Welcome – Natasha Swinscoe
Introduction – Steve West
The year in numbers
Our work in focus
Long term conditions
Maternity and neonatal care
Support for deteriorating patients
Supporting mental health services
The West of England Academy
Supporting industry and innovation
Transforming with digital
Connecting and collaborating
Welcome to our annual review of 2021-2022. I always relish this opportunity to look back and celebrate what our incredible network has achieved together over the last 12 months.
Natasha Swinscoe Chief Executive of the West of England AHSN
The collective mission of England’s 15 Academic Health Science Networks is to transform lives through healthcare innovation. Against a backdrop of the Covid-19 pandemic and continued challenges facing the health and care sector, it has never been more important for the NHS to be harnessing the potential for innovation to improve services and tackle health inequalities.
As the ‘innovation arm’ of the NHS in the West of England, we play an integral role in our regional health and care ecosystem, connecting and collaborating with people from diverse sectors and communities to discover and spread innovation that responds to the priority needs of both patients and care providers.
Central to our work is creating a vibrant innovation pipeline, helping to identify and nurture new products, services and pathways with clear evidence of effectiveness, which are ready to be adopted by our local systems.
Throughout this review, we share a wealth of examples of how we’re working with colleagues from health and care, industry, research and academia, the voluntary and community sector, and with patients and the public, to drive innovation at every stage of this pipeline.
The success and sustainability of our work is based on our approach of supporting ‘home grown’ innovations developed locally. This year I’ve been particularly excited to see PreciSSIon and PERIPrem go from strength-to-strength and by the launch of our new Black Maternity Matters pilot helping to tackle the inequitable maternity outcomes faced by Black mothers.
I’m so incredibly proud of what we’ve been able to achieve together and look forward to continuing this journey of innovation and improvement in the months and years ahead.
It is with great pleasure that I introduce our latest annual review, featuring some incredible work in collaboration with a diverse range of partners to innovate health and care with long-lasting impact.
Steve West Chair of the West of England AHSN and Vice-Chancellor of the University of the West of England
I find my role as Chair of the West of England AHSN extremely rewarding, and never more so than when I helped to host a visit to our region in March by national commissioner colleagues from the NHS England and NHS Improvement and the government’s Office for Life Sciences.
During this visit it was great to receive not only positive feedback to the healthcare innovations we showcased as examples of products and services we’re developing and supporting – many of which you’ll read about in this review – but also to the joined-up approach we take to stimulating and spreading innovation through our role as connectors and collaborators.
Over the last few years our AHSN has become firmly embedded in the West of England heath and care ecosystem, helping to further build and strengthen an energetic and enthusiastic community of innovators and improvers. Considering the challenges facing the NHS currently, this is a significant achievement.
More than ever this collective approach is necessary to tackle the many health inequalities that exist in our society, and we look forward to working ever more closely with our integrated care system colleagues, along with patients and the public, academics and researchers, industry and innovators and the voluntary sector to genuinely transform lives through healthcare innovation.
Our year in numbers
leveraged by innovators through grants and private investment with our support
care staff attended our RESTORE2 training helping them spot the signs of deterioration
patients have moved to electronic Repeat Dispensing
innovators supported by our industry and innovation team this year
babies cared for using our unique PERIPrem perinatal care bundle to date
delegates attended West of England Academy improvement and innovation events
in cost savings to the NHS by preventing surgical site infections through PreciSSIon
innovators have attended our Health Innovation Programme (HIP) since 2015
emergency department staff trained on High Impact User models through SHarED
FeNO devices are available across the West of England to improve asthma diagnosis in primary care
delegates attended our South of England Mental Health Collaborative events
Our work in focus
Our work programmes have made an incredible impact in the last year.
In this section, we summarise some of the highlights achieved collectively by colleagues across the West of England across five key priority areas:
• Long-term conditions
• Maternity and neonatal care
• Managing deterioration
• Mental health
• Medicines safety
Supporting people with long-term conditions
788 patients have benefitted from FeNO testing to diagnose asthma
75 patients have signed up to use the myCOPD self-management app
292 delegates joined our lipids optimisation webinars
174 members of our diabetes community of practice
We are supporting NHS colleagues across the West to improve care for people with long-term conditions, including asthma, cardiovascular disease, type 2 diabetes and bladder and bowel conditions. We have also coordinated pilots to test innovations supporting self-management of chronic fatigue and chronic obstructive pulmonary disease (COPD).
