We can and we should adopt NEWS

Steven West, Chair of the West of England AHSN and Vice-Chancellor of the University of the West of England, explores how we can come together to create solutions that are sustainable, affordable and acceptable to all NHS stakeholders?

Our NHS and social care system are one of the country’s greatest assets. They are a fantastic gift that we give to each other and one that is envied across the globe.

However, the world is changing and the need for us to continue to review, reset and reinvent our health and social care system has never been greater. The demands we are placing on it are huge and it is beginning to fail.

Whilst this is, in part, a reflection of us all living longer and increased potential through new technologies and new drugs to diagnose and treat more and more conditions and diseases, we have to face up to the challenges that this brings. More people are accessing services and there is often greater demand than we are currently able to meet.

The creation of Academic Health Science Networks by NHS England back in 2013 was an attempt to create partnerships to help us to better collaborate, innovate, disseminate and spread learning and best practice. It was done at a critical time as much of the infrastructure that had formerly been in place to facilitate this kind of learning and sharing had been dismantled in successive reorganisations. The uncomfortable truth was that the system had become fragmented, staff and expertise had been lost, resulting in us facing significant financial, social and staffing challenges.

Recent media reports have highlighted yet again just how fragile our health and social care eco-system is. It is difficult to ignore the reports when so many dedicated staff who have committed their whole lives to the service are signalling we have a problem. For those of us in the system it is heart-breaking to watch. We are working hard yet no matter how hard we try we are not gaining enough ground.

This is made worse when you listen to reports that seek to apportion blame in one direction or another. We are one NHS. The problems we face are not just about the funding – it is also about the structures, the interfaces, the mechanisms for collaboration, and the relationship between the government, the professionals and importantly the citizens. We all have a stake in this and it is important that we seek a collective solution to create the integrated and joined-up services that are required 365 days a year, 24 hours a day.

So how can we help, how can we get beyond the current ‘blame, denial and shouting’ culture that is so evident at the moment? How do we come together to really create solutions that are sustainable, affordable and acceptable to all the stakeholders? One of the answers is to look at what currently works. Where have we cracked some of this and can learn and spread this knowledge?

The West of England Academic Health Science Network (AHSN) is one of 15 AHSNs across England that has been innovating and spreading best practice. Each AHSN will have examples of best practice and innovation that have improved services locally. Our challenge now is spreading these beyond our local geography and partnerships.

Recently I read with sadness and frustration reports of critically ill patients dying on trolleys in over-crowded Emergency Departments. Sadly this is not new. But there are things we can, and have done, that is reducing the risks and has even eliminated the problem in some of our hospitals.

I want to shout about the National Early Warning Score (NEWS), which the West of England AHSN is supporting all our healthcare providers in the region to adopt and spread.

I urge our political and clinical leaders to stop arguing and blaming each other, and to wake up and work with us to spread this approach to every Emergency Department, every Ambulance Service, and every Community and Primary Care setting across the country. No more ‘lost’ critically ill patients need to die on trolleys for lack of basic care.

In the Emergency Departments in the West of England we now use NEWS alongside an Emergency Department safety checklist which should be universally adopted too.

This means care can be monitored across every handover throughout the system. This will ensure time is not wasted, and instead we are saving lives.

We have saved lives! We have a sound evidence base, training materials, toolkits and are happy to share and spread. Let’s not waste time and see more patients die needlessly. We can and we should adopt this approach and show we can spread best practice quickly, efficiently and safely.

Yes we can, yes we should, yes we have!


Patient Safety Collaboratives: heartening, ambitious and innovative

What do you get when you cross an urgent care system under tremendous pressure with a newly formed Patient Safety Collaborative looking for a flagship project? asks Managing Director Deborah Evans ahead of our session at Patient First on 22 November.

Against all expectations, we found that our proposition to embed the National Early Warning Score  (NEWS) across the entire urgent care system in the West of England has captured the imagination of clinicians in primary care, acute hospitals, mental health, community services and the ambulance service.

Our clinical director Anne Pullyblank showed a short film at one of our conferences and a few months later 130 people turned up at an engagement event.  The very next day, we started getting phone calls from clinical teams saying they were starting to use NEWS in areas that had never used it before.

We have been living with the consequences ever since. How do you get a good baseline when blessed with clinicians who Just Do It? How do you set a measurement strategy for whole system change? How do you attribute causes when so much is being changed right across the urgent care system all the time?

Our NEWS journey will be the subject of our session in the Best Practice Theatre at Patient First later this month, “The deteriorating patient – what about Bobby?” which will highlight the huge potential NEWS has when used across the entire system at every handover of care.

We’re now 18 months into this journey and have been reflecting a great deal about the role that Patient Safety Collaboratives can play.

We are one of 15 Academic Health Science Networks, comprising the AHSN Network which covers the whole geography of England. Each AHSN coordinates the Patient Safety Collaborative covering the same patch.

The AHSN model of a network of member organisations gives us a strong basis for engagement and grassroots support. We thrive where clinicians and their organisations commit their discretionary effort. We have a system wide perspective because we include CCGs, NHS trusts and other providers of health care, and can draw in statutory and non-statutory partners. We are independent and are seen as such; we are not part of the performance management system experienced by so many. We work in partnership with Sign Up to Safety, the Health Foundation, NHS Improvement and many, many others.

In a landscape of overlaps and gaps we are giving many clinicians an opportunity to work together, rather than in competition.

Patient Safety Collaboratives are now in their third year of operation and all over the country there are heartening, ambitious and innovative projects in play.

We share and learn together and have developed a ‘logic model’ to provide a conceptual framework. We build capability with our member organisations and have developed a software platform ( Seedata Life system) which is already the repository for hundreds of quality improvement (QI) projects – offering all the tools to run QI work and share the learning.

Already we have some ambitious and large scale programmes. The Emergency Laparotomy Collaborative is a shared project across 25 acute hospitals in the West of England, Kent, Surrey and Sussex, and Wessex – we are improving the quality of care together and using a shared national set of metrics to review and learn. The South of England Mental Health Collaborative embraces 16 mental health trusts and offers inspiring learning sets on an ‘all share, all learn’ basis. This is parity for mental health services beginning to move from words to commitment.

We will have a strong presence at this year’s Patient First. Visit our Patient Safety stand to find out more about us and our work. Talk to people from your area. Make connections. Attend our Best Practice Theatre. Feel the energy.

The West of England AHSN’s performance of “The deteriorating patient – what about Bobby?” will take place on Tuesday 22 November at 14:30 in the Best Practice Theatre at Patient First.

Download the full programme here and register for a fully-subsidised place at www.patientfirstuk.com using the code AHSN46.