QI in pharmacy? It’s a brave new world.

In this joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved, including at our first-ever Pharmacy Showcase on 12 January.

First we hear from Chris…

As the Senior Project Manager for the Medicines Optimisation team at the West of England AHSN, but a former Physiotherapist, I won’t say it was always easy, but I have finally got my head around the wider challenges and issues with safe prescribing of medications.

The numbers are eye watering – circa 237 million medication errors occurring at some point in the medication cycle per year in the NHS in England and 66 million of these considered potentially clinically significant errors. Reducing medication errors can clearly have a significant and immediate effect on patient safety.

We know that as experts in medication management and optimisation, pharmacists and pharmacy technicians are ideally positioned in the healthcare system to improve current processes and reduce avoidable medication-related harm – and that QI approaches are vital to creating lasting change.

As every pharmacy team will know they are being positioned more centrally within healthcare services and have more clinical autonomy. Services such as the Discharge Medicines Service and Community Pharmacy Consultation Service provide a step change to embed pharmacy professionals as an important first point of call for healthcare information rather than traditional settings such as General Practice / Emergency Departments.

Introducing QI

Despite all this, pharmacists often lack the basic tools required to lead on or participate in QI initiatives as they’ve historically not been trained or required to perform QI projects. This is slowly changing, and here at the AHSN we’re working to drive adoption of QI approaches across pharmacy.

Here we’re handing over to Ola who gives details of the reasons for this, the impact and our new offer for pharmacy colleagues….

I’m a clinical pharmacist and over the last 12 years I’ve worked in a community pharmacy (very many of them), a General Practice (very briefly) and a hospital (or three, to be precise). Over those years I have met hundreds of pharmacy technicians and pharmacists determined to ensure their patients got the best (aka safest) care they could.

But I’ve never worked on QI before – what is it?

We are diligent, we are keen, and we are truly brilliant! No need to argue that. The thing that we are not good at is quality improvement. It is not that we don’t do it well, we simply don’t do it enough… And why would we? If you are anything like me and your registration number starts with 20*****, you would, most likely, had never been taught what QI is and how to do it well.

It wasn’t until the last couple of years that I started hearing about the QIPs, the PDSAs and the “driver diagrams”. Maybe I was not expected to know then, but I am now. (And there are masses of free resources on the West of England Academy website to help anyone embarking on QI work – but join our Pharmacy Showcase on 12 January to hear more about free, interactive and tailored support for your team).

Embracing QI to support our profession and wellbeing

Like never before, we are forced to do more and faster with less resources and time. We need to learn how to improve what we do in order to survive. And we need to do it now. The numbers are scary, with every fourth pharmacist reporting feeling ‘very stressed’ at work, mainly due to the increased demand for services and the lack of funding. That is 37% of community teams (up from 17% last year), 20% of hospital pharmacists (up from 10% in 2020) and 14% of GP and PCN pharmacists (up from 5% in 2020)[1]. I anticipate that the figures among pharmacy technicians follow a similar trend. Grim. Burnout alarm bells ringing all over the place.

When I asked around, I wasn’t surprised by the number of suggested solutions to various work problems we come across every day.

Not-a-surprise No. 1: We often know what goes wrong.

Not-a-surprise No. 2: We also often know a solution (or improvement) to the status quo. We sometimes even make that improvement ourselves!

For some reason, however, we rarely document the before and after and so are unable to prove our intervention has worked. “I am not wasting time on the data collection when I have so much to do”, I heard recently from a fellow pharmacist. “But your idea is brilliant! And it saves time, so if other people knew about this, the impact could be huge”, I reply. “Nah, too much effort”, I hear back. I bet this sounds familiar…

Don’t we all roll our eyes when an audit arrives and we need to fill out a spreadsheet, often without pausing for a moment to question what it’s for, and how the results will affect us in the future. Here in lies the answer – capturing our learning and experiences through QI.

Get involved

So come and meet us on the 12 January at our Pharmacy Showcase to hear about the projects our AHSN is involved in, meet the team, network with other pharmacy colleagues and learn more about a free, tailored Pharmacy for QI course coming in spring 2022.

[1] The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.114907

Working with the learning disability community to produce our new annual health check videos

The West of England Learning Disabilities Collaborative puts people with a learning disability at the centre of everything we do.

