PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth)

Launched in April 2020, PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) is a unique perinatal care bundle that aims to improve the outcomes for premature babies across the West and South West regions.

PERIPrem reflects the NHS Long Term Plan ambition to reduce stillbirths, maternal and neonatal mortality and serious brain injury by 50% by 2025, with an increased focus on pre-term mortality.

The bundle, which now forms part of our Maternity and Neonatal Safety Improvement Programme, consists of 11 interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born earlier than 34 weeks.

“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, PERIPrem parent.

PERIPrem was developed as a model in the West of England with the project working collaboratively with South West Academic Health Science Network and South West Neonatal Network.

Watch our introduction to PERIPrem animation. 

The challenge

Preterm birth is the main cause of neonatal mortality and morbidity in the UK, survival rates are improving in preterm babies; but rates of severe disability have not followed the same trajectory and there is a growing population of children with neuro-disabilities due to prematurity.

The NHS Long Term Plan (2019) has committed to realising a 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025, with an increased focus on pre-term mortality. PERIPrem directly contributes to this ambition, as well as those of the national NHS Maternity and Neonatal Safety Improvement Programme.

“Perinatal services across the South West have worked with great passion to implement the PERIPRrem Project in order to support improved outcomes and experiences for infants and families who journey through neonatal services. We are so proud to be part of a team of such dedicated, caring professionals.”

Mary Leighton, Network Manager, South West Neonatal Network

Our approach

The PERIPrem bundle was co-created by clinicians, maternity and neonatal teams and parents. The interventions range from ensuring that mums give birth in the right place, to offering mothers magnesium sulphate, which has been shown to reduce the risk of the baby developing cerebral palsy later in life, and optimal cord clamping.

Quality Improvement (QI) methodology was at the heart of implementation alongside coaching and forging new ways of working, where clinicians from obstetrics, midwifery and neonatal, join together to drive forward and revolutionise care for pre term babies.

To enable units to focus on increasing rates of PERIPrem interventions the AHSNs provided funding to each trust to backfill two PERIPrem Leads, one neonatal nurse and one midwifery lead. In addition, units were encouraged to identify PERIPrem Champions to act as advocates for selected bundle interventions, with a focus on obstetrician and neonatologists.

The PERIPrem Steering Group developed a toolkit of resources and materials for each element of the bundle. Units were encouraged to use and adapt these to meet their needs. PERIPrem clinical and parent passports were also created to offer advice and reassurance to families and many resources were made available in multiple languages. The PERIPrem team also ran virtual share and learn sessions and sent weekly newsletters to distribute resources, connect disparate teams kept apart by the COVID pandemic and celebrate success.

Watch our PERIPrem parent video.

Impacts to date

As of December 2021, 1,094 babies had been cared for using our PERIPrem bundle.

In August 2022, an independent evaluation was published in the British Medical Journal Open Quality. It indicated 26% more mothers and babies born prematurely across the South West received the care interventions they were eligible for between July 2020 and June 2021, compared to before PERIPrem started. Explore a summary graphic of the PERIPrem evaluation.

Official PERIPrem resources have received Neonatal Nurses Association (NNA) endorsement.

In April 2022, PERIPrem featured as a case study in the latest NHS GIRFT Neonatology report with teams also being encouraged to access our resources (see pages 10 and 66). PERIPrem case studies were also published by NHS Confederation (April 2022) and the National Child Mortality Database thematic report (pages 21-22 – August 2022).

As measured by the National Neonatal Audit Programme’s (NNAP) latest report, units across the South West achieved, in 2020, on average, the:

  • highest rate of delayed cord clamping (by over 21%),
  • third lowest rates of mortality to discharge,
  • the second lowest rates of necrotising enterocolitis,
  • alongside the fourth highest administration levels of magnesium sulphate (MgSO4) across England.

PERIPrem was highly commended in the Patient Safety Pilot of the Year category at the 2021 HSJ Patient Safety Awards and a finalist in the Provider Collaboration of the Year 2021 HSJ Awards. In July 2022 it was shortlisted as best regional/national project at the 2022 BAPM Gopi Menon Awards.

“PERIPrem brings together colleagues from all 12 maternity trusts across the South West region, along with teams from the two AHSNs and the Neonatal Network, clinical experts and parent partners. In addition to saving the lives of the most vulnerable babies, PERIPrem is improving the chances of disability-free lives and is nurturing high-functioning perinatal teams.”

