Getting the balance right on polypharmacy

The AHSN Network recently launched the new national polypharmacy programme: getting the balance right. Here national Programme Manager, Amy Semple and Clinical Lead, Clare Howard discuss why we need to take action to address problematic polypharmacy and how the AHSN Network is supporting this important area of work.

“As we live longer with more long-term conditions medicines can help but we know that people are sometimes exposed to more medicines than they can manage and some medicines, in combination with others, may cause them harm. The AHSN polypharmacy programme aims to help ensure clinicians, patients and the public understand how to get the balance right.”

Why is polypharmacy an important topic?

Polypharmacy is one of the key themes of the World Health Organisation’s Global Patient Safety Challenge, aiming to reduce severe avoidable medication related harm by 50% globally over five years.

In England, we prescribe and dispense over one billion items each year in primary care. In April 2022 alone, there were almost one million people in England taking 10 or more medicines and 370,000 of those people we aged 75 or over. We know a person taking 10 or more medicines is 300% more likely to be admitted to hospital.

Medicines do so much good but as more people live longer with multiple long-term conditions, the number of medicines they take increases, and this can sometimes expose them to harm. They may increase their risk of a fall or being admitted to hospital, or generally reduce their quality of life. Of course, no doctor, pharmacist or nurse wants this for their patients but sometimes the system that we work in can result in people being on too many medicines.

Our polypharmacy programme aims to support the national effort redressing the balance. We want to ensure that patients can access what is appropriate for them but not take so many medicines that they can’t manage them all or take combinations of medicines that we know increase their risk of harm.

Why do people end up on too many medicines?

This isn’t anyone’s fault. We have a medical model of care that doesn’t always take adequate notice of the situation a person is in or what is important to them. The AHSN polypharmacy programme is supporting GP practices to identify patients who might be at increased risk of harm. We’re helping clinicians carry out high-quality medication consultations based on shared-decision-making and we’re also helping the public understand that it’s important that they ask about their medicines and share their questions, concerns and expectations.

Just as the causes of polypharmacy are complex, so too are the solutions. That is why each AHSN is establishing a polypharmacy community of practice to bring people together to share ideas and best practice and work on local solutions.

What has been done already?

The AHSN Network, working with the NHS Business Service Authority, created the first national data set of polypharmacy comparators for England. This shows GPs and pharmacists which of their patients are deemed to be at greatest risk of harm. This work has been used by many practices since 2017 and we are now running training sessions to ensure that ALL practices access and use the tools as they’ve been designed to be used.  We know that where primary care does this, it can have a real impact on polypharmacy and lowering some of the risks of harm that patients can be exposed to.

What part do patients and the public play in this work?

Pillar 3 of our work is a more experimental phase where we’ll be considering how we can best support patients to be more open about their medication issues. Each AHSN will be testing available patient information resources and the impact these can have on conversations between clinicians and patients. And nationally we’ll be engaging with public, patients and carers, as well as organisations like Age UK, to ensure there is a strong patient voice throughout our work.

Where do you hope to see this programme in three years’ time?

I hope that in three years we’ll have deployed a comprehensive training programme to thousands of clinicians, and as result they’ll be much more confident in stopping medicines safely that are no longer needed or appropriate. I hope that the general public comes to demand a medication review every year and expects to have a meaningful conversation with their prescriber about what is important to them and how their medicines can help with their goals in life, especially in later life.  It is an honour to be leading this programme and I am committed to making taking medicines safer and easier.

How can people get involved?

Each AHSN is setting up a community of practice to bring together clinicians, charities and the voluntary sector and importantly patients and carers to explore and take action on how to address this locally.

We are encouraging GPs and prescribers to join local or national action learning sets. These will ramp up next year and are a practical way to start having conversations with patients about stopping medicines safely.

And if you are a member of the public managing multiple medicines, we want to hear from you – and your carer – to join our local focus groups and help test the patient resources.

So there are lots of ways to get involved. If you have any questions about the West of England Polypharmacy programme, or would like to join our community of practice, please contact Chris Learoyd, Senior Project Manager. You can also contact the national programme team for more information.

The power of language

In response to the growing commitment in the region to work together to address inequality and inequity within maternity and neonatal services the Regional Perinatal Equity Network was launched in July 2021 by the West of England and South West Academic Health Science Networks. In this blog, Katie Donovan Adekanmbi, Inclusion and Cohesion Specialist from BCohCo talks about her experience of attending the Network to discuss the power of language…

Not knowing what to say and how to say it when discussing Diversity, Inclusion, Cohesion and Equity (DICE) can make for an uncomfortable conversation. Bumbling over our words revealing our lack of vocabulary and confusing schools of thought when discussing protected communities can provoke a level of anxiety high enough for some to justify avoiding ‘the conversation’ completely. However, I am here to tell you that ‘unless it feels uncomfortable you are probably not doing it right’.