The Misfits Theatre Company, based in Bristol, have previously worked with the AHSN to create videos on topics such as the flu vaccine. In our latest video series, commissioned by NHS South West, we have worked with the Misfits to produce a range of videos that encourage greater uptake of annual health checks for those with a learning disability. The videos cover a range of audiences including health professionals working in primary care, with a second playlist focusing on people with a learning disability and those that care for them.

In this joint blog from members of the Misfits Theatre Company and Rosy Copping, Project Support Officer for the West of England Learning Disabilities Collaborative, we talk about how the video project came to fruition and what it was like to get involved in the filming.

The AHSN perspective from Rosy

Co-creation is the most important factor in our work at the West of England Learning Disabilities Collaborative. It is essential that we gain an insight into the lives of people with a learning disability and their carers, so that we can ensure the needs, concerns and views of the community is reflected through our work.

The video series was created to educate health professionals, carers and people living with learning disabilities on the importance of annual health checks. Annual health checks are so important for people living with learning disabilities as it can help alert them, their carers and their doctors to any underlying medical conditions, and to help manage any current medical conditions that the individual may also be living with, such as epilepsy or diabetes.

We have worked with many experts by experience to produce these videos, namely, the Misfits Theatre Company, Andrew Bright, Head of Development at Thera Trust and Ian Harper, Service Quality Director at Aspire Living. Without their help, the videos may not have spoken to people with learning disabilities in the same way and we might not have been communicating effectively how important it is to get an annual health check. We think it’s vital that when we produce resources, we ensure people from the community who will be using them, get to shape their creation and be directly involved.

We worked with Ian and Andrew on the development of the scripts, and they helped us to ensure that the wording was appropriate for people with learning disabilities to understand, and that the style and tone was friendly and informative. For example, Ian suggested that we change the phrasing of epilepsy to read “seizures”. We then worked with Misfits Theatre Company to film the videos. The Misfits added their own flair to the videos, and we hope they will inspire many others living with learning disabilities to get their annual health checks.

We very much enjoyed working with the Misfits, Andrew and Ian for this piece of work, and we hope that their depictions of why annual health checks are so important, resonate with viewers as much as they did with us.  We certainly could not have achieved this work without their help, so we’d like to say a big thank you!

The Misfits Theatre Company Perspective from Sara Melton

It was fantastic to be part of this very important project.  It is so vital that people with learning disabilities are aware of the importance of having their annual health check and what’s involved in the process.

We asked the actors working on the project to tell us what it meant to them. Here’s what they said:

Rob “I always enjoy helping create different accessible information about the importance of health care.  The fact that the people are willing to get the information out there is wonderful.  I felt the filming went smoothly.  I always have fun doing filming”. 

Beth “It was nice to be involved in the project and feel like I can make a difference by getting the important messages across.  The day was exciting.  I loved using my skills and abilities to educate and inform others”.

Bill “It was brilliant to be involved and I loved being on location filming.  It is so important for people like me to get an annual health check.  The filming went smoothly, and I really enjoyed myself.  The people we worked with were really friendly, which always helps”. 

Penny “The annual health check film went really well.  It helps people with learning disabilities to get their health check.  I really enjoyed being involved in the project.  The film is informative for people like me.  It is rewarding to know I have made a difference for other people with learning disabilities.  I always have fun being involved in films!”

As you can tell from our actors’ comments they really enjoyed being involved in the project.  It is of utmost importance for them to be able to educate others who also have learning disabilities, as well as health care professionals.  Their first-hand experience really enables them to connect and relate with their audience.  The filming also gives them a platform to educate professionals who will be working with people with learning disabilities like them.

We look forward to the next film project!

To find out more about the West of England Learning Disabilities Collaborative, including signing-up to receive newsletters, please visit the collaborative’s webpage.

Spotlight on Inclisiran

October was National Cholesterol Month, and our team have been busy hosting a series of lipid optimisation education sessions; launching the new Child Parent Screening pilot for Familial Hypercholesterolaemia; increasing adoption and spread of lipid optimisation pathways and preparing to roll out Inclisiran to complement current treatments. Read more about our Familial Hypercholesterolaemia (FH) and Lipid Optimisation programme.

In this blog, Clare Evans, Deputy Director of Service and System Transformation at the West of England AHSN, tells us more about Inclisiran and how local systems can get involved….