As part of the AHSN Network’s support to the Accelerated Access Collaborative, we are driving the adoption and spread of transformative diagnostics and medicines through the Rapid Uptake Products and MedTech Funding Mandate programmes.
Supporting diagnosis, safe discharge and treatment of asthma
Around 1,400 people each year die from a severe asthma attack; and asthma deaths are 50 per cent more likely in poorest areas compared with the richest. Our asthma work relates to improving the speed and accuracy of asthma diagnosis, safe discharge from secondary care and the on-going treatment of severe asthma.
We have been using the FeNO machine in my practice for a couple of months now. I started using it with a degree of scepticism but can honestly say it is a valuable tool for aiding the diagnosis of asthma as well as monitoring existing patients who are uncontrolled and needing potential treatment change.
Nicci Mawer Nurse at Combe Down Surgery
FeNO devices measure fractional exhaled nitric oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs. This can be used to aid in the diagnosis of asthma. We have supported several local projects, as part of the Rapid Uptake Product programme, to implement FeNO testing in primary care since summer 2021.
Testing is quick and easy and can be carried out by any healthcare professional that has received training. This speeds up diagnosis, improves patient experience and reduces secondary care referrals and inappropriate prescribing.
Following our successful bids for Pathway Transformation Funding, Bath and North East Somerset, Swindon and Wiltshire CCG and Gloucestershire CCG were awarded funding to implement FeNO testing and are piloting the approach using several different models.
We are also working with five primary care networks in Bristol, North Somerset and South Gloucestershire to introduce FeNO. To promote the benefits of using this innovation, we have delivered regional webinars with more planned in the coming months. More than 140 people have accessed our online FeNO testing resources.
There are now 38 GP practices across the region with access to FeNO devices, with a further 66 practices planning to go live shortly. Across the West of England, 100 testing devices are now available, benefitting 788 patients so far.
As part of the Rapid Uptake Product programme, people with severe asthma are now being offered a newer type of treatment alongside their usual asthma medicines. These are known as monoclonal antibodies, also referred to as biologics.
Biological therapies can transform the lives of people with asthma by reducing the long-term side effects of other treatments, such as steroids, and can also reduce exacerbations and life-threatening attacks.
Following a successful bid to the Pathway Transformation Fund in April 2021, £129,000 funding was awarded for the treatment of severe asthma. We are working alongside the South West AHSN, the South West Severe Asthma Network, clinical commissioning groups and acute trusts from Cornwall to Swindon to create a common pathway for managing asthma care, streamlining the process of referral to severe asthma centres and access to asthma biologic therapy. 200 patients have benefitted from asthma biologics since the start of the project.Read more about our support for asthma Rapid Uptake Products
Since April 2021 we have supported the safe discharge of patients with asthma. This work formed part of the Adoption and Spread Safety Improvement Programme commissioned by NHS England.
Working with all the acute hospital trusts in our region, we have rolled out the British Thoracic Society’s Asthma Discharge Bundle. This is primarily for patients discharged from emergency departments following an acute asthma attack, but is also suitable for use in admissions wards where circumstances permit. The bundle can be applied to both adults and children over the age of two. The bundle consists of five elements including assessment of inhaler technique and a review of medications.
Supporting remote monitoring and safe discharge of patients with COPD
COPD is the second most common lung disease in the UK with an estimated 1.2 million people living with the condition. COPD is a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed.
We’re supporting a range of projects to improve monitoring and care for people with COPD.
56 patients with COPD completed the 12-week KiActiv® programme
You remember it's there on your wrist and it's making you think about things, whether I just sit there or whether I get up and do something. It's down to KiActiv that I get up and do something most days.
Participant in the KiActiv® programme
Through our Future Challenges programme, we partnered with KiActiv® Health, who have developed a clinically proven digital therapy to improve the self-management of long-term health conditions. Ki-Activ® worked with us on two projects to support patients with respiratory conditions such as COPD.
Sirona Health and Care used KiActiv® Health to help people living with COPD improve the self-management of their condition, by supporting them to understand and improve their everyday physical activity.