One trait of an inclusive leader is an insatiable curiosity for difference. So, I’m inviting you, as I did with attendees of the April Regional Perinatal Equity Network (RPEN), to lean in rather than out when your discomfort is activated…

What I have found to be true – as a woman of dual heritage, thriving with neuro divergency and proud of her working-class roots – is that we aren’t going to build cohesive communities by avoiding the difficult conversations. We won’t swim in the sea of creativity and innovation should we choose our comfort over discomfort and vulnerability any longer.

In my experience, navigating the ambiguous states of mixed ethnicities, neuro-divergence and class has created a resilience I never knew possible. So here’s my confession, never have I achieved more learning than when putting my preverbal size nines in it.

Getting to work

The reality is we are always combating bias, prejudice and discrimination. Organisations dress it up in the positive packaging that is Diversity & Inclusivity or DICE but make no mistake the reason we are fighting for DICE is because the playing field is not even and bias shows up everywhere. I feel very assured by the fact that everyone has biases. No one has made it to a ‘perfect’ bias-free status. We all have work to do, and the work is continuous.

The Covid pandemic exasperated inequalities and left us no choice but to face some serious disparities and biases in our society. Those in care homes initially left out of contingency plans; people trapped in poverty without their support services; those facing domestic abuse. The exam results scandal revealing postcode and class bias. People of colour disproportionately affected by Covid19 and the Black Lives Matters protests erupting on the international stage.

Why focus on maternal inequity?

When focusing on maternity we now know that Black women are 4 times more likely to die during pregnancy or in the postnatal period than white women (Knight et al 2019 MBRRACE-UK). Stillbirth rates of Black and Black British babies are over twice those for White babies (Muglu et al 2019).

In addition, it is accepted that there are inevitable “near misses”, experiences of poor care and psychological impact that have not yet been a focus of research, further adding to the burden of trauma carried by Black women.

The reasons for the disparity are described as a “constellation of biases” (Knight 2020); systemic biases preventing women with complex / multiple problems receiving the care they need ante- and postnatally. What is clear is the diminishing tolerance to the impact of unconscious bias, stereotyping and lack of diversity competency that result in health services that are not safe for all.

Now professionals want to have the uncomfortable conversation, in fact they need to have the conversation. Whether regarding Race, LGBTQ+ or Disability to name a few. Professionals need to know how to better serve their colleagues, patients and team. Whatever your area of expertise we are fast realising that bias shows up everywhere.

So why focus on language?

‘Language is the mirror to our values and principals’ so ensuring that we are using the right language is essential. As this can reveal quite quickly where we stand on an issue, what our personal and private views, opinions or even politics are.

As individuals we need to get cross culturally literate as an essential core competency. Equal in importance to communication, negotiation and safeguarding skills.

If equality is treating everyone the same and equity is assessing individual need to socially prescribe, then there is permission in equity to ask the questions needed to better serve patients. Ask the necessary questions to serve patients effectively. However, know why you are avoiding awkward moments or questions. Marginalised groups have had information extracted for the comfort and convenience of professionals and the system for too long. The acronym BAME being an example of lumping the ‘global majority’ into a four-letter acronym for convivence despite it being reductive and damaging.

My work with the AHSN on projects such as Regional Perinatal Equity Network and Black Maternity Matters will continue, and as part of that we’ll continue to explore the power of language and why it is so important in starting and continuing the conversation to ultimately improve patient safety and care.

Join the next Regional Perinatal Equity Network on 14 July.

Find out more and book your space.

The value of coming together with MatNeo colleagues

Bea Chubb is a Midwife at Yeovil District Hospital and is currently on secondment to the West of England AHSN project managing local delivery of the Maternity and Neonatal Safety Improvement Programme (known as MatNeoSIP).

In this blog, Bea tells us what she’s learnt during her time at the AHSN and how valuable it is for MatNeo teams to join the AHSN and peers at MatNeo Patient Safety Network (PSN) meetings. Bea also tells us what’s on the agenda for the next meeting on 24 May…

I feel I am in a very fortunate position to be working clinically as a midwife alongside my secondment as a Senior Project Manager with the West of England AHSN. It has made me look with fresh perspective at the impact of Quality Improvement (QI) projects on Maternity and Neonatal care, such as with the hugely successful PERIPrem project. The data collected for PERIPrem has never been ‘just numbers’ to any of the team involved, there is always an acute awareness that these are vulnerable pre-term babies and their families. However, it has been a truly life changing and unique experience for me to provide care for ‘PERIPrem babies’ and meet their families on a clinical shift and the next day come to work in my AHSN role and analyse the data!

