COVID-19: collaboration is key

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.

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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.

Civility can save lives

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

Reflecting on 2019/20

Natasha Swinscoe, Chief Executive, West of England AHSN, introduces our  2019/20 annual review, with a look back over some of our achievements from the last year.

All of us working in healthcare are familiar with the concept that the only constant is change. However, this year it feels as though things may never be the same again as we come to terms with the long-term impact of COVID-19. Above all, AHSNs are agile organisations and we were able to respond to this new crisis almost overnight, providing additional support to our members and partners.

So, as much as we look back with pride at our achievements from 2019/20 in this review, we already have an eye on how we can turn these experiences to our advantage, helping our local systems develop and test new pathways of care that will keep us safe and well, while living alongside the virus.

In 2018, AHSNs were set a challenge to increase the uptake of seven tried and tested innovations across the country. No less than four of them started life in the West of England. I’m particularly proud of PReCePT, which nationally has led to an additional 1,106 mothers receiving magnesium sulphate, preventing an estimated 30 very preterm babies developing cerebral palsy.

Working as a cohesive, national network allows us to have a wide reach while maintaining a local focus. This is evident through the Patient Safety Collaboratives, hosted by AHSNs to promote safer care through quality improvement programmes. I’ve been delighted to be the national AHSN Network’s chief officer lead for a dedicated group of patient safety leads working in areas such as maternity and neonatal, medicines safety and the management of deteriorating patients.

This year has seen a change of gear, as we exceeded the targets we were set for the spread of these national programmes. Going forward, we have the capacity and renewed confidence to refocus on developing further local pipeline programmes.

Innovation is not a single action. We see it as a journey, and the innovation spiral as the map, guiding the way ideas are generated, tested and implemented, ultimately impacting the whole healthcare system. This year we launched a series of thought leadership events, ‘Future of Care’, which have already debated the potential of genomics and personalised medicine, and robotics and autonomous systems to deliver care in radically different ways.

We also relaunched our West of England Academy, which is open to all health and care professionals in our region and aims to support a culture of innovation within our member organisations, encouraging innovation to be seen as part of everybody’s business.

And we’re excited to be supporting two projects identified through our Evidence into Practice challenge for regional adoption and spread. PERIPrem is a new perinatal care bundle designed to improve the outcomes for premature babies, and SHarED will help reduce attendance rates and support the most frequent and high-impact users of emergency departments.

All of this work is made easier thanks to our supportive Board, which shapes and directs our work and includes representatives from many of our members. This year we said goodbye to James Scott and Ian Orpen and you can read some of their reflections here and meet our new Board members in Steve West’s Chair’s update.

You can read more about all of this in our annual review – you can read it as an online magazine here, or pick and choose your way through the contents here.

Please contact us to find out more about any projects that interest you and we look forward to working together in future.

Innovating for economic growth

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.

Midwives rise to the challenge in the International Year of the Nurse and Midwife

Ann Remmers, Maternal and Neonatal Clinical Lead for the West of England AHSN, reflects on how brilliantly midwives are adjusting to working in these unprecedented times, and thanks each and every midwife for the amazing job they are doing.

No one could ever have predicted what a momentous year the International Year of the Nurse and Midwife was going to be. And yet here we are in the grip of a worldwide pandemic which has completely turned everyone’s world upside down.

For the last four years we have been focussing on developing our maternity services to provide choice and personalised care for all women and their families in response to Better Births.

To meet the recommendations of Better Births, midwives have developed many innovative and exciting ways of working together with women and Maternity Voices Partnerships. For some midwives this has meant completely changing the way they work so that they can give women personalised care and continuity of carer.

Midwives have shown themselves to be adaptable to many changing situations but none have been more challenging than the current Covid-19 pandemic. Anyone who has ever met a midwife will know that we are a pretty huggy bunch! We spend so much of our time in close contact with women, none more so than when we are with women in labour. It is really hard to change our ways to social distancing when caring for women and to not use touch to reassure women. Wearing face masks, gloves and protective glasses means midwives have to work harder at creating that connection with women, using their voices and their eyes to convey feeling and support. But midwives are finding ways to overcome this and reassure women that despite the protective clothing they are still the same kind and caring midwife underneath.