There were high levels of engagement in the programme, with those patients who were able to engage in more physical activity reporting improvements in overall fitness, mood and less pain. Results indicated that the use of KiActiv® in this way can have a positive impact for patients with COPD and staff also acknowledged the benefits to embedding KiActiv® Health in the pulmonary rehabilitation pathway.Read about our work to support COPD
Since October 2021 we have worked with partner organisations across the Healthier Together Integrated Care System to improve patient safety and reduce emergency admissions through the COPD Digital CHAMP project. This pilot aims to rapidly adopt and use digital self-management technology, through the myCOPD app and recruitment of digital champions, to address the growing challenges and costs associated with COPD.
Supported by the West of England AHSN, the Bristol, North Somerset and South Gloucestershire system was awarded funding from NHSX’s Digital Health Partnership Award with the aim of recruiting 215 actively engaged myCOPD users by September 2022.
The myCOPD app is initially being used with three digital health champions in North Bristol NHS Trust and Sirona Care and Health, with referrals also coming in from two GP practices. 75 patients have been supported so far. Rollout is now extending into University Hospitals Bristol and Weston NHS Foundation Trust and other interested GP practices.
We have also worked with a group of patient representatives to best understand their needs and any barriers to use. A full evaluation will be completed by October 2022.Read more about COPD Digital CHAMP
The NHS England-commissioned Adoption and Spread Safety Improvement Programme supported the use of effective and safe evidence-based interventions and practice.
For COPD our local activity has focused on supporting an increase in the proportion of patients in our five acute hospitals receiving every element (for which they are eligible) of the British Thoracic Society COPD Discharge Care Bundle. The bundle describes five high impact measures to reduce the number of patients who are readmitted following discharge from hospital.
Interim results include a 43% regional increase (to November 2021) in the number of patients receiving all elements of the COPD Discharge Bundle for which they are eligible.
During COPD Awareness Month in November 2021, we hosted a virtual event in collaboration with South West and Wessex AHSNs. This promoted the use of both the COPD and Asthma Discharge Bundles but also to look beyond them at other factors that can lead to readmissions.Read more about the COPD Discharge Bundle
Reducing cardiovascular disease
The NHS Long Term Plan states that the biggest area where the NHS can save lives over the next 10 years is in reducing the incidence of cardiovascular disease (CVD). CVD causes a quarter of all deaths in the UK and is the largest cause of premature mortality in deprived areas. We’re supporting a range of CVD projects:
It’s good to be able to talk to parents about FH because of the child parent screening pilot; people don’t always realise, that by identifying FH in their baby we’re potentially helping lots of other family members too. I think the screening programme is going to make a big difference.
Dr Amy Howarth Gloucestershire GP
Familial hypercholesterolaemia (FH) is an inherited condition passed down through families, which can lead to extremely high cholesterol levels. It affects one 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. Identifying affected individuals before the onset of disease is important because treatments can be put in place that promote a healthy, active life and lower blood cholesterol levels, all of which substantially reduce the risk of heart disease.
The Child-Parent Screening programme aims to identify families with FH and is currently being piloted across seven AHSN regions, initially for 24 months from summer 2021. In the West of England, we hope to screen around 3,000 children.
As part of the pilot, we are working with nine GP practices to implement a clinical pathway that identifies children with FH through a simple heel prick blood test, taken at the child’s routine one year immunisation appointment, plus subsequent genetic testing as required. Where a child is identified as having FH, parents, siblings and grandparents can also be tested, potentially identifying multiple family members who were not aware they had FH.Read our blog with Gloucestershire GP, Dr Amy Howarth
We are supporting the increased use of lipid management medicines to help prevent CVD due to high cholesterol. Our lipids optimisation work is part of the Rapid Uptake Products and MedTech Funding Mandate programmes, which focus on three medicines: high intensity statins, ezetimibe and PCSK9 inhibitors. These are usually prescribed in primary care.
Following our successful application for NHS Pathway Transformation Funding, we’re working with Gloucestershire CCG, Gloucestershire Hospitals NHS Foundation Trust and five GP practices to use search options within practice databases to identify patients at risk of raised cholesterol who would benefit from a detailed medication review.
We also ran a pilot in Bristol, North Somerset and South Gloucestershire (BNSSG) with 10 practices to search for patients who need their treatments reviewed and may benefit from PCSK9 inhibitors. A total patient population of 149,280 was included in the search and 444 patients were identified for a review of their medication.
As a result of this project a sustainable pathway has been developed for BNSSG to optimise the lipid management of high-risk patients in primary care. The findings are relevant for other integrated care systems, with learning shared across the region. This work will support primary care to provide a standardised, evidence-based approach to support people with established cardiovascular disease.
