourages as fulfilling as we did.
One for the road
Lars Sundstrom, our Director of Innovation and Growth, who retires on 28 March, reflects on how much the West of England AHSN has achieved, and how we might fail better.
Clearing out my desk today deep down in the bottom of a drawer I found one of the first drafts of a strategy paper which Liz Dymond and I produced over 5 years ago. It was about wealth creation. Originally people thought AHSNs should be largely about that, before they became more synonymous with adoption of existing stuff into the NHS.
Rather amazingly we more or less did everything we set out to do and pretty much stuck to our original strategy for the first 5 year license, so I guess it wasn’t a bad plan.
I could look back and chalk that one down as a success and claim it was all plain sailing, but for some reason my thoughts focus much more on the difficult times we had along the way
So as a final blog I thought I’d pick up on one of my favourite topics – ‘failure’. This is not because of some sense of self-pity, but because throughout my life it has been one of the most important drivers for why I chose the paths that I ended up on.
Looking back at all that has happened in my working life I guess I can honestly say that I’ve taken some big risks. As a result I found myself in a few interesting places, like being chased by a pack of hungry wolves in the Canadian wilderness (it’s in BBC documentary If you don’t believe me). Maybe I’ll tell you about that one another time if you buy me a beer.
Curiously, my most vivid memories in reality are the failures, the times when it didn’t work out so well. I don’t really remember the successes like selling my first start up business when I was in my twenties or having the highest cited scientific paper in my research field in my thirties (I didn’t even know until someone recently pointed that out). I don’t remember what I learned from any of that. However, the really tough times are etched in brain forever, like laying off all the staff in one of my companies that didn’t go so well, that memory still hurts today and I never want to go through that again.
I played a video for some of the staff a couple of weeks back which made the point that failure is not the opposite of success, it is a stepping stone on the way to success and it is more our failures that shape us and make us learn hard lessons rather than the easy wins. Just look at Steve Jobs at Apple, one of the greatest innovators of our century, clearly spectacular at both failing and succeeding. Eventually his innovations changed the world forever.
Failure and taking risks is essential if you want to succeed in innovation, or rather the permission to fail is essential if you want to innovate. If we can’t try new things, we can’t innovate and without innovation we don’t progress as fast as we need to.
So let’s look now at healthcare and particularly the NHS. Being honest, it’s not the easiest place to do innovation. It has everything going for it though, so it and should be the best place in the world to innovate, but it isn’t and it generally follows others. It lags way behind other sectors, why is that?
There are many reasons, but I believe a major one is the NHS’s low tolerance to risk and it’s fear of failing. It seems to me that the fear of a few bad news headlines has a greater impact with people than celebrating the successes that happen in the NHS every day.
In a way that’s not a bad thing. After all people’s lives could be at risk, so treatment has to be safe. I wouldn’t want doctors or nurses trying things out on me for the first time unless it was a well-controlled trial.
Nevertheless, the point is that innovation also saves lives. If we are afraid to innovate, and instead stick to the old ways of doing things, in the long run we will actually do more harm than good. Do no harm does not mean don’t do anything different for fear of doing harm.
I don’t have all the answers to this conundrum. It seems to me a big part of the problem is a risk averse culture and a system which seek to improve by punishing failure rather than rewarding those trying to succeed. An answer must be to create a place where we can innovate and fail safely in the NHS and it seems to me that’s what AHSN should really be about rather than just a distribution channel for existing products into the NHS.
There are 2 things I know we can do:
1) Create an effective and safe test bed system where we can try new things in the full understanding that they may not always work out. Let’s encourage people to think of new ways of doing things and stop penalising them for trying, even if they don’t succeed at first.
2) Have a more open and honest dialogue with the public and bring them on the innovation journey with us. They should understand why we might not always succeed at first and why we need to keep trying.
Above all we need to be brave enough and ambitious enough to be the best we can and that means being bold enough to try things we have never done before.
I was recently told that there are more people alive today than have ever died, so if that is true, we can’t simply improve on what we already have, we need a step change in the way we deliver care. We can only do that through innovation and it will be disruptive by definition.