Noshin Menzies, Senior Project Manager, West of England AHSN

The West of England Learning Disabilities Collaborative

We established the West of England Learning Disabilities Collaborative (LDC) in early 2019 bringing together individuals and organisations from across the region interested in the care of people with a learning disability and experts by experience, with a focus on three priority areas:

  • Improving recognition of deterioration through use of soft-signs and National Early Warning Score (NEWS2).
  • Promoting the uptake of flu vaccinations (for both care staff and patients) and the use of reasonable adjustments such as the nasal vaccine.
  • Supporting increased uptake and quality of Annual Health Checks (AHC).

The LDC provides a space for collaboration, cross-system working and sharing of good practice in a way that did not previously exist in the region.

The overarching aim of the collaborative is to reduce the inequity in care for people with a learning disability that has been identified nationally through the LeDeR (Learning Disabilities Mortality Review) programme.

Read our blog on how the LDC was formed.

In October 2021 the LDC team presented to the West of England Patient Safety Collaborative Board. Watch their short presentation which gives an overview of the LDC’s work and why co-creation is vital to its effectiveness:

The challenge

It is estimated that approximately 2% of the adult population has a learning disability. On average, people with a learning disability die 20 years younger than their peers. Many of these deaths continue to be from avoidable causes, such as pneumonia and sepsis.

Whilst the healthcare needs of people with a learning disability have been considered throughout our project cycles at the AHSN, we had never before undertaken a specific project for people with a learning disability. The collaborative aims to put people with a learning disability, their carers and the healthcare staff that support them at the centre of our work. Read our blog on the importance of co-creation to the LDC.

The LDC advocates use of NEWS2 and soft-signs tools including RESTORE2 to support early identification of physical deterioration in patients. “Soft signs” training (including RESTORE2 and RESTORE2 Mini) is particularly valuable in the management of deterioration where individuals have difficulties in communicating when they are feeling unwell or in pain including in care homes for people with a learning disability or developmental needs.

Our approach

The collaborative’s first priority is to build on the work across the region to implement NEWS2 and expand into the learning disability sector, incorporating the use of soft signs through RESTORE2 training. Based on the recommendation from the LeDeR programme to empower carers, and the success of our RESTORE2 training for care homes (including learning disability settings), and in collaboration with Wessex Patient Safety Collaborative (PSC), we were commissioned by NHS England to train 120 ‘Super Trainers’ to deliver training remotely to paid and unpaid carers across the UK. The training and resources were co-created with people with a learning disability, carers, and supporting organisations, and this has created the potential for the training to be delivered by people with lived experience. To accompany this training, we worked with partner organisations to develop a series of short, bitesize videos in plain English. These include measuring heart rate, oxygen levels, temperature, how to recognise soft signs, and how to tell someone if you are worried.

To support our second priority during the 2019 flu vaccination season we collaborated with NHS England to produce a flu vaccination communications toolkit, including easy read information about the flu vaccine, for providers to use to promote uptake for people with a learning disability and their carers. We also had the NHSE website updated so that people with a learning disability were explicitly mentioned as being at risk. The toolkit is now updated and re-released each year. We also contributed to a letter for care workers to give to their GPs to obtain the vaccination for free, based on feedback from our members that they were being told they were not eligible for a flu vaccination and turned away.

Improving the uptake of annual health checks is the third aim of the collaborative and remains a high priority for systems and NHS England. Initially we were commissioned to increase the uptake of annual health checks through meetings and workshops. We were subsequently commissioned by NHS England South West to produce a series of videos that encouraged greater uptake of annual health checks for people with a learning disability. The videos were co-created and produced with Misfits who are a theatre and social group led by people with learning difficulties. We also collaborated with a number of experts by experience to produce these videos. The videos were published in October 2021 and 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. This project was selected by NHS England as an exemplar case study for the LeDeR 2021-22 Action from Learning Report (see pages 25 and 45).

In addition, we established a community of practice with over 300 members including representation from NHS England, our member organisations, Public Health England, Royal College of GPs, community learning disability providers, the local LeDer team and experts by experience. This is a hub for sharing best practice and information. A wide range of webinars have been held and members are sent a quarterly newsletter. We have also co-created videos and resources to support, amongst other campaigns, the uptake of covid boosters and oral healthcare.

Since March 2022, through Blue Stream Academy, RESTORE2 Mini is available as a free e-learning module to all carers (paid or unpaid).