To further spread learning about the diagnosis and management of high cholesterol for those working in primary care, we have hosted multiple lipid disorder webinars. These events, including a series tailored to practice nurses, have so far been attended by 292 delegates.
Fostering stronger relationships between primary and secondary care and utilising real-world clinical data will enable earlier identification of areas for improvement and better prevention/outcomes for our patients. The advent of inclisiran therapy and NICE support has enabled this collaborative approach and heightened awareness of the need to enhance patient support and outcomes.
Dr Tom Johnson Associate Professor of Cardiology and Honorary Consultant Cardiologist at Bristol Heart Institute
Before now, if a patient was on the maximum dosage of statins and had been prescribed medicines such as ezetimibe or PCSK9i but their cholesterol levels were not decreasing, the options were limited. But now inclisiran can support these patients as part of the updated lipids care pathway.
Locally we’ve worked with our systems to share learning about prescribing of inclisiran and how it can complement the lipid pathway for certain patients. We have been reviewing local barriers or challenges to uptake of inclisiran and are working collaboratively to try and address these. 255 inclisiran orders from 42 practices have been placed across the region to date.
To increase the use and spread of inclisiran as part of the lipids pathway, we organised a series of online education sessions for GPs and healthcare professionals, delivered by secondary care consultants and pharmacists.Read more about our work on CVD
41 patients with chronic fatigue completed the 12-week KiActiv® programme
Being about to understand my activity in the way it has, has made me be able to look at the mental and emotional energy and give it the same attention as the physical.
Participant in the KiActiv® programme
Through our Future Challenges programme, we partnered with KiActiv®, developers of a clinically proven digital therapy designed to improve the self-management of long-term health conditions, on a project to empower patients with chronic fatigue syndrome (CFS).
The Bath Centre for Fatigue Services (BCFS) introduced the use of KiActiv® Health to explore patient-led behaviour change for patients with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) symptoms.
High levels of engagement were seen in the 41 patients that completed the 12-week programme and results demonstrated that the KiActiv® technology may contribute to helping patients to better understand and manage their physical energy. Statistically significant improvements across a range of outcomes suggests KiActiv® Health could be offered as part of a personalised approach to managing CFS/ME for some patients, when used as an integrated supplement to specialist clinical interventions.Read our work to support chronic fatigue
This has streamlined how we work, reduced the burden on the practice through calls, as well as helped support patients to become more responsible for their care. We have identified issues and improved staff and patient awareness of diagnosis as well as treatment of diabetes.
Advanced Nurse Practitioner
We have been working with Bath, North East Somerset, Swindon and Wiltshire CCG (BSW CCG) on a 12-month project to improve care for patients with type 2 diabetes. The project used an innovative care framework, developed by UCL Partners, to help practices manage large numbers of patients with long-term conditions, whilst empowering the primary care workforce and the patients themselves.
Since the project launched in February 2021, a community of practice has been established with 174 members from 58 practices, alongside secondary care staff. By the end of March 2022, 22 practices were implementing the approach, with 44 more planning to go live in the next year. Interim results show the percentage of BSW patients with type 2 diabetes in the high-risk category has reduced by 4.5%.Read our work to improve diabetes care
Wow, this report is a real tour de force! It will be cited and used up and down the country, and beyond, by all of those advocating for improvements in this area, for a long, long time to come. It truly is an amazing and powerful piece of work. A rare contribution to this field that really enables the voices of people with symptoms to be heard and has such potential to drive real change.
Nikki Cotterill Professor in Continence Care, UWE
83 people with lived experience of bladder and bowel conditions took part in Voices for Change
Through our Voices for Change project, we have worked in partnership with the Bladder and Bowel Confidence Health Integration Team (HIT) at Bristol Health Partners to explore some of the challenges faced by people living with bladder and bowel conditions or caring for someone who does.
More than one in five people in the UK are affected by bladder and bowel conditions, but it is a topic not openly discussed due to the embarrassment that surrounds the symptoms.
By giving people who are living with bladder and bowel problems a voice, we have been able to gather key learnings, insights and real-world stories from those with lived experience, which we have pulled together into a report to clearly articulate the needs and areas for action.