At the Royal Cornwall NHS Trust, an innovative group of midwives have produced a video specifically aimed at reassuring women before they come into hospital. In the video one of the midwives shows what she looks like before donning personal protective equipment and gradually puts on her “work” gear reminding the viewer all the time that she is the same midwife with the big smile underneath it all. Watch the video:

I think back to my days as a community midwife many years ago when a call in the middle of the night could sometimes lead to the unexpected. One particular night a man called from a telephone box (not everyone had mobile phones then!) to say his wife was in labour and could I come straight away. As I rubbed the sleep from my eyes I asked him to give me his address. Well there wasn’t an address exactly, he said and directed me to a disused factory car park where he and his partner who were travellers were temporarily living in a caravan. I picked up my bag and headed off into the night; he met me at the edge of the car park and led me to the caravan with a torch shining the way. This was their home and they had prepared for the birth of their baby in the same way every parent does. After several hours in the caravan their baby arrived safely and it was wonderful to see this happy family able to have the birth they wanted despite the unusual location.

This reminds me of how midwives are used to adjusting to working in many different situations but what midwives and all healthcare workers are dealing with today is unprecedented in our lifetimes. Midwives are plunged into new situations and new ways of working for which they have not been prepared. Midwives are used to knowing the answers to women’s questions but now, because so much is new and unknown, sometimes they don’t always know the answers and that can be very unsettling.

Everyone is trying very hard to provide up-to-date information and guidance and the rate at which this excellent guidance is being produced by our national bodies is phenomenal. But sometimes the guidance raises more questions and anxiety: “Which PPE do we wear?” “What do we do about testing?”. This is where the frequent contact midwives are able to have with their leaders and each other is so important and reassuring. Through regular virtual meetings and calls we have all become more adept at using technology!  Midwives are good at supporting each other; there is always someone willing to share their experience and their learning.

Keeping contact with women and providing them with timely advice has become crucial and midwives are finding different ways to make this happen. Across the West of England and the South West midwives are working hard to support women to have the birth they dreamt of before the Covid-19 pandemic changed everything; this includes keeping our Birth Centres open for women to access. Midwives across the region are providing video consultations and telephone advice to women antenatally and postnatally. Across Bath, Swindon and Wiltshire, Community hubs are a focus for mothers and families to obtain advice and to keep in contact with each other. In Gloucestershire midwives have started online parent education classes and are now developing this to have the ability to do Facebook Live Q & A sessions across the county. There are many other examples where midwives are changing the way they provide care to adapt to the current situation.

Midwives really are rising to the challenge to ensure that despite the difficult circumstances women and their families receive the right care for them and their new born babies. Maternity services are keen to point out to women that they remain open and ready to provide them with the care and advice they need whenever they need it.

I am very proud of my profession and all my nursing and medical colleagues who are working so hard to ensure healthcare continues to be provided that is safe and timely. I think we all feel emotional when we stand on our doorsteps on Thursday evenings to applaud NHS and key workers for what they are doing and the sacrifices they are making right now.

This is the International Year of the Nurse and Midwife and 5 May is International Day of the Midwife, so I will be celebrating with all midwives and thanking them for continuing to provide support and care as women go through this remarkable experience in their lives. I hope each and every midwife gives themselves time to celebrate with their families and reflect a little on the amazing job they are doing.

It’s a big thank you from me for all you and your colleagues are doing in rising to this significant challenge.

What’s the NEWS? Supporting the identification of the deteriorating patient

Alison Tavaré, GP and Primary Care Clinical Lead here at the West of England AHSN shares a personal experience of surviving sepsis, and explains why she’s now such a strong advocate for the use of the National Early Warning Score (NEWS) in supporting the identification of the deteriorating patient.