If you listen to the radio or read a newspaper it won’t be long before you hear the word ‘Cholesterol’. In my experience as a former nurse cholesterol can be seen as something only some of us have but we all have a level of cholesterol in our bodies. The question is whether each of our levels of cholesterol is ‘good’ or whether it’s high and could be doing us harm and lead to cardiovascular disease (CVD).

CVD is a health equity issue

CVD has been identified in the NHS Long Term Plan as the biggest single area where the NHS can save lives in the next ten years – 150,000 to be exact. Heart disease causes one in four deaths in England, and two in five people in England are thought to have high cholesterol. These stats make sobering reading. We also know that those living in areas of multiple deprivation are more likely to be affected by CVD. If we’re serious about tackling health inequity, CVD and cholesterol is one of the most significant areas to focus on.

Through the AHSN Network’s Lipid Optimisation and Familial Hypercholesterolemia (FH) programme we have been making significant progress in the West of England region. The programme includes working across our region’s three systems to increase the diagnosis and treatment of FH patients, including young people and children. Some of us may be pre-disposed to CVD because of FH – an inherited condition passed down in families. FH can lead to extremely high cholesterol levels. It affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed. Our new pilot, also taking place across six other AHSN regions in England, will use a heel-prick test to identify FH in children and subsequently their families.

So where does Inclisiran come in?

Before now if a patient was on the maximum dosage of statins, had been prescribed Rapid Uptake Products such as ezetimibe or PCSK9i and their cholesterol levels were not decreasing, options were limited. But now Inclisiran can support these patients.

Inclisiran injections use a biological process where molecules can shut down protein translation to help the liver remove harmful low density lipoprotein cholesterol (which are often simply referred to as ‘bad cholesterol’) from the blood. Inclisiran can be used with statins or on its own.

In line with NICE guidance, Inclisiran won’t be available to all patients with high cholesterol and can only be prescribed if someone has had a CVD event such as a heart attack or stroke. Inclisiran provides a new option when other treatments are not working – it can reduce cholesterol levels by 50%.

Read more about Inclisiran and the partnership between the NHS and industry to tackle cardiovascular disease.

What’s next?

The Accelerated Access Collaborative are responsible for the implementation of the Inclisiran partnership. Now that Inclisiran is available to NHS patients in England, AHSNs, as the delivery partner, are working to ensure that the new treatment fits seamlessly within the lipids care pathway.

Locally we’ve therefore started conversations to discuss Inclisiran and how it complements the current lipid-optimisation pathway for a specific subset of patients. It’s our job at the AHSN to hear about any local barriers or challenges to Inclisiran uptake and work collaboratively with systems to try and remove these.

Inclisiran remains one part of the lipid optimisation pathway, so we’ll be complementing our ongoing programme, so all of those with CVD see benefits rather than ‘just’ those who will be able to receive Inclisiran.

We’re also working to ensure our systems are fully briefed on the Accelerated Access Collaborative’s revised lipid pathway (which is currently being developed).

How do I get involved?

If your work is related to CVD and lipids optimisation in the West of England region whether that be as an Integrated Care System lead, in a Trust, Primary Care Network, General Practice, pharmacy or as a local lipid specialist, please get in touch with me, clare.evans14@nhs.net or my colleague Rachel Gibbons, rachel.gibbons10@nhs.net so we can discuss how Inclisiran can be adopted by your organisation.

Read more about our Familial Hypercholesterolaemia (FH) and Lipid Optimisation programme.

In addition, there is a comprehensive cholesterol awareness and education campaign targeted at health care professionals involved in lipids management which can be accessed on the Heart UK website.

Marking World Mental Health Day – reflecting on our mental health training for care home managers

In this new blog to mark World Mental Health Day, our Programme Assistant, Millie O’Keeffe talks through the journey she and Bristol Mind took as they worked together to build a free mental health focused training package for care home managers across the West of England. Millie picks out some of the feedback the training (which ran in cohorts from January to June 2021) received and why working on this project was so important to her, our care homes programme and the care home managers who attended.