The project’s long-term aim is to initiate positive change for those affected, by highlighting potential improvements to existing information, services and pathways and by guiding thinking around developing or identifying innovative healthcare solutions.Read more about the Voices for Change project
Maternity and neonatal care
1,235+ babies cared for using our perinatal PERIPrem care bundle to date
£1 million investments in the breastfeeding app LatchAid, which began development through our Health Innovation Programme
261 delegates attended MatNeo Patient Safety Networks
60.6% rate of delayed cord clamping in South West – at least 21% higher than other regions
15 midwives have joined our Black Maternity Matters collaborative
52 attendees at Regional Perinatal Equity Network events
Across the region we are supporting maternity and neonatal communities to improve the safety and care of babies and their parents.
Our innovative PERIPrem perinatal care bundle, which reduces variation in care of premature babies through the use of 11 interventions, is achieving positive impacts for babies and their families. And through our unique Black Maternity Matters project and the Regional Perinatal Equity Network we are creating communities focused on tackling the health inequalities facing too many parents and their babies.
Read more about our work:
Our Maternal and Neonatal Patient Safety Network forms the structure and delivery model for our contribution to the national Maternity and Neonatal Safety Improvement Programme (MatNeoSIP). This programme has focussed on three key areas:
Led by NHS Improvement, the national MatNeoSIP’s mission is to create and embed the conditions for all staff to improve the safety and outcomes of maternity and neonatal care across England.
Our Patient Safety Network has continued to host regular online events for those working in maternity and neonatal teams, commissioners and families. Over the last year we have been joined by 261 delegates.
We have continued to support the development and spread of a national Maternal Early Warning Score (MEWS) and the spread and adoption of the Neonatal Early Warning Trigger and Track score (NEWTT).Read more about maternity and neonatal work
I truly believe that this package saved my boys’ lives, and without it I’m not quite sure where we’d be now. But because of PERIPrem I have two (17-week-old) beautiful little boys who are just starting to smile, and that is down to PERIPrem.
Lauren Knott, parent
PERIPrem (which stands for Perinatal Excellence to Reduce Injury in Premature Birth) is our perinatal care bundle, co-designed with parents and clinicians, to improve the outcomes for premature babies.
Working in partnership with the South West AHSN and the South West Neonatal Operational Delivery Network, we have supported 12 hospital trusts across the region to deliver this system-level improvement project. Launched in April 2020, PERIPrem is now used as the local delivery vehicle for the optimisation and stabilisation of the pre-term infant ambitions of the national MatNeoSIP.
The bundle consists of 11 perinatal interventions, such as delayed cord clamping, early breast milk and magnesium sulphate. These have been shown to have a positive impact on brain injury and mortality rates amongst babies born prematurely. So far at least 1,235 babies in the South West have been cared for using the PERIPrem bundle, and several NHS trusts beyond the South West are now using elements of the bundle.
The Neonatal Nurses Association have endorsed our free implementation resources available on our website for teams looking to implement PERIPrem, which include share-and-learn recordings and information videos. Our webinars were attended by 411 delegates during 2021/22. In April 2022, PERIPrem featured as a case study in the latest NHS GIRFT Neonatology report.
PERIPrem has reduced variation and optimised care by using a novel quality improvement (QI) data tool for recording trust-specific monthly outcomes, by creating a regional perinatal clinical collaborative, and by putting parent partners at the heart of the project. The National Neonatal Audit Programme’s (NNAP) latest report, showed units across the South West in 2020 achieved on average:
At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended as the Patient Safety Pilot of the Year, and was also shortlisted for Provider Collaboration of the Year at the 2021 HSJ Awards.Find out more about PERIPrem
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 AHSNs.
The network is open to all working within maternity and neonatal services, related organisations or with a responsibility or interest in reducing inequalities in the NHS and parent or patient partners. The ambition for the network is to serve as a community of practice, exploring the delivery of meaningful, actionable improvements to reduce inequity of outcomes for women and families.
Our regular online events have been attended by 52 colleagues from our regional perinatal communityRead more about the Regional Perinatal Equity Network
We are honoured to have been invited to collaborate on such an important initiative, integral to the future of Black women and children’s health and wellbeing.
Katie Donovan-Adekanmbi Inclusion and Cohesion Specialist at BCohCo
Inspired by a shared vision that one day Black mothers will no longer be disproportionately at-risk during pregnancy and the first year after birth, the West of England AHSN is working with partners on a new project called Black Maternity Matters.