Impact to date

  • In February 2021 we delivered the ‘Super Trainer’ RESTORE2 model to 167 experienced trainers, who by the end of May 2021 had trained over 7000 paid and unpaid carers, with training continuing to be delivered across the country.
  • The bitesize deterioration videos have had over 44,000 views and were 2021 finalists as part of a wider series on deterioration for a HSJ Patient Safety Award.
  • Our work was highlighted in the LeDeR Action from Learning report on sepsis
  • NHS England reported a 57% uptake of flu vaccinations in our region in November 2021 which is higher than the national average of 50%.
  • We campaigned for COVID vaccinations for people with a learning disability when this vulnerable group were not initially included on the priority list for vaccination. We contributed to a letter to the House of Lords which resulted in the list being updated in February 2021.
  • We presented our work to support the uptake of annual health checks at the September 2021 HSJ Patient Safety Congress with Andrew Bright, Head of Development for Thera Trust, an expert by experience.
  • Most recent data shows that 72% of people with a learning disability in the West of England accessed an annual health check.
  • We produce a regular newsletter to share best practice and resources which is sent to our collaborative of more than 300 members.
  • We have run a series of seven webinars on topics such as advanced care planning, physical health, and mental capacity during Covid-19 which had more than 560 attendees.
  • To March 2022, over 2240 care staff have been trained in use of RESTORE2 or RESTORE2 Mini with 417 West of England care providers participating.

To illustrate how RESTORE2 training has improved patient outcomes and care staff confidence in communicating at the handovers of care a series of ‘in our words’ case studies have been collated. These illustrate the positive personal impact training has had on care staff, their patients and teams.

Key to developing the LDC’s soft signs videos and super-trainer model was co-creation, and working with us was one of our experts-by-experience Andrew Bright, who is Head of Development at Thera Trust:

“RESTORE2 will make such a difference and save lives. From my own personal experience of taking part in the training and watching the videos; I feel like they will make a huge difference, and from my own point of view I felt included in the work”.

Next Steps

The West of England collaborative ceased in its current format in March 2022. In early 2022/23 the collaborative is being relaunched to cover the entire South West region. The new South West LDC will be funded and delivered in partnership with NHS England South West.

The reformed collaborative aims to share learning and best practice across the South West and focus on the adoption and spread of tested diagnostics, products and technology that supports both people with, and those who care for people with, a learning disability.

Find out more

Find out more by visiting our Learning Disabilities Collaborative webpage or email us.

Electronic health records in care homes

With support from the West of England AHSN, Bath and North East Somerset, Swindon and Wiltshire (BSW) CCG built on a recent trial using an early ‘mobile’ version of TPP’s SystmOne electronic health record, by introducing a new care home module across a small number of care homes.

Early feedback is indicating demonstrable benefits in improved communication between care homes and primary care, as well as efficiencies around access to patient clinical records.

In October 2020 BSW CCG successfully bid for NHS England funding, aimed at projects supporting accelerated use of digital technologies during the Covid-19 pandemic to enable the ‘virtual’ care of patients across primary, community and acute care settings. This allowed the project to extend its scope, with the aim of spreading the use of SystmOne into 20 care homes during 2021.

“Our team at BSW CCG have thoroughly enjoyed working with our colleagues at the West of England AHSN, who played a crucial role in securing regional funding from NHS England to scale up our work programme. They also helped us to shape our approach to the planning and delivery of the project, which has made a real difference in releasing clinical time to care for patients within the care homes who have adopted the new system.”

Jason Young, Assistant Director of Digital Transformation at BSW CCG

The challenge

Prior to using SystmOne in care homes, the registration of a new care home resident could take on average three to four hours, as information to complete paperwork needs to be pulled from multiple sources. It can be difficult to obtain a full medical history for individuals new to a care home, particularly when coming from another care setting or if they have few family members.

Care home staff also spent significant time contacting local GPs to discuss resident health problems, reorder prescriptions, arrange consultations – or just seek advice. The Covid-19 pandemic increased pressure on these services and demonstrated the relevance for potential online consultations.

The approach

The West of England AHSN provided programme management support to the BSW CCG team, as well as local experience of delivering digital transformation projects.

The AHSN also part-funded an external technical specialist to assist implementation and was also instrumental in securing additional funding from NHS England as part of the Covid-19 response.

The project team approached 67 care homes to establish their interest in having access to SystmOne.

Where there was a positive response from a care home, the team also engaged with the local GP practice and provided a product demonstration to both.

This formed stage one of the four-phase approach:

  1. Engagement and demonstration of SystmOne.
  2. Information governance training, covering the Data Protection Security Toolkit (DSPT)
  3. Technical implementation and system training for SystmOne
  4. Transformation – design of processes and procedures between the care home and local GP practice.