From a seed

The journey started when some of our key stakeholders in local systems told us about the significant challenges staff in care homes were facing around high COVID rates, deaths of residents, PPE and staff shortages, and isolation – we’d heard about these challenges in the news too – and the effect this was having on care staffs’ wellbeing and mental health. We knew our colleagues in social care were struggling and so wanted to support them somehow. Line managers at the West of England AHSN had recently been trained by Bristol Mind in mental health awareness, and we had heard good feedback from those sessions, so we reached out to Bristol Mind who were happy to work with us to tailor the line manager session for a care home manager audience.

Pulling the jigsaw together

The content of the free training focused on supporting the wellbeing of managers so they were able to better support their staff. There was a lot of ground we could have covered but the fantastic team at Bristol Mind focused on the stress curve, tools like STOPP, how to have a sensitive conversation, and advice on supporting staff who are grieving or anxious about COVID. We also shared lots of resources, including a workbook, and signposted to local support organisations after the training.

Suzanne Pearson, a mental health trainer and consultant and BABCP Accredited Cognitive Behavioural Therapist, worked with us to adapt the content and deliver the training.

How did it go?

I am really proud to say we received incredibly positive feedback from the managers about Suzanne and 97% of attendees said they would recommend the training to a colleague.

“I found it calming, almost therapeutic, I know that may sound odd but just listening to others’ experiences made me feel connected.”

Thanks to the efforts of our contacts in regional systems, provider organisations, primary care, councils (and more) in promoting the training to their local care homes, over two busy cohorts we trained 159 care home managers from across the West of England region.

What did the data look like – how did the training make a difference?

I’m always keen to dig into the data and understand what changed because of the training we provided. Prior to the training, managers cited they were most concerned about their staff’s own mental health and wellbeing, with fear of spreading COVID to residents coming in second. When asked how concerned they were about their staff’s wellbeing, zero responders chose ‘I am not concerned at all’ – that showed me just how much stress each and every care home was dealing with. However, most (59%) managers believed themselves to be fairly confident in supporting their staff, and following the training, their confidence improved even further. A follow up survey showed a third of responders use the tools and tips from the training regularly (a few times a week), and that the training has changed how they support their own (76%) and their staff’s (94%) wellbeing for the better.

It was great to see such positive data from the surveys, but what really hit home to me and the rest of the care homes team were the comments from managers:

“I was really interested in the approach of asking the care home managers how they were feeling and giving them a voice. This was a powerful and quite shocking start. The look on 25 participants faces at the thought of focusing on themselves instead of on their staff. The shock came from the understanding that with COVID we have all just kept going and going, the instruction ‘right, now stop, what about you’ was bizarre.”

Making connections

A positive by-product of the training was that a large number of attendees mentioned they felt the session provided valuable time and space to connect with other managers who have experienced similar pressures over the past year, especially managers from different organisations, and specifically managers in social care.

Suzanne also offered some valuable insight from discussions in the sessions, including a fear that the sector could not influence decision makers and was at risk of being forgotten about. Many managers described burn out, exhaustion, and weariness, and shared concerns around staff recruitment.

These key messages and the evaluations have been shared with our regional stakeholders and internally with colleagues across the Care Homes Programme, so we hope that the training has not only supported managers and staff in care homes but will also go towards illuminating the wellbeing needs of the sector going forwards.

Talk ‘ain’t’ cheap

As I reflected on the training programme and World Mental Health Day, I considered that making time and listening and learning from all our colleagues across the whole health and social care spiderweb is vital – talking is so important and sometimes we forgot to do it.  Mental health has always been something I’ve felt should be spoken about more honestly and openly, so as I bid farewell to the AHSN in the weeks to come I remain proud to have coordinated this positive training programme.

Read more about the free resources, support and training available to social care staff across the West of England here.

Inequalities in maternity care

In this blog our Maternal and Neonatal Clinical Lead, Ann Remmers, reflects on inequalities in maternity care and how we’re working collaboratively to support positive change…

The Black Lives Matters movement brought into sharp focus the shocking inequalities experienced by people based on the colour of their skin. It has not only raised awareness but led some of us to examine our own prejudices, which we may previously have been unaware of. These words by George Floyd’s brother really resonated with me “educate yourself”. Our outlook on the world is based on our personal experiences, race, ethnicity, socio economic background. As a starting point we can look at ourselves, our identity and our influences and how this may impact on others.