The project partners include two local trusts (North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust), and community organisations – Black Mothers Matter, Representation Matters and BCohCo.
This is one of nine projects around the country to be awarded funding from the Health Foundation through its Q Supporting local learning funding programme.
Black Maternity Matters has selected 13 midwives, maternity healthcare support workers and maternity care assistants from across the Bristol, North Somerset and South Gloucestershire Local Maternity System to take part in a structured programme of peer support, education and training, and coaching in quality improvement (QI), supported by two midwife champions.
These maternity staff have formed a supportive collaborative, providing a psychologically safe and brave space in which to explore the issues facing Black mothers and develop practical changes in how we provide more equitable maternity services and care.
Starting in May 2022, the members of the collaborative will take part in an innovative six-month education and training programme, led by Representation Matters and BCohCo alongside two Midwife Champions. This programme will focus on cultural competency and diversity fluency. Participants will examine unconscious biases and the role of the individual in perpetuating unsafe systems of care for Black women.
The training programme will increase capacity and embed learning through a ‘train the trainer’ approach, resourcing the participants to take back and share their learning with colleagues in their own maternity units.
Participants will also be supported to develop as quality improvement (QI) practitioners. Using the learning and insights they gain and with ongoing support from the wider collaborative, they will receive training and coaching to help them design and implement QI projects in their own maternity services, running small tests of change aimed at improving experiences and outcomes for Black women.Find out more about Black Maternity Matters
When I became a mother I experienced tremendous breastfeeding challenges because of the bad latch… I suffered from breast infection, baby’s weight loss and postpartum depression. And all this made me realise that this space needs innovation.
Chen Mao Davies Founder of LatchAid
LatchAid utilises cutting-edge 3D interactive and AI technology to help parents who are having problems getting their baby to latch, to visually learn breastfeeding skills. An avatar demonstrates vital breastfeeding skills, such as how the baby should take the mother’s areola into his / her mouth, achieving a ‘deep latch’ that prevents damage to the breast.
It also allows users to join webinars and interact with Anya AI (the app’s chatbot) and lactation consultants to ask questions, as well as connect with others in a virtual peer support group.
The app, developed by Chen Mao Davies after experiencing huge breastfeeding challenges herself, began its innovation journey on our Health Innovation Programme in 2018.
Last year with our support, LatchAid closed its seed funding round with a £510,000 Innovate UK Innovation Loan, bringing total investments to £1 million. Chen won the prestigious Innovate UK’s Women in Innovation Award, and was recognised as one of the ‘Top 40 Female Innovators in the UK’, securing a £50,000 grant to continue development of the app.
LatchAid recently completed a successful pilot with 12 NHS trusts across the UK, including several in the West of England, demonstrating positive health economic benefits.Read more in our LatchAid case study
Support for deteriorating patients
2,240+ care staff attended our RESTORE2 online training
700,000+ views of our videos to manage and respond to deterioration
40,886 patients have completed ReSPECT forms across the region
8,900+ views of our ReSPECT animations
Much of our work in the last year to improve the management of patients who are at risk of deterioration has continued to support the Covid-19 response.
We have worked to enhance the confidence of staff working in the community in detecting and responding to deterioration through training in RESTORE2. The ReSPECT emergency care planning process is now live across all three of our region’s integrated care systems, whilst one of our acute trusts is piloting the new Paediatric Early Warning Score (PEWS).
Read more about how we’re supporting management of deterioration:
We have a better relationship with our GP now we use RESTORE2. We can now speak a common language with the clinicians. We are now able to clearly communicate our observations and concerns when we ask for a GP home visit, and the GP better appreciates the complexity of needs of residents living in the home.
Ella Redler Care Home Team Leader, Brandon Trust
71% of nursing homes in the West of England have received our RESTORE2 training
As part of the NHS response to Covid, and the NHS Improvement-commissioned Managing Deterioration Safety Improvement Programme, we have been working to enhance the confidence of care staff in detecting and responding to deterioration.
In collaboration with Health Education England and Wessex AHSN, in 2020/21 we produced a series of short training videos to support staff working in care homes to care for residents who are at risk of deterioration. We have continued to promote these in the last year and they have now been viewed over 700,000 times.
RESTORE2 is a tool that helps carers recognise signs of deterioration in health, measure physical observations and communicate their concerns to healthcare professionals.