Surgery to stabilise my spine sorted the pain and power was restored to my leg. I was re-admitted feeling vaguely unwell and with a CRP of 600, but that had returned to normal and I arrived home, admittedly with a PICC line in place, but relishing the peace and the contrast to a busy Nightingale Ward.

A few hours later I was deeply asleep, but suddenly woke with a profound feeling of doom. My husband called 999 saying something had happened but I was not making sense. Within minutes an ambulance crew were running into our house and, blue lights flashing, I was transferred to hospital.

I remember doors swinging as the F1 ran onto the ward, but this was followed by a very disjointed conversation when I kept saying ‘I feel really, really ill’ and being told ‘you can’t have an infection as you have a low temperature and low white cell count’.

My bewildered and non-medical husband watched as his confident and experienced GP wife transformed into an anxious, timid patient whispering ‘you don’t have to have a raised temperature to be sick’.

I remember my heart felt as if it were about to explode, but seeing the cardiac trolley at the end of the bed and knowing the team would not have to go far when I arrested was an odd kind of comfort.

Again something changed; I became very calm as I knew death was imminent and resigned to the inevitable. There was a grey tunnel over my husband’s shoulder and as I gently moved towards it, I told my husband I was about to die but that I loved him, our sons, and my family. Apparently I started to look very pale, and luckily the F1 returned to the ward and put up some fluids; although I still felt very unwell the feeling of doom ebbed away. I spent hours in theatre having the pus washed out and the spinal scaffolding replaced.

Although sepsis was one of the diagnoses on my discharge summary very few people knew what had happened as any discussion provoked vivid and distressing flashbacks.

However, the following year, clinicians at my local trust were raising awareness of sepsis and I offered to share my experience. In preparation I reviewed my notes; there was mention of recent surgery and the PICC line, but as I suspected the provisional diagnosis was a panic attack. Seeing my severely ischaemic electrocardiogram and the evidence that my perception I had been in peri-arrest was correct made me cry. National Early Warning Scores (NEWS) had not been in use at that time but I noted the individual observations, which included both a marked tachycardia and tachypnoea.

My very private experience has now become much more public. I am involved in raising awareness of sepsis and improving the identification and management of the deteriorating patient. As part of this I learned about NEWS and with curiosity I looked again at my observations; my NEWS was 6, or 9 if the NEWS2 update was used and my confusion included. There is increasing evidence that the higher the NEWS on admission, the more likely the patient is to die.

So why does NEWS matter? As a GP I use NEWS alongside clinical judgement when arranging admissions, so supporting secondary care colleagues deciding where patients should be seen, by whom, and with what urgency. However, I feel strongly that NEWS also protects me as a clinician; if a patient unexpectedly has a high NEWS it makes me think ‘have I missed something?’ Sepsis and an overwhelming feeling of doom undoubtedly made me anxious, so the F1 did not intentionally make a mistake but instead the diagnosis was informed by my behaviour and not my physiology. If NEWS had been in place, a NEWS of 9 would have led to immediate escalation and it is unlikely I would have progressed to peri-arrest.

We all want to do the best for our patients, so think about spreading the NEWS and if it helps you sleep better at night what’s not to like?

What is innovation, and how will an Academy help?

David Evans, Programme Manager for the West of England Academy reflects on innovation, and what role that we, as an AHSN, might play in helping others understand and embrace innovation.

Take a glance through the NHS Long Term Plan and the word ‘innovation’ appears time after time. Simon Stevens is accredited as saying, ‘the AHSNs are the innovation arm of the NHS.’

But what does innovation really mean here? And what is our role?

Reading up on innovation can lead you to stories like Edison’s 1000 tests to perfect the lightbulb or Dyson’s many thousands of bag-less vacuum cleaner prototypes. They are remarkable examples of persistence and resilience, but I don’t think it’s all about ‘lightbulb’ (or vacuum) invention moments.

My reading has helped me understand we are already innovating at the West of England AHSN. We have taken ideas from others, helped adapt and develop them for use in a different setting. Then we spread them. PReCePT, NEWS, the Emergency Department checklist are all examples of ideas taken from others and developed for a different setting. That is a powerful form of innovation.