So my hope for AHSNs is that they retain the ambition to be brave enough to take risks and become the home of innovation in the NHS, rather than just measuring the number of new products which are taken up and used by the NHS.
If you have read my previous blogs you will know that I am one prone to mock politicians (particularly US ones). Who wouldn’t, given their current inability to govern on either side of the Atlantic? Occasionally, however, the Americans do turn out a few great ones, usually when times are tough.
So I’ll end by paraphrasing JFK : ‘We choose to send people to the moon, not because its easy, but because its hard; because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win
Below is a short film reflecting on the change in attitude he has seen towards the role of companies and innovators in healthcare:
Polypharmacy – benefits vs risks
Mark Gregory, our Lead Pharmacist, reflects on the risks associated with polypharmacy and the benefits of deprescribing.
In 1995 only 2% of the population over the age of 65 years were prescribed 10 or more medicines. By 2010 this figure had increased to 5% and by 2018 increased further to 8%. For those over the age of 85, almost 1 in 4 of the population are now prescribed 8 or more different oral medicines.
This level of ‘pill burden’ represents a significant multi-drug dosing of the elderly population. Taking this amount of oral medication two, three or even four times every day also presents a practical challenge, even if we can assume full cognitive functioning.
No doubt the individual clinical benefits of each of these multiple medicines outweighed the risk of potential harm at the time they were started. However, the results of clinical trials of individual drugs do not give us an detailed understanding of the long term effects of the complex interactions within these cocktails of pharmacological active chemicals within the body . A number of years on, particularly for the frail elderly, the potential harms vs benefit equation changes for many of these medicines, increasing the risks of adverse effects. This is the basis of the increasing interest in the application of the concept of ‘deprescribing’ as one approach to aiming to achieve ‘appropriate polypharmacy’ for medicines optimisation.
Academics such as our own Bristol Uni expert on this subject, Dr Rupert Payne, inform us that one of the ‘gaps in the evidence base’ on this subject is the lack of evidence on the proven benefits of deprescribing – a subject of research interest. However, whilst recognising that even in the frail elderly, there is clearly a strong case for the ongoing prescribing of many drugs, individual patient feedback on the quality of life impact in practice resulting from selective deprescribing are convincing enough for many of us to promote the application of deprescribing principles in pursuit of ‘appropriate polypharmacy’.
At our recent West of England AHSN polypharmacy event, a useful reminder of this was hearing the experiences of a local patient, Ann, describing her difficulties with managing her multiple medication regime and the medicines supply pathway associated with it. Her wish was for ‘regular and effective medicines reviews to be undertaken to ensure that people don’t remain on medication they don’t need to be on’.
Patient experiences of long term polypharmacy were further highlighted at this event in the presentation of a successful polypharmacy project by our colleagues in Yorkshire and Humber AHSN. In particular, the story of an elderly patient with dementia in a care home who had been on more than 10 different medicines for a number of years. He was showing increasing symptoms of BPSD and disturbing behaviour. Following an extended, patient centred polypharmacy medication review, it was possible to stop nine of his medicines. The impact was summarised in a quote from his wife – ‘I cannot remember when we last played dominoes together and we have now done it every day this week’.
Actual patients’ experiences are powerful reminders of a key question that underpin our pursuit of ‘appropriate polypharmacy’ beyond the published evidence: What is most important to individual patients in the wider context of their current lives? Fully understanding individual patient’s values and engaging in shared care prescribing decision making, takes time. This adds pressure on already pressurised patient consultations – the practical implementation challenge!