This balance between clinical and AHSN roles has also opened my eyes to the benefits of MatNeo PSN events. Despite working clinically as a midwife for ten years, it was only when I began my secondment that I discovered them – and I am so glad I have. I now talk about them to my clinical colleagues all the time – they offer so much in a few hours! These events are for all health care professionals (neonatal nurses, midwives, doctors etc) and students but also for women, birthing people and their families. The patient/parent voice is considered throughout and sharing a training/education space with parents is so important.

During a time where we have been unable to come together physically for conferences, and even if we could staffing doesn’t often allow for it, the virtual PSN events are a great resource and networking opportunity. Being able to register for them even if you cannot join on the day and receive the videos after the event is a brilliant resource for busy front-line staff.

I see the role of the PSN becoming more important in light of the latest Ockenden report, which, amongst its devastating findings, discusses the importance of teamworking, culture and staff development. While PSN’s are not strictly staff training, they do provide a platform for shared learning, address topics like culture and escalation and create a safe space for staff to have important discussions.

As we move forwards, exploring ways to improve maternity care after Ockenden, I see the PSN being able to play an ever-growing part in improving not just patient safety but also helping to address the psychological safety of staff. The topics covered very much reflect elements of Ockenden and as a team, when we are organising these events, we very much have at the forefront of our mind ‘what is useful for busy staff’, I ask myself ‘what topics do I want to hear about’ in my usual day job. Hopefully this is reflected in the exciting agenda that we have for our next morning event on the 24 May . We’ll be sharing innovation around managing maternity emergencies, updates on PERIPrem, we look at escalation and also feature discussions about Ockenden and how the MatNeoSIP can help support trusts implementing the Immediate and Essential Actions.

When I started my secondment with the AHSN I thought that being a midwife would help me meet the objectives of the post, I had not envisaged how much working with the AHSN – and what I would learn – would make me a better midwife, and now I want to share to make sure all midwives have the chance to get involved. As I enter the last couple of months of my secondment, I am grateful to my amazing colleagues for the learning and experiences. I am really excited for our last event together and to take all that I have learnt back into clinical practice and continue to spread the word about the PSN events.

Book your space at the 24 May Maternity and Neonatal Patient Safety Network.

 

Why every healthcare professional or commissioner has a role to play on No Smoking Day and beyond.

Mark Juniper is a consultant in respiratory medicine at the Great Western Hospital in Swindon. He also works as a clinical lead at the West of England AHSN. Over the last year, Mark has been working on our adoption and spread safety improvement programme. This is part of a national programme using a collaborative approach between acute hospitals helping to deliver improved care for patients with respiratory problems such as severe asthma and COPD.

In this blog, Mark reflects on how vital it remains, as the adoption and spread programme draws to a close and we mark No Smoking Day on 9 March, that colleagues across healthcare systems encourage patients to stop smoking…

As a doctor who sees people with lung disease, I have spent a lot of time encouraging people to stop smoking. Smoking tobacco is the single most important cause of preventable death and illness and services that support smokers to quit are very cost effective. Every healthcare contact represents an opportunity to help smokers to quit. This starts with very brief advice and continues with the provision of treatments that help patients to stop. Ideally all of these people should be referred to specialist smoking cessation services. Sadly, this doesn’t always happen and in some areas, there is limited service provision.

No Smoking Day gives us a great opportunity to highlight the impact of smoking on health and help our patients to improve their health by quitting. Every hospital admission represents a chance both to identify current smokers and to provide them with advice and support to stop. Hospital admission is a particularly good area to focus on as people are not able to smoke while on the hospital ward. A short period of enforced abstinence gives us a chance to offer treatment that will help patients to quit.

I have been involved in quality improvement work in the NHS for much of the last ten years. For me, variation in how things are done has become a ‘red flag’ that identifies an opportunity for improvement. Sadly, smoking cessation is one of these areas. We don’t always ask people if they smoke and even when we do, we aren’t consistent in offering advice and treatment. Sometimes it can feel as if we are too busy even to take the time to offer brief advice. What this actually does is add to our future workload!

Over the last two years, hospitals across the West of England have been working together to deliver a group of interventions that reduce readmission rates for patients admitted with chronic obstructive pulmonary disease (COPD). This is one of the diseases caused by smoking and also one of the most common reasons for hospital admission. During this time, we have increased the referral rate to smoking cessation services in our hospitals from 41 to 58%. There is clearly lots more to do but every patient who quits will experience less ill health – and that will help to make us all less busy in the future. Surely a win-win like that is a good reason to act!