Earlier this year I attended a two- day Cultural Competency and Safety virtual work shop run by the Sheffield Maternity Cooperative and accredited by the Royal College of Midwives. I quickly realised even before the workshop began how little I really know about racism, discrimination and bias and how much more there is to learn, just by looking at some of the excellent pre-course resources. The workshop was very interactive and I think all of us who attended were open to exploring difficult issues and challenging ourselves. One really simple thing I learnt that we can all do is check with someone how they pronounce their name, it shows you care and makes that person feel like you are treating them as an individual.

What do we know? 

Sadly there are some pretty stark statistics about outcomes and experience for black and brown women and their babies. For example while stillbirth rates overall have reduced by over 16% and neonatal mortality has reduced by 11% between 2013 and 2018, “rates of death are falling more slowly among [Black and Asian] babies compared to White babies” and thus initiatives to reduce baby loss are “failing to reach many women from higher risk ethnicities”. Stillbirth rates for Black and Black British babies are over twice those for white babies and neonatal mortality rates are 45% higher.  Maternal mortality is almost five times higher in women from black ethnic backgrounds and Asian and Asian British new-born babies are 60% more likely to die than white babies (MBBRACE, 2020).

Professor Marion Knight describes a constellation of biases that result in some women having poorer experiences and outcomes than others (MBBRACE, 2020) These biases include living in deprived areas, belonging to a minority ethnic group and being non-English speaking.

A national focus

It is encouraging that these inequities are now a national focus and maternity systems and organisations are being encouraged to look at their own data to address these. Two charities are exploring this further: this year, birthrights are convening a human rights inquiry to investigate and drive action on racial injustice in maternity care and Fivexmore are launching a black maternity experience survey to better understand outcomes and experience.

So how do we start to address these issues?

I think the first step has to be a personal one, we are all coming from our own personal experiences that have shaped us as we have developed and grown into adults. By examining these experiences and thinking about how they can be impacting on our interactions with others and the care we give is a massive first step. We all go to work to do a good job and want the best possible outcomes for those we care for, by educating ourselves we can achieve more for people that are disadvantaged by the way they may be viewed.

What are we doing locally?

In my organisation we are just embarking on our focus on health inequalities in maternity care and indeed all our work at the West of England AHSN. We are working with an organisation called BCohCo who are helping us to understand where inequity and inequality exists and how we can address this. It is both a personal and an organisational journey. Read more about our organisation’s work with BCohCo.

In our maternity and neonatal team we have been looking at ways to gain a greater understanding of our local population’s needs. Opening up discussions about women’s different experiences and how this impacts on their health care and outcomes and working with local groups who are raising the profile of women who experience racism. To bring people together to share approaches and experiences to tackle racism in maternity care we are setting up a Regional Perinatal Equity Network together with the South West AHSN. This first meeting will be held on 21 July.

Join us

We are all learning, and being on this journey together has to be the right thing to do to improve outcomes and experience for all mothers and babies. We know it is vital we create time and space to hear voices of parents and families that have been seldom heard, that’s why we are launching our new Network – we invite you to join us if you are interested in this area. Find out more and book your space at our first Regional Perinatal Equity Network.

It is only by working together and really listening to and learning from everyone’s experiences that we will create positive lasting and structural change which will benefit those who are at a unique and vulnerable time in their lives.

Co-creation in the West of England Learning Disabilities Collaborative: ‘Done with, not to’

So, what is co-creation? Co-creation is when an organisation or team work with a group of people to create something, particularly when that group will be affected by the outcome, or use the resource or service being created. For example, the NHS might work with a group of people with lived experience, in this case people with a learning disability, to design a leaflet to help others in the learning disabilities community to make healthy food choices.

The West of England Learning Disabilities Collaborative puts people with a learning disability at the centre of everything we do, and that includes involving them in anything we create to support the learning disabilities community. In the past our valued experts-by-experience have worked with us to make online training and meetings more accessible, to prepare for webinars, and to create videos for carers, healthcare professionals, and people with a learning disability. We always strive to ‘work with, not do to’ the learning disabilities community.

Andrew Bright, Head of Development at Thera Trust, is a person with lived experience of a learning disability. Andrew works closely with the collaborative on several projects. To mark Learning Disability Week 2021, Louise George, Senior Project Manager at the West of England AHSN caught up with Andrew to discuss his experiences of co-creation, and working with the collaborative…

Andrew, how would you explain how important co-creation is to others in the learning disability community?