Therefore, when I recently analysed the prescribing data on polypharmacy metrics across the West of England AHSN healthcare systems, it was pleasing to see that this clearly indicated that positive progress is being made in achieving improvements in polypharmacy across our area. One of the key aims of our medicines safety programme as an AHSN is to support and further build on this trend, to help to maximise the benefits patients across the West of England obtain from their multiple medicine regimes, whilst minimising undesirable side effects and avoiding unnecessary negative impact on daily lives from individual patients own perspectives. It is in all of our interests to ensure that consideration of deprescribing principles become embedded in routine prescribing practice – as after all, based on current prescribing trends, all it is likely that many of us ourselves will be prescribed multiple medication regimes in our old age…
Read more about our polypharmacy programme here
Read the report from our polypharmacy event here
Fear is not an option for leaders of health-tech businesses
James Barsby, a Health-Business Mentor at Bristol Ventures, has supported business leaders across a range of backgrounds in getting their innovation ‘NHS ready’. He is one of the four business mentors offering free advice through the Swindon and Wiltshire Health and Life Science Innovation Hub.
Here, James shares his top tips for innovators and clinical entrepreneurs starting a healthcare focussed business. These words cover 15 years’ experience of working with companies varying in size, from one person to over 90,000 employees, where luck is not a factor in success. Continue reading “Fear is not an option for leaders of health-tech businesses”
Taking a step outside the clinical bubble
Megan Kirbyshire is six months into her secondment with us here at the West of England AHSN, working to spread and embed ESCAPE-pain across our region. Here Megan reflects on how the secondment has given her the opportunity to see her work in a wider context.
I recently had the privilege of presenting at the annual NHS Innovation Accelerator (NIA) Summit. Funded by NHS England, NIA selects around 15 innovations that have a good evidence base and have been shown to make a positive impact on the ground.
The founders of the NIA innovations become fellows of the programme and are given support through funding, coaching and networking. The consequence of the fellowships has seen their innovations being successfully spread around the country.
ESCAPE-pain is one of these innovations. I had the privilege of presenting alongside Professor Mike Hurley, the designer of ESCAPE-pain, at the summit about our successful programme in Cheltenham. The characteristic that made us ‘special’ is that we were the first successful site to fully embed the programme while working in partnership with the local leisure centre.
ESCAPE-pain is a programme designed to enable patients to self-manage their hip or knee osteoarthritis through education, exercise and behaviour change. It is exactly the sort of innovation I love working with on the ‘day-job’ as a Senior Musculoskeletal Physiotherapist at Gloucestershire Hospitals.
The summit was in part a celebration of the release of a report called ‘Understanding how and why the NHS adopts innovations’, which highlights the difficulties of spread and adoption within the NHS and in which we feature as a case study. However, I was able to proudly present what happens when adoption has all the right ingredients: positive working relationships, a flexible local funding agreement, forward thinking clinical leadership and passionate staff. It was an honour to be able to promote and celebrate our trust on a national stage.
A real eye opener
I would also like to take a moment to outline some of the activities that take place in the NHS outside of face-to-face clinical work, which have been a real eye opener to me.
In the first three months of my secondment, I learned so much about the functioning and complexity of the NHS. As clinicians, we tend not to take a step back to establish what else is going on outside of our clinical bubbles.
The learning opportunities are endless and as a starting point I would recommend scoping around organisations such as the AHSNs, Office for Life Sciences and of the NHS Innovation Accelerator programme – there are many more but to me they seem like a good place to start.
There are countless fantastic innovations coming through, which may be appropriate to your own clinical area. The learning from these may help make yours and your patients’ lives that little bit easier. It has made me realise the importance of being receptive and open to these innovations to continue to develop ourselves and the services we deliver to be resilient to change.
Lastly, what I learned at the NIA Summit was that just one great idea can make a positive impact. So if you’ve made a difference with a new pathway or product then make sure you share this with others and get in contact with the West of England AHSN.
For further information on the current innovations, visit nhsaccelerator.com.
Gloucestershire’s journey to become an ICS
Kay Haughton, our Director of Service Transformation, reflects on learning opportunities on her home patch of Gloucestershire.
Gloucestershire has recently been designated as an Integrated Care System (ICS) which recognises that their system is successfully developing effective partnership working. Gloucestershire is where I live, and Gloucestershire CCG is where I very happily worked until May 2018 when I moved to West of England AHSN. I was therefore delighted to be invited to Gloucestershire in October to a “Continuous Improvement Communities” workshop to share some of the great collaborative improvement work taking place across the county.
