Impact review 2020-21: transforming lives through innovation

From Natasha

“Thank you for taking the time to read our impact review for 2020-21. I always find it a somewhat humbling experience to reflect on the impacts of our work in these annual reports, but never more so than this year. When I look back at what we have collectively achieved over the last 12 months in the midst of a global health crisis, my heart is filled with pride, gratitude and indeed awe at the commitment, creativity and at times courage of so many colleagues across the West of England health and care system and within our own staff team.

“We’ve worked hard over the years to support the spread and adoption of innovation and transformation of services in a truly inclusive and collaborative way. Our approach has always been as joined-up and system-wide as possible to allow the impacts of our work to have the broadest and most sustained benefit. Building relationships and trust takes time and effort, but I am so grateful for these foundations as they meant we were able to rise to the challenge this last year, rolling up our sleeves and directing our energies where they were most needed.”

From Steve

“In a year that has laid bare the many health inequalities that exist in our society, I have seen so many in our local health and care community rapidly rethink how we deliver services and embrace opportunities to use new approaches and technologies to get the right care to those who need it most.

“This impact review is full of incredible examples of this. Members of the West of England AHSN, from NHS health and care providers and commissioners and universities, along with partners from industry, innovation and research, have joined forces with one common goal: to transform how we deliver healthcare services for the benefit of patients and the public.

“While necessity might be the mother of invention, our collective ambition is now to maintain this momentum born out of a crisis. We have seen a glimpse of what we can achieve together. Let’s use this as an opportunity to build on this genuine partnership approach. In this way, we can bolster the resilience and integration of our health and care system, placing patients firmly at the heart of our services while supporting regional economic growth.”

As with all health and care organisations, our work programmes and focus took a dramatic shift last year as we supported colleagues across the West of England to support the response to Covid-19.

Due to the strength of our network and our system-wide, joined up approach, we were in an advantageous position to rapidly redeploy our teams and resources where they were most needed.

You’ll find numerous examples of this support throughout this impact report but key activities to highlight include:

• Support to introduce COVID Oximetry @home and COVID virtual wards
• Training for care homes to identify the soft signs of deterioration (RESTORE2)
• Self-management support for chronic respiratory patients no longer able to receive face-to-face pulmonary rehabilitation
• Continued engagement with our Learning Disabilities Collaborative to share resources and guidance, including advanced care planning and DNA CPR decisions during Covid
• Encouraged increased use of Electronic Repeat Dispensing
• Pivoted our Transfer of Care Around Medicines programme to support people being discharged from hospitals to care homes
• Supporting the introduction of online patient triage and video consultation in primary care
• Securing over £3 million in NHSX funding and provided support to increase remote monitoring across the region
• Improving safety and support to healthcare staff caring for patients with tracheostomies.

Tracey Cox, Chief Executive, Bath and North East Somerset, Swindon and Wiltshire CCG, said: “The past year has been one of the most difficult and challenging for all parts of the NHS. We have had to be responsive and agile in implementing initiatives at very short notice. It was excellent to have our AHSN partners in the background supporting us in some of the work we were doing both in relation to our work with Care Homes and the Home Oximetry Service.”

Supporting and enhancing our key areas of work, we coordinate a range of cross-cutting strategic enabler programmes.

These help to build the innovation and improvement skills and capabilities of colleagues from both industry and health and care, match technologies and solutions to the gaps and priorities identified by health and care commissioners and providers, tackle health inequalities, and promote a culture of inclusivity.

Read about our strategic enabling work over the last year in the following sections.

As healthcare innovators, the West of England AHSN recognises and takes seriously our leadership role in tackling inequalities and promoting a culture of inclusivity.

In the last year, we have taken positive steps to move forward as an organisation on our diversity journey, and in September we signed up to the Bristol Equality Charter.

We are now working closely with Bristol-based BCohCo to explore and review how we ensure diversity, inclusion, cohesion and equality are embedded as part of our core values across both the organisation and the work we do.

All staff members are involved in shaping and contributing to this programme, which will also build on our commitment to achieving the AHSN Network’s national diversity pledges.

Despite the challenges of the Covid pandemic, we continued to provide an invaluable guidance and signposting service to healthcare innovators developing products and services with the potential to improve patient outcomes.