More than 2,240 staff from 417 care providers in the community have taken part in our free virtual RESTORE2 training, including more than 71% of nursing homes in our region. We offer this to all care homes in the West of England, including those for people with a learning disability, domiciliary care and supported living providers.Read more about our training and support for care homes
We have supported the adoption of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) across our three integrated care systems, providing a more standardised process of emergency care planning. 40,886 ReSPECT forms have now been completed across the region.
ReSPECT enabled our Network members to meet the demand for more end-of-life and emergency care planning conversations due to Covid-19 and reduce the strain on staff. During 2021 we hosted a series of webinars focused on the launch of ReSPECT in Bath, North East Somerset, Swindon and Wiltshire, alongside online learning events tailored to the need of paramedics. These were attended by over 200 delegates.
Developed by the Resuscitation Council in collaboration with patients and their families, ReSPECT is a process to plan a person’s clinical care in the event of a future emergency when they might be unable to make or express choices. The personalised plan is created through conversations between a person and one or more health professionals involved in their care, as well as family members.
We have worked with the Resuscitation Council to create animations, launched in September 2021, telling the story of Joe and how his ReSPECT form improved communication and coordinated personalised, individualised care with different health and care professionals. The videos have been viewed more than 8,900 times.Find out more about ReSPECT
A Paediatric Early Warning Score (PEWS) can effectively recognise and respond to an acutely deteriorating child or young person. While almost all hospitals use a form of PEWS, currently there is no single nationally validated system in England.
A standardised PEWS tool used in every inpatient setting could help eliminate variation and remove the challenge for clinical staff as they move between sites using different observation charts, scoring systems and escalation processes.
The initial focus of this work has been on developing a system that works in inpatient settings. We have supported the national scoping and development of the PEWS model.
Over 30 sites have been chosen to pilot the new PEWS chart, including Gloucestershire Hospitals in the West of England region.
Over the last year we have continued to support our three integrated care systems with Covid Oximetry @home and Covid virtual wards. This included the rapid expansion of the pathways from December 2021 with the emergence of the omicron variant. We have continued to work with South West and Wessex AHSNs to offer virtual learning and sharing of best practice, alongside updating our wide range of implementation resources.
Covid Oximetry @home is a ‘step-up’ pathway which provides at risk patients with pulse oximeters to safely self-monitor their condition at home. A decline in condition can be quickly detected so that patients can be admitted to hospital where appropriate. Covid virtual wards is a ‘step-down’ pathway enabling people in hospital with Covid-related illness to return home safely.
By the end of March 2022, the regional programme had helped over 22,500 people most at risk from Covid-19 to be safely supported.
The national Covid Oximetry @home and virtual wards programme won the Patient Safety Award at the 2021 HSJ Awards.Read more about Covid Oximetry @home and virtual wards
Supporting mental health services
£64,827 estimated regional savings to NHS from Focus ADHD programme
508 delegates attended South of England Mental Health Collaborative events
360+ emergency department staff trained on High Impact User models
159 care home managers trained in mental health awareness
2 reports published evaluating innovations piloted in secondary schools to support mental health resilience
We are working with NHS commissioners and providers, industry partners, other AHSNs, local trusts, child and adolescent mental health services (CAMHS), social care and community providers on a wide range of initiatives to support mental healthcare and wellbeing.
We continue to build networks to collaborate, share and promote good practice as well as spreading and implementing proven solutions.
146 high impact users of emergency departments in the West supported by SHarED
The SHarED project has propelled our work to support some of the most vulnerable, marginalised patient groups in society, who access emergency departments frequently, for a variety of reasons. Working with teams from EDs all over the West of England, we’ve educated staff and supported patients to work towards safer patient care and an improved experience for patients and staff.
Rebecca Thorpe Clinical Lead for SHarED and ED Consultant, University Hospitals Bristol NHS Foundation Trust
Our SHarED (Supporting High impact users in Emergency Departments) project aims to improve outcomes for the most frequent users of EDs and reduce their attendance rates.
Developed at University Hospitals Bristol and Weston NHS Foundation Trust, the SHarED modelled was piloted in all the EDs across the West of England, with three out of five sites securing additional or ongoing funding.
High impact users of EDs suffer some of the most severe health inequalities in the UK. They experience exceptionally high rates of mental health problems, learning disability, homelessness, substance misuse, domestic abuse and safeguarding concerns. They often attend the ED as they have nowhere else to go.