Our pioneering of the use of Quality Improvement (QI) in healthcare is another form of innovation. We take ideas from other sectors (e.g. Toyota in the motor industry) and then adapt and use them to improve care in our own organisations. The ‘Godfathers’ of QI (Shewhart, Deming and Juran) didn’t work in healthcare, but we have adapted the approaches and the tools they used.

So, how can we encourage others to think and work more innovatively, more of the time?

A few minutes on Google and you can find lots of organisations who want to help you and a plethora of toolkits.  Many point to the fact that innovation is a state of mind, but using specific tools and techniques can help to develop new healthcare tools and procedures.

We have found ways to support individuals through our business support work and courses like our Health Innovation Programme (currently recruiting), but we will widen this support to everyone who wants to understand innovation and its role in healthcare.

I don’t think I am an innovator, but through my work here I’ve learnt a lot about innovation. What excites me is using my skills in project and programme management to help others that want to understand innovation and think and work innovatively. I work with talented individuals that can support any stage of innovation from the early stages of understanding a problem, through creative thinking, developing, testing and evaluating and implanting ideas.

What we are doing now to share this knowledge and expertise is developing a suite of courses, toolkits and online resources. These draw on our expertise, contacts, and the best external resources to support anyone wanting to understand innovation in healthcare. We are calling this the West of England Academy.

The West of England Academy will build on our successful work spreading Quality Improvement (QI) knowledge. We’ll work with our existing QI advocates and seek out new converts as well. We’re already running prototype courses and resources are currently being added to our website. The Academy offering will continue to grow throughout 2020. Perhaps you might explore and use our new online toolkit of resources or maybe I will see you at one of the many events we are planning to help spread the use of innovation and improvement tools and techniques. Or maybe you would like to discuss an idea you have.

Either way – do check out the West of England Academy

 

Neonatal care: collaborating to improving outcomes

Noshin Menzies, Senior Project Manager at the West of England AHSN reflects on prematurity interventions, ahead of World Prematurity Day.

This Sunday (17 November) is World Prematurity Day. It’s close to my heart, being a mum to a premature baby and working on PReCePT, an initiative to reduce risk of cerebral palsy in premature babies. I’ve worked on PReCePT since 2014 and seen the impact this simple intervention can have on families.

I’ll be feeling positive on this World Prematurity Day. At the West of England AHSN we are embarking on an exciting collaboration with University Hospitals Bristol and Great Western Hospitals to improve the outcomes for premature babies across the region through a new neonatal care bundle. The bundle is the first of its kind, and builds on what we have learned from PReCePT. It will support maternity and neonatal units in implementing or improving elements of care that will contribute to a reduction in brain injury and death in the smallest and earliest born babies. Magnesium sulphate (the basis of PReCePT) will be one of the interventions, but the bundle will bring together many more that collectively can make a really significant impact on brain injury and mortality rates amongst babies born prematurely.

This project will bring together neonatologists, obstetricians, midwives and neonatal nursing staff to redesign the way in which preterm babies are cared for, before and after birth. We aim to bring innovation and creativity into the design process to embed effective ways of working that we can then share nationally. Having wrapped up delivering quality improvement (QI) coaching to 13 units across the country for the PReCePT study, I am raring to go and share what I have learned with the local teams.

I’m looking forward to meeting parents across the region. We’re setting out to involve and co-produce this project with a wide range of people reflecting the diverse communities that make up our vibrant region. We know that outcomes for mothers and babies born to women of colour are poorer than women of other heritages and backgrounds. We will ensure that all women have a voice and are able to work in collaboration with us as team and I look forward to getting out and about and meeting them!

ReSPECT the process and talk early

Tony Goring, Project Manager on the Patient Safety Collaborative at the West of England AHSN reflects on a conversation with student paramedics on the day ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) rolls out across parts of the West of England.

As ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) launched across parts of the West of England today (10 October 2019), I had the absolute pleasure of meeting 50 student paramedics at The University of West of England’s Glenside Campus.