I think co-creation is really important. It is easy for professionals without lived experience to think the things they are doing are great, but there is added value in having people with lived experience of a learning disability work on things that will affect them.

I enjoyed working with the collaborative on creating training and a series of videos for carers, and it was great to be involved in something that was so important nationally.

 Do you think people and organisations do enough to involve people with a learning disability in designing the services and resources they use?

People are making a start, but they are still not involving people with lived experience as much as they could. People need to do more, as many self-advocates would jump at the chance to work with the NHS to make things better.

I feel that the work I was involved in creating the video series and training for carers sets an example of successful co-creation.

 How has your experience of working with the West of England Learning Disabilities Collaborative been so far?

We are still at the start of learning how to work together, but I have really enjoyed it so far. Using Teams instead of emails allows us to have more of a conversation, and work through things we are working on together. The only thing I would like is more advance notice of deadlines; however I know this is not always possible, and I am not put off by this.

I feel that the people are easy to talk to and that my contributions are valued.

What would you like people to know if they are nervous about getting into co-creation?

That there is nothing to be nervous about. I also work with others on co-creation within Thera, and feel it benefits a lot of people. We cannot do things alone; we can achieve more as a team, and people should know that their opinions and contributions will be valued.

To find out more about the West of England Learning Disabilities Collaborative, including signing-up to receive newsletters, please visit our collaborative webpage.

If you or someone you know is a service user who would be interested in learning more about or getting involved in co-creation with the Learning Disabilities Collaborative, please contact with Louise George.

How our Learning Disabilities Collaborative was formed

In this blog to mark Learning Disabilities Week 2021, Dr Alison Tavaré, who is a GP, one of our Primary Care Clinical Leads and South West Clinical Lead for the NHS@home programme, discusses how the idea for the West of England Learning Disabilities Collaborative (WELDC) took shape…

As a GP and a clinical lead at the West of England AHSN I have always had a special interest in the use of NEWS2 (National Early Warning Score) to support clinicians in the early identification and management of the unwell patient. However, the more I used NEWS2 the more I wondered if patients could record observations such as their blood pressure or pulse rate and share these measurements with clinicians to help us decide whether they needed to be seen, and if so by who, and with what urgency. Read more about NEWS2.

Making connections

The idea evolved and I shared it with my brother Ian, and his wife Kate, who are the parents of Toby who has a learning disability and therefore finds it a challenge to tell others when something is wrong. A few months later Toby developed a cough and became very quiet and subdued; while this may not be unusual for many people, for Toby this can be a sign that he is unwell. Kate took a full set of observations, calculated a NEWS2 score of 6 and took Toby to the local emergency department where he was promptly treated for sepsis.

LeDeR (Learning Disability Mortality Review) has identified that not only are people with a learning disability more likely to die of sepsis but on average they die more than 20 years younger than the general population. While this may partly be due to underlying health conditions it is also known that being unable to say you are unwell is another contributing factor.

Sharing Toby’s story

With permission I started to share Toby’s story when I spoke about NEWS2 and soon found there were many others who shared my concern that communication could be difficult if someone who has a learning disability becomes unwell. Anne Pullyblank, the medical director of the West of England AHSN, and I therefore decided to find out if there could be any interest in developing a group where practical ideas and strategies could be shared. We sent a speculative email which immediately generated lots of positive responses, and in 2019 the West of England Learning Disability Collaborative (WELDC) was established. There are now over 300 members from diverse backgrounds and include experts by experience, families, carers and clinicians.

Continuing the WELDC journey

The WELDC has continued to flourish and in the past year alone have delivered webinars on COVID-19, annual health checks, digital solutions and advance care planning. Alongside this there has been lots of sharing of knowledge and expertise and we have even had a question asked in the House of Lords. Most recently we have worked with the NHSE Learning Disability and Autism team to co-create training on ‘soft signs’ and communication which has been delivered to 8000 families and carers.

As there is increasing awareness of the health inequalities experienced by people with learning disabilities, we feel that the WELDC is well placed to support new models of care and look forward to seeing the collaboration continue to evolve and contribute to better outcomes for people like Toby.