Later, an additional stage was included to make contact with the care home two to four weeks after implementation to check progress and offer additional support where needed. This provided a useful opportunity for an informal conversation to start to understand the initial impacts being experienced, and whether these matched the original hypothesised benefits.

As of 30 November 2021, 18 of the projected 20 homes had fully implemented SystmOne, with a total capacity of 738 beds. Further care homes are now interested in the technology.

“SystmOne has saved us time and having access to information allows us to feel less of a hinderance to the GP, where we would otherwise have to call the surgery.”

“Getting to know a resident and their medical history much faster, this includes all open referrals to other services. Easier to plan the future care for residents, used to wait one to two weeks for GP summary, but now have immediate access.”

Feedback from care home staff

The impact

Data on the usage of SystmOne for the eight months to 31 October 2021, when 17 care homes were using the technology, reveals varying use of the system. Two homes had been using it significantly and consistently for several months, while another six are considered regular users.

Further analysis suggests usage levels may reflect uptake by specific members of staff in particular homes, with a number of users ‘dropping off’ the data, possibly reflecting the transient nature of the workforce in the care home sector.

Overall, 50 different staff members across 14 of the 17 care homes were using SystmOne in this eight-month period, viewing 4,085 patient records in the period.

It is estimated that up to 2,820 hours of time was saved during registration of new patients into care homes. This is based on it previously taking an average of three to four hours to register a new resident, pulling the information needed to complete paperwork from multiple sources. Whilst these numbers are not validated, a former care home manager confirmed, “the documentation when registering someone new in a care home is immense.”

Further feedback captured:

  • All the participating care homes say they believe they are delivering better care by using SystmOne.
  • The access to GP notes and medicines history via SystmOne are seen as particularly helpful.
  • The care homes report clinical time saving due to improved communication channels with GPs (less telephone queueing for example).
  • They get quicker responses from GPs – less ‘telephone tag’.
  • Significant time saving is being reported in registering new residents, due to accessing patient records more quickly, giving the ability to plan for care immediately, rather than having to wait for paper records to arrive.
  • Some reports of quicker access to test results (bloods, pathology/radiology, etc), with a couple of examples of this leading to earlier prescribing and receipt of medication for a resident – reducing pain.
  • Care homes using SystmOne report quicker and more confident clinical decision making – leading to better care.
  • Three care homes say they have avoided ambulance call outs or ED visits as a result of using SystmOne.
  • Three care homes are using the GP tasking facility.
  • Four care homes are keen to record information into patient records (such as test results) – involving a potential upgrade of service.
  • Care homes are keen to use the medicines ordering facility once a planned enhancement is released later this year by TPP.

Whilst from a relatively small selection of care homes, the feedback gained to date supports the original aims to improve to patient care and create internal efficiencies through implementation of the TPP Systm One solution.

“Overall SystmOne has helped our residents.’’

“We are finding it really useful, especially if we have queries about GP consultations, allergies, lists of meds and medical history and resus status for new people.”

“We avoided having to send a resident to hospital where they may have continued to suffer by being resuscitated/treated against their will.’’

Feedback from care home staff

Key learnings

Care homes were at the forefront of the challenges encountered during the Covid-19 pandemic, which meant engagement was difficult as staff had different priorities to contend with. These were exacerbated by:

  • Outbreaks of Covid-19
  • Covid vaccination programme
  • Restricted visiting for relatives.

Additionally, agile project delivery was negatively impacted by:

  • Relatively high turnover of staff
  • Low digital literacy levels
  • Limited Wi-Fi capacity
  • Care homes’ IT incompatibility with SystmOne.

It is important to understand that staff in care homes work under very different pressures to many staff in the NHS and other industries. Homes range in size and in the services they offer. Many are small, family-owned business, whilst others are chains within larger corporate organisations. But each has its own culture, systems and processes that need to be accommodated when collaborating with the care home teams to implement new ways of working – particularly when introducing a new technology.

The majority of homes contacted, regardless of their structure, didn’t have capacity to see implementation through to fully embed the use of SystmOne. Those that had the perseverance to be able to do so are now seeing efficiency benefits, but the capacity to engage and transform should be a consideration for any future care home projects.

Next steps

The project has now transitioned to ‘business as usual’ for BSW CCG, so more homes can benefit from the implementation of TPP SystmOne.

BSW CCG have also shared their approach and learnings with Gloucestershire CCG who are ‘fast following’ with some early successes.