Through their support to innovators in the last year, our business development team has helped companies to leverage £9.7 million through grants and private investment.

Our popular Health Innovation Programme, now in its sixth year, went completely virtual in November. In partnership with SETsquared, we supported 15 budding healthcare entrepreneurs develop their business ideas, from tele-presence robots and prosthetic fitting software to a diagnostic and prognostic decision-support tool for neurologists.

Chen Davies, CEO of LatchAid, an innovative breastfeeding app, said: “The West of England AHSN has been a great support in my journey: from the Health Innovation Programme, which was amazing and benefitted us so much, to the support received afterwards. I would absolutely recommend the Health Innovation Programme to anyone in my position.”

At the West of England AHSN, we have always advocated a joined-up, system-wide approach to embracing the opportunities and tackling the challenges around the digital transformation of healthcare.

And this approach gave us an incredibly strong foundation to work from during the Covid-19 pandemic in our support to primary care in moving patient communications online and accelerating use of remote monitoring for our most vulnerable residents.

Steve Trowell, South West Regional Director for Digital Transformation, NHS England and NHS Improvement, said: “The scale and pace of digital transformation required during the last year was unprecedented and the tireless effort from so many AHSN staff was critical to the successful delivery across the South West region – a big thank you to all involved. The multi-agency ‘blended team’ approach and alignment and coordination of the three South West AHSNs around common digital transformation objectives in the region proved to be remarkably effective, and we look to build on these new ways of working as we embrace the next set of challenges and digital opportunities over coming months.”

Dr Michael Marsh, South West Regional Medical Director & Chief Clinical Information Officer, NHS England and NHS Improvement, said: “What we have been able to achieve in the rapid deployment and adoption of digital solutions during the pandemic has been incredible. This required a change of mindset, a willingness to make leaps of faith by teams to new ways of working, and expertise and meticulous work from teams including the AHSNs to make this possible. The collective effort has made amazing changes happen.”

Supporting health and care professionals and industry innovators gain knowledge and develop essential skills for innovative thinking and working, our popular Academy responded quickly and creatively to the challenges presented by Covid-19, adapting all curriculum content and delivery to work virtually.

Our programme last year included a summer and winter quality improvement series, an introduction to human-centred product design, and a course on the adoption and spread of healthcare innovations and improvements.

Melinda Tilley, Project Administrator, Bath and North East Somerset, Swindon and Wiltshire CCG, said: “I just wanted to say ‘thank you’ for delivering the Quality Improvement Winter Series. I am very new to working in this area but I found the training really engaging and useful and you balanced pace and the learning of new information brilliantly.

“I really am glad I attended the training and I am looking forward to being able to go back through everything on your course notes and refresh it in my mind.”

Our Future Challenges programme is an exciting approach to supporting innovators and local partners to pilot innovations and validate them in a real-world setting. The aim is to generate evidence to support the wider introduction of promising new innovations to address identified health and care challenges.

In the last year, we have run a number of projects in two main challenge areas: ‘Keeping healthy at home’ and ‘Supporting mental health resilience in the young’. In response to the pandemic, we were also able to support a third emerging challenge: ‘Keeping active during Covid-19’.

In March we launched a major national call, in partnership with Health Education England and the South West AHSN, for innovations to support the domiciliary care workforce to take part in adoption and spread pilots in our region.

We launched our Evidence Repository in May 2020 in a partnership with local integrated care systems and hospital libraries to support rapid evidence sharing. This need increased in importance as the Covid-19 pandemic unfolded.

The Evidence Repository is an online workspace on the FutureNHS platform for safely sharing non-peer reviewed documents not published elsewhere to promote a culture of shared learning and collaboration.

With 103 registered users and 74 documents shared to date, the Evidence Repository is steadily growing. Based on feedback from users we have expanded the membership to include public health organisations and the content to include quality improvement and population health management projects.

We work hard to build supportive relationships with all those in our region who need and want to contribute to improve and innovate healthcare. Together, we identify shared goals, building a shared vision for the future of health and care in the West of England.