The SHarED approach, which utilises High Impact User Teams, has had great success in reducing attendances to the ED, as well as supporting users to seek healthcare and support in a more appropriate way.
During the collaborative project, 360 ED staff received training and 146 high impact users were supported. Our most recent data shows a 43% reduction in the number of attendances following the first month of engagement for 91% of these patients.
Whilst the SHarED project has now ended, we are continuing to support trusts develop business cases for continued funding and are awaiting a full project evaluation, expected in autumn 2022.Read more about SHarED
Our Future Challenge Programme worked on two innovative approaches trying to provide help to young people to build mental health resilience and reduce the likelihood of more serious mental health problems.
Piloted at the Royal Wooton Bassett Academy in Wiltshire, MiHUB used an interactive avatar-based approach, designed by UK tech company ProReal Ltd, to help young people with self-reflection and coping skills. The platform, which was co-designed by six stakeholder groups including the young people using it, had strong engagement with the students and the school have continued using beyond the trial period.
SmartGym was piloted at Newent Community School in Gloucestershire, taking a more physical approach. They used the SmartGym CardioWall® Resilience Programme from Rugged Interactive and the Anna Freud National Centre to engage and support young people through physical activity, mental challenge and fun. The students reported positive impacts, including better sleep, more positive mood and improved attention and energy. Parents reported their children looked forward to their sessions and also noted improvements in mood and motivation.
We established the South of England Mental Health Collaborative (MHC) in partnership with Kent Surrey Sussex, Oxford, South West and Wessex AHSNs. Membership now includes all five AHSNs alongside 16 mental health trusts.
Led by the West of England AHSN, the collaborative aims to improve the quality and safety of services for people with mental health conditions through the use of quality improvement methodology.
The collaborative also acts as the regional delivery vehicle for the Mental Health Safety Improvement Programme, commissioned by NHS Improvement Patient Safety and delivered by each of England’s 15 AHSNs.
During the last year, the MHC has held a wide variety of virtual learning events and coaching sessions. These have been attended by 508 delegates. MHC learning events enable collaboration across the mental health sector. For example, in November 2021 our all-day learning session, attended by 108 delegates, focused on health inequity and reducing restrictive practice.
In March 2022, the MHC launched an innovative tender opportunity for an organisation to lead a unique mentoring scheme matching people with lived experience of mental health services with MHC healthcare managers. Over the next year we will develop and launch the scheme alongside continuing to build on the success of our events and learning programme.
189 children and young people have been assessed for ADHD using QbTest
Diagnosis of attention deficit hyperactivity disorder (ADHD) can take significant time and resources, with an average 18 month wait for accurate diagnosis.
Along with other AHSNs across the country, we are continuing to implement objective testing using the QbTest tool to support diagnosis and reduce waiting times through our Focus ADHD project.
We are currently supporting seven children and adolescent mental health services (CAMHS) or community paediatric services in the West to implement QbTest. In our region, 189 patients have been assessed since the start of the programme using the QbTest, with estimated savings to the NHS of £64,827.
In January 2022, the South West and West of England AHSNs hosted their first Community of Practice event, exploring innovation needs on the children and young people’s neurodiversity pathway. A second meeting was held in March 2022. This online community is open to commissioners and service leads in children and young people’s mental health, as well as those working in community paediatric services, supporting ADHD assessment.Read more about Focus ADHD
I was really impressed in the approach of asking care home managers how they were feeling and giving them a voice. This was a powerful and quite shocking start. The look on 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?’
Between January and June 2021, we trained 159 care home managers in mental health awareness. The free training was delivered virtually by Bristol Mind.
97% of attendees said they would recommend the training to a colleague. A follow up survey showed the training has changed how managers support their own (76%) and their staff’s (94%) wellbeing for the better. A positive by-product of the training was that many attendees mentioned the session provided valuable time and space to connect with other managers who have experienced similar pressures during the pandemic, especially those from different organisations and systems.Find out more about the training
First-episode Rapid Early intervention for Eating Disorders (FREED) is an evidence-based, innovative, specialist care package for 16 to 25-year-olds with a first-episode eating disorder of less than three years in duration.
We are working with Avon and Wiltshire Partnership Mental Health NHS Trust and Gloucestershire Health and Care Services NHS Foundation Trust to introduce the FREED model and support the recruitment of FREED Champions.Read more about early intervention for eating disorders