Find out more

Find out more about the West of England AHSN’s digitial transformation work or email dave.evans5@nhs.net.

 

RESTORE2 training for care providers

Building on the AHSN’s leadership of national projects to support the management of deterioration including New Early Warning Score (NEWS2) and ED Safety Checklist, since December 2019 free RESTORE2 training has been delivered to over 2240 care staff across the region.

Originally created by Hampshire, Southampton and Isle of Wight CCG, RESTORE2 is an escalation tool for use in care settings to enable early recognition of deterioration. Training in RESTORE2 supports more effective communication, efficient workflow and improves patient safety at the handovers of care between care staff, primary care and the urgent care system.  Calculating a NEWS2 is an important part of the RESTORE2 tool.

Prior to the use of NEWS2 across healthcare systems there was no standardised response to deterioration or common language used at handovers of care for acutely unwell patients.

Supported by the West of England AHSN, NEWS was adopted across all elements of the region’s healthcare system. NEWS2 was subsequently rolled out nationally through the AHSN Network’s Patient Safety Collaboratives in 2018-20.

To build on this work and cement the importance of managing deterioration in care homes, the AHSN launched a programme of free RESTORE2 training for care providers. Whilst initially delivered face to face, learning was moved online in spring 2020 due to the COVID pandemic. Training remains online with over 415 care providers having now taken part.

As part of our COVID response plan, we have worked in collaboration with Wessex and South West AHSNs to improve the early identification and response to deterioration.

“We also 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

Watch our short video on RESTORE2 training:

The challenge

Prior to the use of NEWS2, health care settings did not use the same common language or set of measurements at the handovers of care, or where different parts of the health and social care systems met.  This resulted in a lack of consistency in identification and response to acute illness. Equally there was no standardised training or process for the management of deterioration in care settings.

NEWS2 is a simple scoring system, based on the six physiological measurements that make up the routine vital signs of an adult patient. By monitoring scores over time, NEWS2 can demonstrate a positive response to treatment, or more importantly, allow early detection of patient deterioration. Early recognition and management of deterioration leads to improved outcomes for patients. Whilst NEWS2 was rolled out across healthcare services it was vital that a similar approach was adopted in care settings where many of the most vulnerable patients are supported. The COVID pandemic brought an increased emphasis on the value of managing deterioration in care settings.

Calculating NEWS2 is an important part of the RESTORE2 tool alongside building the confidence of care staff to communicate concerns about patients with primary care and urgent care systems through the development of a common language. The RESTORE2 Mini tool is suitable for use in domiciliary care and acts as an important development opportunity for non-registered care staff.

“Soft signs” training is particularly valuable where individuals have difficulties in communicating when they are feeling unwell or in pain including in care homes for people with learning disabilities or dementia.

Our approach

In March 2015, the West of England Patient Safety Collaborative became the first region to implement NEWS. National adoption and spread of NEWS2 took place from 2018-2020.

During this time, the AHSN also created Primary Care, ED and Community Collaboratives to enable sectors to meet and share best practice on improving patient safety through the effective management of deterioration.  Identifying that many of the most vulnerable patients reside in care homes, or receive domiciliary care, the AHSN launched care homes training in late 2019.

Prior to and during the pandemic – and in line with the British Geriatrics Society paper offering key recommendations to help care home staff support residents through the pandemic – the West of England AHSN recognised the importance of supporting care staff in managing deterioration through the observation and escalation of ‘softs signs’.

Initially training was offered face to face but the pandemic required a pivot to virtual learning which presented an opportunity for greater attendance and representation at sessions. The AHSN has been offering a choice of three workshops tailored to the different needs of care staff: RESTORE2 Mini, RESTORE2 and Train the Trainer.

Since March 2022, through Blue Stream Academy, RESTORE2 Mini is available as a free e-learning module to all carers (paid or unpaid).

The AHSN also developed supporting materials including posters, videos and case studies.

Impact to date

“I cannot say how much I would recommend investing in this training. Staff will feel upskilled, more competent and I truly believe our use of RESTORE2 saved lives. I absolutely, 100% believe in RESTORE2 for all staff, residential and nursing.” Jacqui Croxford, Care Home Manager, Darbyshire Care

To illustrate how RESTORE2 has improved patient outcomes and care staff confidence in communicating at the handovers of care a series of ‘in our words’ case studies have been collated. These illustrate the positive personal impact training has had on care staff, their patients and teams.

To date we have trained 71% of nursing homes in RESTORE2 or RESTORE2mini across the West of England region achieving the NHSEI target of 60% for 21/22.