Reflecting on our PERIPrem journey

As our PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) project becomes part of our wider Maternity and Neonatal Safety Improvement Programme (known as MatNeoSIP), Senior Project Manager, Noshin Menzies reflects on the year she spent supporting the project from her kitchen table and what lessons she’s learnt from launching and managing PERIPrem during a pandemic…

It has been 11 months since I was first asked to reflect on launching PERIPrem in the early days of the pandemic. A year that seems to have lasted a decade and ten minutes simultaneously. I have put off starting this blog post for a while now, as when I was asked to reflect once again on the lessons learned, I was hit with a wave of clichés that seem trite and tired. As the team providing the infrastructure for PERIPrem, we have learned to be agile, to be flexible, to swap offices for kitchens and to home-school whilst facilitating meetings, but this all seems so trivial when we now know what was demanded of our frontline colleagues.

The lessons I want to share are about the skills of knowing when to step back, when to rally teams and when to employ the odd joke to lighten the load in a virtual room. The lessons I will keep with me as we move into the next year of unknowns are those of camaraderie, collaboration and community through laptop screens and the tinny pings of whatsapp messages.

Steering the ship on a new journey

PERIPrem has now transitioned into the Maternal and Neonatal Safety Improvement Programme (MatNeoSIP) and my time as a core crew member has ended, as I move on to other projects and PERIPrem doesn’t need us all quite like before.

When considering this, and what it would mean, I realised that PERIPrem had been the solid ship I and many others needed in the unchartered waters of the pandemic. The strength of PERIPrem is in its power to bring community to teams across the entire region. To individuals working from kitchen tables and to clinicians sitting into offices wearing PPE just so they can share a screen, HMS PERIPrem offers a lounger on deck to sit beside friends, and for a while, focus on the horizon.

The horizon, is of course, healthier, fuller lives for the most vulnerable pre-term babies. Babies who rely on the dynamic of the perinatal team seamlessly working as a united crew to ensure that they and their mothers, receive the very best of care, to give them the best chances.

The plans we made and changed

When we had to rapidly reassess how to launch PERIPrem virtually, when we had dreams of large, vibrant events and working side-by-side with our perinatal colleagues, we faced the unavoidable question of whether we could ask clinicians for their precious time when they were under such pressure.

It became clear, that for many of our colleagues, PERIPrem offered a space outside of the pandemic to channel creativity, innovation and a passion to improve care that they very much welcomed.

Our virtual celebration events will remain with me as such joyous, energy-filled times, where despite being spread across the South West, we were able to feel as though we were all together.  We have collated a vast library of resources, a valuable record of the journey we have navigated, which would not have come to fruition if we were able to proceed as planned.

I feel so proud when I see our PERIPrem logo. It is more than branding, it stands for what is possible when we all do what we can to retain community when physical distance is demanded and an emblem of our collective commitment to reduce brain injury.

What 2020 taught me – and how PERIPrem embodies those lessons

One of the most important lessons we have all learned is that no matter how dedicated we are to ensuring that all mothers and babies receive the very best care, that rolling wave of inequality keeps hitting the side of the ship and making the journey more treacherous for many.

The pandemic for me will be synonymous with a call to action, with a letting drift of the tolerance of social injustice and seeing with newly opened eyes the splinters of discrimination built into our society and thus the NHS.

PERIPrem has always kept this at its core, to look at the myriad ways that women and their babies may be disadvantaged. Now we are able to galvanise this and I am filled with excitement as we firm up plans to be bold and innovative in our commitment to do better for the women and families that need us to hold space for them.

The power of the team

I’m so grateful to the community that PERIPrem has offered us all during the strangest of times. It serves as a reminder that we all share such willing to do the very best for the people in our region. It has been such a privilege to watch how each team has dedicated their precious time to implement PERIPrem, led by such inspirational women, Karen, Sarah, Ellie, Ann, Tracey, Sally and Aless, most of whom were also working clinically alongside steering this ship.

As I reflect on the extraordinary experience of working, mothering and keeping my head above water over the last year, it is with nothing but pride that I can say, “No I didn’t learn a new language, make a sourdough starter or learn how to crochet.”  What I will treasure (show off about) is that I got to be a part of PERIPrem, travel across the South West from the comfort of my dining chair, and learn from the most dedicated, empathetic, energetic and quick-witted team.

Read more about PERIPrem.

Read more about our Maternity and Neonatal Safety Improvement Programme.