Understanding the unintended consequences of healthcare apps

Dr Andrew Turner, Senior Research Associate, CLAHRC West, discusses the move towards ‘digital first’ care, the possible unintended consequences of healthcare apps, and how the DECODE study aims to improve the adoption of a range of digital health tools in primary care by understanding these unintended consequences.

We all know that people are living longer, but often with multiple long-term health conditions. Maintaining people’s quality of life in these circumstances requires a lot of support from the NHS.

At the same time, GP practices are under pressure to improve patients’ access to healthcare while coping with their own workloads and growing patient demand. Policymakers are proposing new ways to relieve the strain by using digital technologies such as phone apps to improve the convenience and reduce the cost of healthcare.

The move towards ‘digital first’ care is explicit in the new NHS Long Term Plan. It puts forward a vision in which “people will have more control over the care they receive and more support to manage their health, to keep themselves well and better manage their conditions, while assisting carers in their vital work.” Continue reading “Understanding the unintended consequences of healthcare apps”

Driving sustainable, responsible and inclusive economic growth

As well as being Vice-Chancellor of the University of the West of England and chair for the West of England AHSN, Professor Steve West chairs the West of England Local Enterprise Partnership (LEP). Here Steve writes about how the LEP is working alongside authorities across the region to drive sustainable economic growth and improve health and social care for local communities.

How do you drive economic growth in a way that is sustainable, responsible and inclusive? What do businesses need in order to thrive, sustain and grow? And how do we do that in a way that delivers prosperity to all? These questions are exactly what the West of England Local Enterprise Partnership (LEP) has been working on since our formation about six years ago now. Continue reading “Driving sustainable, responsible and inclusive economic growth”

A successful start for the West of England Learning Disabilities Collaborative

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”

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.

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 or please feel free to drop me an email at megan.kirbyshire@weahsn.net

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.

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.

My AHSN connection – Sandra Akintola

Sandra Akintola, Clinical Project Lead for Bristol Community Health, writes about how her work with the AHSN helped her to hone her networking style, make valuable connections and see the bigger picture to her work.

I first connected with the AHSN when I attended a network meeting in place of my manager. Although I didn’t quite know how I fitted in, I knew I was amongst like-minded people. As I got to know people in the AHSN it helped me see beyond my immediate role and see how my workstream fits in a bigger picture. I’m a natural networker, but the richness of the organisations the AHSN works with has helped me hone my networking style, and has introduced me to clinicians who have become my role models.

My role involves introducing new clinical approaches and monitoring their implementation, so I’m always open to new ideas. Where I’ve found working with the AHSN to be especially helpful is introducing the clinicians and clinical directors I work with to others, maybe working in different settings, trying to make the same changes. I’ve heard phrases like “I didn’t realise so many other people out there are doing this – it makes it seem real.”

It is this sharing of knowledge and experience that is so vital, helping clinicians feel part of a wider process of change and improvement. It makes sense to share knowledge, as we share patients all the time as they move from community settings to hospital and then back again.

This story is a highlight from our 2017/18 annual review: joining the dots to healthcare innovation. Check out the full review here.