Our priority has always been to work across organisational and geographical boundaries, involving our entire network in both development and delivery to drive transformation that is based on genuine need, is successfully embedded and sustainable.

Below we take a look at the work and achievements of some of our collaboratives and networks during the last year.

We set up the West of England Learning Disabilities Collaborative in early 2019 in response to the findings of the national Learning Disabilities Mortality Review (LeDeR) programme. This provides a space for collaboration, cross-system working and sharing of good practice in a way that did not previously exist in the region in the learning disability community.

Our main areas of focus are increasing uptake of annual health checks and flu vaccinations, and use of the National Early Warning Score 2 (NEWS2) and soft signs tools for early identification of physical deterioration.

The collaborative now has over 300 members, including representatives from primary and secondary care, social care providers, commissioners, charities, community learning disability teams, and people with lived experience.

Zain Patel, Transformation Programme Manager, Bristol, North Somerset and South Gloucestershire CCG, said: “The West of England Learning Disabilities Collaborative has enabled a culture of collaboration and the rapid adoption and spread of innovation across the different systems. This spread of ideas and practice has helped deliver improvements at pace and helped systems to respond to the growing challenges of mainstreaming the needs of the learning disabilities population across local pathways.”

Throughout the pandemic, the collaborative continued engaging with the community through bi-monthly webinars, including one on advanced care planning in response to media coverage surrounding blanket DNA CPR (do not attempt cardiopulmonary resuscitation) decisions during Covid.

At the start of 2021, we worked with Wessex AHSN to train 167 ‘super trainers’ across the country to train carers of a person with a learning disability to spot the soft signs that they may be unwell, using a specially adapted version of the RESTORE2mini tool. This was co-designed in collaboration with experts by experience and the national LeDeR team. These super trainers have gone on to train over 6,700 paid and unpaid carers.

Our video series to support carers of a person with a learning disability to recognise soft signs and take observations (in collaboration with Health Education England and NHS England) has been viewed 6,478 times since posting in January.

The West of England Patient Safety Collaborative is one of 15 across the country, each hosted and coordinated by its local AHSN.

Our Collaborative is made up of all the NHS providers and commissioners across the West, including hospitals, mental health and community organisations, the ambulance service, primary care and clinical commissioning groups.

It brings together local patients and healthcare staff, all driven by a collective ambition to bring about system-wide improvements to ensure the safety and wellbeing of people in the care of our health services.

Our patient safety work programme is informed by the NHS Patient Safety Strategy, and the National Patient Safety Improvement Programmes (known as NatPatSIP), which are led by NHS England and Improvement.

The Patient Safety Collaborative Board oversees our five safety improvement programmes: managing deterioration; maternity and neonatal; medicines safety; mental health; and adoption and spread.

Through our network and collaborative approach we maintain a thorough understanding of the needs and priorities of our local systems and frontline services.

Our Link Director Network allows us to engage directly with transformation and innovation leads in our member organisations and other partners.

This year we expanded our cohort of Clinical Leads, who are all experienced clinicians in both primary and secondary care and work with us on a sessional basis. Their blend of knowledge and experience combined with their insights from the frontline is central to the success of our projects and programmes.

Our work programmes have made an incredible impact in the last year, many of which were reoriented to support the response to the Covid-19 outbreak.

In this next section we summarise some of the highlights achieved collectively by colleagues from across the West of England.

Across the region and the country, we are supporting maternity and neonatal communities to improve the safety and care of babies and their parents.

We have been working with the national team to develop guidelines for the care of pregnant women at home with Covid-19 to ensure they have the appropriate medical and maternity care.

And despite the challenges of the Covid pandemic, the legacy of our national PReCePT programme continues to reduce incidence of cerebral palsy in preterm babies across England, with maternity units continuing to hit the 85% target for uptake of magnesium sulphate for neuroprotection.

Closer to home all maternity hospitals in the West of England are now using diagnostic tests to rule out pre-eclampsia in pregnant women.

We’ve also successfully launched the innovative PERIPrem perinatal care bundle to reduce variation in care of premature babies.

In the video below, parents of premature babies share their accounts of how their births were affected by use of our PERIPrem care bundle.

Much of our work in the last year to improve the management of patients who are at risk of deterioration was refocused to support the Covid-19 response.