To March 2022, over 2240 care staff have been trained with 415 West of England care providers participating.

Building on our RESTORE2 training, free videos were produced by the AHSN and partners to help staff working in care homes spot and respond to the soft signs of deterioration. The videos have been viewed more than 700,000 times and were shortlisted for a 2021 HSJ Patient Safety Award.

Our West of England Learning Disabilities Collaborative continues to advocate use of NEWS2 and soft-signs tools including RESTORE2 to support early identification of physical deterioration in patients who may be less able to communicate feeling unwell. In February 2021 AHSN staff delivered a ‘Super Trainer’ RESTORE2 model to 167 experienced trainers, who by the end of May 2021 had trained over 7000 paid and unpaid carers. Training continues to be delivered across the country.

Our programme to support the use of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), evolved from insights gained through our NEWS2 project, inappropriate end of life ED attendance and conveyance, alongside our wider work on Structured Mortality Reviews. RESTORE2 training in the West of England showcases ReSPECT and the importance of care planning for emergencies and end of life care.

“As a GP I can clearly see how RESTORE2 would benefit patients through the earlier identification of deterioration and treatment commencing earlier. When I am triaging home visits, having a NEWS2 score and soft signs available allows me to ensure that a visit is prioritised within an appropriate timescale.” Chris Turner, GP, Swindon Community Health Services

Next steps

Our RESTORE2 training programme continues, and the ongoing impact of our adoption of NEWS2, and related collaboratives, continues to be felt today in the work of the AHSN and our Patient Safety Collaborative, particularly around managing patient deterioration.

Find out more

Find out more about the training and resources available to care home staff or email: weahsn.transformation@nhs.net

LatchAid

LatchAid is an easy-to-use breastfeeding support app which utilises cutting-edge 3D interactive and Artificial Intelligence (AI) technology to help parents learn vital breastfeeding skills. It also allows users to connect with others for invaluable peer-to-peer and professional support.

With our support and expertise, LatchAid has grown from business acorn to a winner of the Innovate UK Awards 2021 and has, to date, been awarded over £250,000 in grant funding.

The app has recently been trialled as part of an NHS pilot project, where it was available for free on prescription in select regions of the UK. It is also available to purchase on the Apple App store and currently has users in 73 countries. Plans are in progress for the launch of an Android version of the app in Summer 2022.

The challenge

The UK has the worst breastfeeding rate in the world. Sadly, 90% of mothers give up before they want to, due to lack of support, pain/health issues, and feelings of isolation and depression.

Difficulties in achieving a good latch can led to breast infections, baby weight loss and postpartum depression.

This costs the NHS £50m a year on excess appointments for babies fed on formula milk, who are then more prone to illness.

Our approach

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 chatbox) and lactation consultants to ask questions, as well as connect with others in a virtual peer support group.

The app, which was developed by Chen Mao Davies after experiencing huge breastfeeding challenges herself, began its innovation journey on our Health Innovation Programme (HIP) in 2018.

Chen Mao Davies

Here she was able to test the validity of her early-stage business proposition with experts and learn how to navigate a very complex healthcare landscape and pitch into the NHS.

Since graduating from the HIP, we have continued to support Chen and LatchAid on its healthcare innovation journey; presenting funding opportunities, reviewing and steering applications for funding (such as the Innovate UK award) and making introductions to key contacts within the NHS. We funded an expediated ORCHA Review, connected Chen to NHS maternity services and commissioners and supported with the design of the evaluation framework for an NHS pilot. We also sponsored LatchAid to exhibit at the HETT show in the London ExCel.

“I learned a huge amount in the HIP bootcamp training and was able to share my business ideas with fellow innovators, present my business proposition to a panel of experts and start building relationships with a network of experts and fellow entrepreneurs. Since then, I have continued to receive ongoing support from the AHSN with regards to funding opportunities, application reviews, pilot evaluations and connecting me to NHS maternity services and commissioners. I definitely would not be where I am now without the help of the West of England AHSN.”

Chen Mao Davies, Founder/CEO of LatchAid and HIP graduate 2018

Impacts to date

To date, and with our support, LatchAid has been awarded over £250,000 grant funding from Innovate UK, EU, UnLtd, and the NHS.

In 2021, Chen Mao Davies was recognised as a ‘42 under 42’ rising star by South West Business Insider magazine.

She was also named as ‘one of the top 40 female innovators in the UK’ by Innovate UK and awarded a ‘Women in Innovation Award 2021’ with £50,000 of funding.