No Smoking Day is a call to all of us to take action – and that should include personal reflection if we ourselves are smokers. Everyone can play a part in helping smokers to quit. That includes healthcare professionals working in primary and community care, acute hospitals, mental health and maternity services. It also includes those with responsibility for designing and commissioning local services. Don’t forget the influence we can have on friends and family too. To make the most of all opportunities that will help improve health – remember that every contact counts. All of us can make a difference!

Piloting child-parent screening to detect FH and save lives

In this blog, Rachel Gibbons, Programme Manager, speaks to GP Dr Amy Howarth whose practice in Gloucestershire is participating in the Child-Parent Screening Service Programme. The Child-Parent Screening Programme is currently being piloted, initially for 24 months, across seven AHSN regions, including in the West of England.

The programme aims to identify families with Familial Hypercholesterolaemia (FH) through the use of a simple heel prick test undertaken at a child’s one year immunisation appointment. FH is an inherited condition which can lead to extremely high cholesterol levels. In those children with a reading of >95 percentile, further genetic testing can be undertaken for family members. FH affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed.

Without treatment, FH can lead to heart disease at a young age and significantly increases the incidence of fatal or non-fatal heart attacks. Early detection of FH is important as, if started early enough, treatment gives patients the same life expectancy as the general population.

Child-parent screening offers a population wide, low-cost solution to the management of CVD and is currently the best model for FH detection.

Dr Howarth, why was it important to you to be part of this new programme?

I have Familial Hypercholesterolaemia, so when I heard about this project, I was quite keen to get involved.  It’s a really interesting way to potentially increase the diagnosis rate and find more cases.

Apart from those times when there’s a very high cholesterol result, I’m not sure we’re (in primary care) considering FH as often as we could. This programme can help change that.

I was eleven when my dad had a heart attack, in fact it was on my 11th birthday.  He was 39 and he went off to work and then my mum had a phone call from his boss saying they had called an ambulance for him.

He was taken to the BRI in Bristol, made a recovery and came home five days later on Christmas Eve – people had longer inpatient stays for MIs (Myocardial Infarction) then. They said that his cholesterol was very, very high and that my sister and I both ought to have our cholesterol tested.

Mine was 6.8 I think at that time and hers was 8.8 so they made the diagnosis of Familial Hypercholesterolaemia. There was a great deal less in the way of diagnostics at that point, no genetic testing or anything, no lipid clinics that I remember.

My parents were advised that we should follow a low-fat diet. No medication was suggested at that time. It wasn’t until I was 17 that my GP prescribed statins and apart from four or five years off when I was trying to get pregnant, being pregnant and breastfeeding, I’ve been taking them ever since.

So, did you feel was there was much support for you as a patient at that time?  It was obviously a big shock what had happened to your father.

My father is 72 now and he still gets emotional thinking about that time. My mum was told that he might not make it to the next day. It was all touch and go.

They were also worried about me and my sister. And now I’m a parent, I can imagine how hard that was.

I was referred to a lipid clinic in my 20s. I’d been on statins for several years and my GP wanted to check I was on the right treatment, whether we should be doing anything else.

We know a great deal more about FH now and there’s a lot more support available.

My daughter has been tested and will continue to be monitored.

So, it’s still early days for your Practice, but now you have started to screen children, how have you found it?

We’ve been screening for six weeks and we’ve found that it’s been well received. Everyone who has brought children for their immunisations has wanted to take part in this screening.

And it’s been a straightforward procedure once we’ve gotten used to it and we’ve settled into a routine.

What would you like to see for the future for child-parent screening?

I’d love to see the pilot be successful and demonstrate an increase in case detection rates.

And if it then gets rolled out across the country then that would be amazing.

It would mean that as primary care nurses and doctors we’d be much more aware of FH and FH screening generally. If screening happened at everybody’s one year immunisation appointment, it’s bound to raise awareness amongst healthcare professionals.

I think if it was something that happened nationally, then my nurses would be quite pleased they were involved from the outset. It’s quite exciting to be involved in something that might lead to a national change in practice – and ultimately save lives.

It’s good to be able to talk to the parents about FH as well; people don’t always realise, that by identifying FH in their baby we’re potentially helping lots of other family members too.

I think it’s going to make a big difference.

What would you want other GPs to know if they were considering joining the pilot?

I would say “do it!”.  It’s been a good experience so far and it hasn’t taken lots of resources or time.

I’m also keen to know how else we could use the point of care testing machine and whether it’s something that might be a good asset to the practice in the future.

We don’t get all that many opportunities in general practice to be involved in research if you’re not a dedicated research practice, so it’s something exciting and valuable to be involved in.

Get involved

If your GP practice in the West of England and would like to get involved in this programme please contact Rachel Gibbons, Programme Manager – rachel.gibbons10@nhs.net.

Read more about our cardiovascular disease (CVD) programme, including the roll out of Inclisiran.

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.