This included support to our three integrated care systems to rollout Covid Oximetry @home and virtual wards, making use of our existing expertise, infrastructure and resources. By mid-February 2021 over 2,000 patients had been enrolled on these services across our region.

“The Covid Oximetry@Home and virtual wards programme was born out of the pandemic to assist people to be monitored at home who were Covid positive and were at risk of developing silent hypoxia,” explains Emma Matthews, Regional Community Development Lead for NHS England & NHS Improvement – South West.

“The West of England AHSN clinical and programme leads enabled us to share learning and upscale the programme across the region at pace which supported frontline clinicians to work in new ways. This meant that people were empowered to stay at home and escalated to hospital only if needed. The future of this clinically led, digitally enabled programme has immense opportunity and we look forward to continuing to work with our AHSN colleagues in this very exciting space.”

We also worked to enhance the confidence of staff working in the community in detecting and responding to deterioration through online training in RESTORE2 and developed a suite of training videos with Health Education England and Wessex AHSN.

The ReSPECT emergency care planning process enabled our Network members to meet the demand for more end-of-life conversations and reduce the strain on staff.

Working closely with Wessex and South West AHSNs, we supported systems across the region to implement digital technologies to improve remote monitoring support for our most vulnerable residents.

We are supporting NHS colleagues across the West to improve care for people with long-term conditions, such as cardiovascular disease, asthma and type 2 diabetes, as well as increasing self-management of chronic respiratory issues, chronic fatigue and chronic obstructive pulmonary disease (COPD).

This includes rollout of clinically-proven rapid uptake products, exploring use of proactive care frameworks with GP practices, and a number of pilots testing a digital therapy app.

We are working with NHS commissioners and providers, industry partners, other AHSNs, local trusts, child and adolescent mental health services (CAMHS) and community providers on a wide range of initiatives to support their work to improve mental healthcare and well-being.

We build networks to collaborate, share and promote good practice as well as spreading and implementing proven solutions. We also connect innovators with funding, evaluation and partners to allow their innovations to be refined, proven and adopted.

In the last year, we have carried out projects with local partners to test products and approaches to support mental health resilience in young people, and are helping to spread proven innovations as part of national AHSN Network programmes for young people with ADHD and eating disorders.

All five hospital trusts are engaged in our SHarED project, which aims to improve outcomes for the most frequent users of emergency departments. Over 200 staff have received training and 127 high impact users have been supported to date.

As part of our work to support care homes, we have also provided training to care home managers in mental health awareness in partnership with Bristol Mind.

We have also broadened the membership and remit of our South of England Mental Health Collaborative to help deliver the main ambitions of the Mental Health Safety Improvement Programme around reducing restrictive practice, suicide or self-harm, and increasing sexual safety.

In partnership with all five hospital trusts in the region, our work through the PreciSSIon project has achieved significant impact in the last year. Through the introduction of an enhanced bundle of evidence-based interventions, we have successfully reduced rates of surgical site infections after colorectal surgery by half.

We have also helped hospital teams to improve safety for patients with tracheostomies, which increased in importance as a result of Covid-19.

And with the support of the Rapid Uptake Products programme, we have supported increased use of innovative solutions to improve safety in surgical practice: SecurAcath and PlusSutures.

In the last year, our work to improve medicines safety has largely focused on supporting the healthcare system’s response to Covid-19.

In collaboration with the South West AHSN, we encouraged increased use of electronic repeat dispensing to help reduce the number of people visiting GP practices to collect prescriptions through a series of webinars and by sharing resources.

We continued to support the national Transfer of Care Around Medicines (TCAM) programme. This identifies patients upon discharge from hospital who may need help with their medicines, and refers them to their community pharmacy for advice and support.

During the pandemic, we also spotted an opportunity to reorient TCAM to focus on patients being discharged to care homes and new residents moving into care homes.

Looking ahead to 2021-22, we carried out scoping work for our new project to optimise the dispensing of Medicines Compliance Aids. We also supported NHS England and NHS Improvement in the diagnostic phase of the Medicines Safety Improvement Programme, exploring approaches and priorities with our regional stakeholders to inform national programme development.