In August 2021, LatchAid launched on the Apple App store and has users in 73 countries (as of January 2022).

Most recently, Chen has worked in partnership with 12 NHS trusts and VirginCare on a pilot project to prescribe the app to 5,000 families, as part of their infant feeding support. Infant feeding experts, midwives and health visitors were able to prescribe LatchAid for free to all new parents (iOS users) in participating regions. The pilot will be evaluated and – if it proves successful – it is hoped this will lead to wider adoption and spread of the solution across the NHS.

With a growing media presence, Chen and the LatchAid app have received positive press spots in several industry and regional titles to date, including an interview in December 2021 with BBC Radio Gloucestershire, leading to a feature on the BBC news website. Watch the video here or below:

“Put this app on your phone, it’s the closest thing you’re going to have to a Lactation Consultant or a peer supporter in your pocket.” 

Emma, a breastfeeding mother

“Just to have that instant support, all hours of the night. Amazing”.

Breastfeeding mother

 

“I have used the app with colleagues who have found it really useful. They enjoy the 3D effect and the ability to view things from different angles.”

Amanda, NHS Health Visitor

 

Next steps

We will continue to work with the LatchAid team to:

  • Review outcomes/outputs from the pilots
  • Understand any gaps in evidence base (and explore further evidence generation support)
  • Review and provide feedback on NHS business case
  • Continue to broker NHS relationships within the region.

The West of England AHSN began work with LatchAid began in 2018 and continues to provide support.

Find out more about LatchAid – www.latchaid.com

LatchAid featured on the BBC – https://www.bbc.co.uk/news/av/uk-england-bristol-59655402

Want to find out more:

getUBetter

getUBetter is a digital self-management physiotherapy platform, for all common musculoskeletal (MSK) injuries and conditions. It integrates with local musculoskeletal (MSK) care pathways, to aid the recovery and prevention of minor injuries.

It can support the self-management of 80% of new or recurrent MSK injury and conditions presenting to primary care, providing patients with a better service – via direct and immediate 24/7 support and whole pathway care.

The platform has been proved to reduce the need for prescriptions, follow up appointments and referrals, therefore helping to reduce inefficiencies and costs to the healthcare system.

The getUBetter app, developed by Dr Carey McClellan, and launched in 2016, has been developed and deployed with AHSN support. Very early on in his innovation journey, Dr McClellan sought support from the West of England AHSN to get ownership of his ideas and content – the intellectual property. He then secured a place on our 2015 Health Innovation Programme (HIP), teaching him about healthcare business strategy and planning.

His innovation is now deployed in the NHS and occupational health sectors across South London and South West England and is prescribed by clinicians (GP, physiotherapist, occupational health) during patient consultation, when injury recovery is recognised as suitable for self-management.

In April 2022, Carey was announced as one of the 2022 cohort of  NHS Innovation Accelerator fellows.  Carey is one of ten innovators selected for the NIA programme, which will provide support over the next three years to scale getUBetter up across England’s NHS, for the benefit of patients and staff.

The challenge

To provide direct and remote access to better support for patients with MSK injuries and conditions and help to reduce inefficiencies and costs to the healthcare system.

Common injuries such as back pain have a massive impact on patients, the NHS and the workplace/economy.

  • 20 – 30% of population will visit GP every year for a musculoskeletal complaint
  • Musculoskeletal injuries and conditions account for 18-30% of all GP appointments
  • Treatment waiting lists can be long with patients requiring support as they wait
  • The NHS spends £5 billion pounds treating these conditions every year
  • 20% of this is over-treatment
  • Musculoskeletal complaints account for half of all days off work and cost the economy £7billiion every year

Almost all minor injuries and MSK conditions will recover or improve with good self-management support (and without the need to visit the GP or physiotherapist, overuse medication or have an investigation).

Digital management solutions such as getUBetter can help to deliver a better service, by providing direct and immediate day-to-day 24/7 support, and access to whole pathway care, connecting people to their local MSK pathway and support services.

Our approach

getUBetter is a physiotherapy self-management digital therapy platform that integrates with local musculoskeletal (msk) pathways, to aid the recovery and prevention of minor injuries.

Patients are enabled to trust their own recovery via a day-to-day standardised, clinically led, self-management recovery and prevention pathway. This releases capacity and cost pressure on health professionals, as patient referrals to secondary care and repeat visits to GP are reduced.