The visit was coordinated by the One Gloucestershire Integrated Care System (ICS), and a number of staff from across partner organisations in Gloucestershire came together. One of the reasons I was excited to attend, in addition to hearing more about the great work in my part of the world, was to hear from Don Berwick.
Don was the founding CEO of the Institute for Healthcare Improvement and in 2010 was appointed by Barack Obama as the Administrator of the Centers for Medicare and Medicaid Services. I am a longstanding fangirl of Don Berwick and was looking forward to hear his always sensible and inspiring comments. Don was very vocal in his praise for what is happening in Gloucestershire; describing it as very special. He said that in his travels around the country he had not had an experience as exciting as he had in Gloucestershire!
As a result of the move to become an ICS, Gloucestershire colleagues are now working closely with Don along with Chris Ham. Chris has been Chief Executive of the Kings Fund since 2010 and is frequently called upon to chair large conferences on health policy in England. In the June 2018 Birthday Honours he was awarded a CBE for his services to the NHS. What great people to get advice from!
Ellen Rule Director of Transformation at Gloucestershire CCG described how pleased Gloucestershire were to be selected as an ICS and described how she sees the model that is emerging as a ‘flagship to the fleet’ to future ICSs. The programme for the workshop covered presentations on continuous improvement projects from the One Gloucestershire health community and was inspiring.
Don’s reflection on the presentations was that this is what the NHS was founded to do: to bring communities together. He went on to question “what is in the water in Gloucestershire?” He had not seen such a level of partnering across all sectors as he saw in Gloucestershire.
Don was also full of praise for Andrew Seaton, Director of Safety, noting that the scientific based approach to Quality Improvement was a way of life, and the culture of testing and continuous improvement was very evident.
We are currently planning a conference for our West of England Q community to create a valuable space for exactly this kind of networking, learning and sharing, with a focus on developing the skills that will help us adopt and spread innovative ways of working, firmly supporting the vision set out in the NHS Long Term Plan.
Watch this video to hear what Don had to say about his visit.
Call the midwife: an AHSN special
Ann Remmers, our Maternal and Neonatal Clinical Lead, looks back at a lifelong career in midwifery from bell bottoms to bed baths…
Celebrating the 70th birthday of the NHS in 2018 has led to me to reflect on my career in the NHS as it has done for so many people.
Thinking back to my first day in the NHS as a student nurse at Guy’s Hospital, it is hard to believe that I was an 18-year-old, fresh from school, setting out on a career that would span from the 70s to today.
Then the fashion was bell bottoms, hot pants and tank tops. Now it’s… Well, maybe it hasn’t changed that much! If I had followed the family tradition set by my three brothers, I would have become a professional drummer. I am still curious to know whether drumming is in the genes and once I am fully retired I might try my hand…
I still clearly remember my first day in PTS – Preliminary Training School. I felt so proud to be there. (We weren’t considered safe to go on the wards until we had completed our six weeks’ PTS). The Director of Nursing told me she really wanted to make a Guys nurse of me.
There were two other things I remember her telling us on that day. Guy’s Hospital is near London Bridge and in those days it wasn’t the trendy, thriving area it is now. There was no Borough Market as we know it now; there were some fruit and vegetable stalls and a few pubs but it wasn’t the sort of area you would hang around in for long at night. She was very proud of the area we worked in and of her nurses. She told us, if we went to the market stalls in our uniforms we would be rewarded with a free bag of fruit because Guy’s nurses were so well respected and we didn’t even know about five-a-day then!
The second piece of advice I remember her giving us was that it was impossible to catch venereal disease from sitting on a toilet and that we should sit comfortably on any toilet seat confident that it was safe to do so. It sounds crazy now but truly there was a view at the time that it was possible to catch a sexually transmitted disease in this way. Wow, we all thought – too much more to learn about life!
Our six weeks’ PTS was filled with learning on how to care for patients before we were let loose on the wards. It was such a lot of fun and I made lifelong friends in that time. We learnt how to make a patient feel comfortable during long periods when they would be bedbound. I particularly remember the class on how to wash a patient’s hair in bed. It was pretty hilarious, with many near misses like the removal of bed heads almost rendering a colleague unconscious. But we did learn how to provide basic nursing care in a way that I have never forgotten.