I spoke to this group of young and enthusiastic second year second students about the benefits a ReSPECT form provides for patient outcomes and for families. One question put to me by a student focussed on their concern that patient family members might be in opposition to the preferences that have been recorded on the ReSPECT form. To this I asked whether the benefit of having conversations much earlier in a patients’ prognosis would help patients’ families support a decision made by the patient in consultation with their doctor or specialist.

The group came to a consensus that earlier conversations around health and treatment preferences would enable patients and their families to have much broader conversations on other matters pertinent to end of life planning, and make it easier to support their loved one’s preferences. It was also agreed that having all family members made aware of the preferences made by their loved one on a ReSPECT form would help the best decisions to be made in the event of an emergency. A colleague of mine, from a paramedic background, often says that, ‘having something to help make a clinical decision in an emergency is far better than nothing at all’.

Hopefully the hour I spent with them this morning provided the students with a greater understanding of the ReSPECT process, probably more than the vast majority of their paramedic colleagues working in the field today.  It was great to help them get ‘ahead of the game’.

I left them with a few words from  another colleague who had recently had a conversation around end of life care and treatment preferences with a family member. He said that, following discussions with his wife and mother-in-law, he could honestly say that talking about health and treatment preferences ‘made all the relatives feel better and allowed us to talk more openly’.

For more information on the ReSPECT process and the adoption of ReSPECT in the West of England, visit https://www.weahsn.net/our-work/improving-patient-safety/respect/

Diversity in Innovation: Alan Bec’s story

Alan Bec, Founder of the Wellbeing Indicator Badge (wib) and graduate from our West of England AHSN Health Innovation Programme is one of the innovators featured in the recently published AHSN Network Diversity in innovation report. Alan shares his story of living with chronic fatigue syndrome and developing the wib as a shorthand way to communicate with people.

I became a healthcare innovator almost by accident. My career had taken me through a number of roles: psychologist, university lecturer, student mentor and executive coach. I was the first BAME head of coaching and training for the Institute of Directors.

Then I was struck by chronic fatigue syndrome and became housebound. Talking was exhausting. I just didn’t have the energy.

After three years of living like that, I created the Wellbeing Indicator Badge (wib), a shorthand way to communicate with people – family, friends, healthcare professionals. I’d been a high-functioning, respected professional and academic, and there I was a lump of meat in a bed. I wanted to reconnect.

I’d use the wib to show my energy levels on a scale of one to ten. People could instantly see how I was feeling and respond appropriately. This was particularly helpful with my GP, who could tailor his approach to consultations and care. With fluctuating symptoms, it helped me understand the impact of my illness and self-regulate my activity.

Others became interested in the wib and in 2017 I was put forward to do a TED talk, which attracted media attention. The West of England AHSN approached me to consider their Health Innovation Programme for healthcare entrepreneurs, and as I was getting better, using my time more strategically, I had more ability to work on the wib as a product to help others.

Looking back, feeling like an ‘outsider’ at key stages of my life was also influential in developing the wib. It’s all about leveling the playing field for people who find it hard to articulate their sense of wellbeing for whatever reason; it’s about inclusion and reducing social isolation.

I was born in Scotland. My mother is British and she fell for my father who came over from India on a boat at 16 – he is Anglo-Indian with mixed eastern cultural heritages. I didn’t know what racism was until we moved to England when I was eight when my dad was promoted. Then we went up in the world, moved to a posh house in the countryside amongst doctors and dentists. I experienced racism from day one.

But I don’t come from a place of anger; I come from a place of wanting to connect. Healthcare is for all, so must include all! Innovation is the result of the diversity of ideas and experience that drives cutting edge solutions. Organisations like AHSNs working in this space need to demonstrate to BAME innovators they are not simply ‘welcome’ but also essential to healthcare innovation. It’s exciting that together we are innovating our organisational culture to become genuinely representative. Together we can co-create social innovation and wellbeing for all.

This story is an extract from the AHSN Network’s Diversity in innovation report – celebrating diversity across the Network, and setting out pledges to further support the diversity and innovation agenda. Read the full report.