We all lived in the nurse’s home at that time and, as it was the first time we had been away from home, there was much excitement about having a degree of freedom. Of course there were strict rules about having visitors to your room after 10 pm!
On night duty we took our breaks in the changing rooms on the ward and often used this time to support each other and share our experiences. As student nurses we had a lot of responsibility, especially on night duty when as a second and third year student we were often in charge of the ward. This was both exciting and terrifying! We really needed the support of each other to keep us going.
The most memorable Christmas Day was as a staff nurse on a medical ward. Once the patients had all been given their dinner, the table was set down the centre of the ward and the consultant carved the turkey. It does sound a bit Nonnatus House à la Call the Midwife, and at times I suppose it was. It did feel very much as though we were a family and it was great for team building.
After completing six months working as a staff nurse on a male medical ward, I decided to do my midwifery training in Bristol. It was very common at the time to undertake the one year midwifery course once we had qualified as a nurse.
Following a two-month break to travel around Canada and the USA, I moved from London to Bristol. I have to admit that when I first started my midwifery training it was a bit of a shock. After all the responsibility of running a medical ward, to be asked if I knew how to do a blood pressure…
To be honest I wasn’t sure if I liked midwifery in the beginning. Some of the midwives were positively scary! It was not until I was qualified as a midwife and had my own autonomy that I started to love it. This was the 1970s and some of the practice then was definitely not woman-centred. We have come a long way since those days when it was routine to do perineal shaves and give enemas when women went into labour. And if you came out of a room having admitted and examined a woman, you would be questioned as to why you had not artificially ruptured her membranes, and started electronic foetal heart monitoring.
It all sounds a bit horrific now and it is thanks to years of campaigning from women and passionate midwives that things have changed to the degree that they have.
I remember one particular busy night when I was a newly qualified midwife being asked to go out on the ‘Flying Squad’. This was the obstetric emergency team that could be called to deal with problems at home births or in one of the maternity homes. The team consisted of the on call obstetric registrar, a midwife and an anaesthetist from the maternity unit. We did not exactly fly but were taken in the Blood Transfusion car. We had to pick up the kit first and then the registrar and anaesthetist.
This particular night the call was to a woman at home who was giving birth to twins. By the time we arrived, the twins were born and were both healthy. I remember feeling quite elated – it was quite an adventure – only to be brought back down to earth when we got back to the hospital and told to go to the sluice and clean the scalp electrodes before going off duty. I was expecting a pat on the back or at least a thank you! That stuck with me and I vowed if I did stay in midwifery and got into a senior position I would always make sure that my staff felt valued.
Although we still need to be reminded to ensure that women are at the centre of their care, the Better Births Maternity Transformation programme has certainly put the focus on safe and personal care for women. We are also reminded about the importance of kindness to each other and to the women and families that we care for. If it had not been for the midwives who I saw displaying this kindness to others I don’t think I would have stayed in the profession.
I recently heard Suzette Woodward speak at the annual Royal College of Midwives conference about the importance of kindness and how it has a positive effect on safety, which really struck a chord with me. I think the time I enjoyed most was when, working as a community midwife, getting to know women and their families, being there to care for them in labour was always a bonus, and then to visit them at home after they had had their baby was joyous.
Continuity of carer is one of the recommendations of Better Births and is both an opportunity and a challenge for midwives. Providing continuity for women and ensuring midwives are able to have work life balance is key to achieving the right balance.
I have been very fortunate to have a lifelong career in midwifery; it has at times been stressful, tiring, joyful, demanding and rewarding.
My hope is that midwives in the future will be able to have the same positive experience that I have had and will be supported and cared for to enable them to in turn support and care for women.
Let’s talk about mental health
Kay Haughton, our Director of Service Transformation, explores different perspectives on mental health and the enormous impact talking can have on people’s lives.
In 2008, 20-year-old Jonny Benjamin stood on Waterloo Bridge, about to jump. Neil Laybourn, a complete stranger to Jonny at that time, saw his distress and stopped to talk with him – a decision that saved Jonny’s life.
Jonny and Neil now work together campaigning for mental health and suicide prevention. I heard their story at my inaugural meeting with the Mental Health Collaborative last week.
The West of England AHSN, alongside our colleagues in the South West AHSN, sponsor the collaborative, which aims to make care safer by improving quality in mental healthcare.
The study sessions this group delivers are now the stuff of legends and I was really looking forward to my first session. I knew it would be a tough day; the topic was suicide prevention, which I had personally experienced as my brother took his own life in 1993 when he was 27. Michael had schizophrenia and had been unwell for a number of years.
During the latter years of my profession I have been very closely involved in mental health services. I have read many serious incident reports and have often reflected that my experiences have always been depressing.
But I was really looking forward to hear Jonny and Neil speak about their work. They came highly recommended… ‘In my world, the word inspirational gets bandied around a lot, but Jonny Benjamin is truly deserving of that adjective.’ – HRH The Duke of Cambridge.
Jonny and Neil’s work now takes them to schools, hospitals, prisons and workplaces to help end the stigma by talking about mental health and suicide prevention. The overall message is one of hope, especially as during the presentation Jonny told us he had recently relapsed and been in hospital the previous week, and yet there he was sharing his story with such humility and grace.
The South West collaborative had done a great job in securing them as speakers, and Jonny commented on what a well organised conference it was!
Their message is a positive one, and this is the optimism we need to ensure is shared. I wept most of the way through their story and a kind stranger asked me if I was OK. I told her I was fine whilst silently appreciating I realised I didn’t look it!
The truth was I was crying for a number of reasons, sadness at the unnecessary waste of my brother’s life: but more so with happiness that this was an uplifting story, that there is hope for people who think about taking their lives.
Jonny says: “Talking about my illness to other people who suffer as well as my family and friends has been a huge factor in helping me, and hopefully helping others along the way, too.
“We underestimate the value and importance that talking about our mental health has in society, because it can open up a door to a conversation that someone might need. Conversations really can save lives, I am living proof of this.”
Neil describes his contribution as a random act of kindness. This sounds small and yet the impact has been enormous, not just for Jonny but for all the people who have been impacted by the work they now do together. So the take home message for me was ‘It’s OK to talk about mental health’. It really is, and be kind.
All the sessions I attended were well facilitated and presented with the golden thread of quality improvement running throughout them. If you are interested in the work of the Mental Health Collaborative contact sallyashton@nhs.net.
And if you don’t already know Jonny’s story, I recommend you read his book, the Stranger on the Bridge.
My AHSN Connection – Tony Watkin
Tony Watkin is Patient and Public Involvement Lead at University Hospitals Bristol NHS Foundation Trust. Here he writes about how the West of England AHSN helped his team to develop a group of patient and public advocates who now help shape health services in the West of England.
I have worked with the AHSN since the early days of People in Health West of England (PHWE). We’ve all spent time trying to figure out the best way to give patients and the public a voice in the development and management of health services in the West of England.
With the support of the AHSN we joined up with partners at North Bristol NHS Trust and Bristol Community Health and, with an external facilitator, worked through how to train and support patients who wanted to take on an advocacy role.
Watching the AHSN pull together a team of public contributors inspired us and others to have the confidence to recruit and develop our own Patient and Community Leadership Programme. We learned from each other’s experiences and gained confidence to develop our work and approach. Pulling together 16 diverse individuals, training and developing them into effective Healthcare Change Makers has been a big leap for us all.
Where the AHSN has been so effective is at working across the system and bringing people together to provide mutual learning and support – even linking us up with other AHSNs who had valuable experiences to share.
Not only have we managed to recruit and engage patient leaders, we are also working together to advance thinking in the area. Traditional patient involvement can centre on simply harvesting information. Now we are moving to actively involving patients as leaders working collaboratively in designing change. Again, the AHSN is leading the way, and helping to provide a context for the rest of us to operate in.
This story is a highlight from our 2017/18 annual review: joining the dots to healthcare innovation. Check out the full review here.