Carey McClellan, CEO getUBetter

By supporting patients using evidence-based tools, the platform promotes safe self-management but also automates referrals for treatment appropriately (planned care, unscheduled and local support services.) The support can be accessed at any point the patient enters the health care cycle.

The app, developed by Dr Carey McClellan, and launched in 2016, has been developed and deployed with AHSN support:

The West of England AHSN first supported Carey very early on in his innovation journey, (in 2013), to help him get early ownership of the content and ideas he had, the intellectual property and, in 2015, he secured a place on our Health Innovation Programme (HIP). We have continued to support Dr McClellan from development through to deployment and scale – connecting him to relevant organisations and helping him to write bids for funding.

The Health Innovation Network (AHSN for South London) has also supported Carey with deployment across the South and South West London.

The innovation is now deployed in the NHS and occupational health sectors across South London and South West England and is prescribed by clinicians (GP, physiotherapist, occupational health) during patient consultation, when injury recovery is recognised as suitable for self-management.

In 2021, getUBetter secured a place on DigitalHealth.London’s accelerator programme.

“It gave me reassurance when I was worried about my pain and helped me manage my expectations about the speed of recovery”. Patient

“The app is a great complement to seeing a GP or as an alternative” Patient

“I think it is a fantastic resource on its own but also because patients can then be referred on through the Wandsworth pathway directly.” GP, Wandsworth

“We see the ever-expanding app as a major part of our service redesign going forward.” Jim Fenwick, CEO Battersea Healthcare

Impacts to date

getUBetter can support the self-management of 80% of new or recurrent MSK injury and conditions presenting to primary care.

  • 10,000 patients have been helped so far
  • In Wandsworth 1 in 10 patients with a MSK problem are using getUBetter
  • Reduces physiotherapy referrals by 20%
  • Reduces GP follow-up appointments by 13%
  • Reduces prescriptions for MSK by 50%
  • Independent economic evaluation demonstrates a cost saving of up to £1.9 million per CCG for back pain alone
  • 86% of patients would recommend to family and friends
  • 73% felt the app would provide a better GP service (none disagreed)
  • 100% of patients felt the app would help recovery

The West of England AHSN work with getUBetter began in April 2013 and is ongoing.

Find out more about getUBetter

Meet the innovator blog with Carey McClellan

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)

The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. ReSPECT was developed by the Resuscitation Council, working alongside NHS stakeholders, patients, and families.

The roll-out of ReSPECT in the West of England is one part of a national Patient Safety Collaborative strategy to improve the care of patients at risk of deterioration. The West of England AHSN worked to ensure three local systems aligned to use and spread the same process. ReSPECT was implemented in Bristol, North Somerset and South Gloucestershire (BNSSG) and Gloucestershire Integrated Care Systems (ICS) at the end of 2019, and is now well embedded in services across both regions, with Bath and North East Somerset, Swindon and Wiltshire (BSW) ICS implementing ReSPECT in October 2021.

Our programme to support the use of ReSPECT evolved from insights gained through the ED Collaborative, and roll out of the ED Safety Checklist and NEWS2, around inappropriate end of life ED attendance and conveyance, alongside our wider work around Structured Mortality Reviews.

Ensuring there are high-quality advance care plans, accessible to the clinicians who need them, enables better care for patients, peace of mind for their carers and reassurance for staff who can be confident they are following their patients’ wishes.

Watch our Journey of a ReSPECT form video. 

The challenge

Before the start of this project, frail and complex patients might have a do not resuscitate form or treatment escalation plan but few had advance care plans describing what should happen in an emergency. This meant that clinicians and carers had to make decisions about a person’s best interests and preferences and rarely very frail patients were resuscitated against their wishes.

In 2018, there was a mixed picture across the region for managing end of life and emergency care. The West of England AHSN aimed to create a unified system to make these challenging conversations easier and ensure a person’s wishes were recorded and easily accessible to health care workers in an emergency.

The aim of the project in the West of England was also to make sure the ReSPECT process offered confidence and an effective framework for encouraging and empowering staff when having these important conversations with their patients.

Our approach

The West of England AHSN invited the Resuscitation Council to introduce ReSPECT to the region in June 2018. Delegates from 54 organisations attended the ‘Exploring approaches to end-of-life care’ event. Following the event Gloucestershire and BNSSG ICSs, agreed to implement ReSPECT together.

In October 2018 and March 2019, the West of England AHSN held learning and sharing events to prepare for the joint launch in October 2019. The launch covered a population of 1.6 million people, including primary care, four acute trusts, four community healthcare providers, one mental health trust, the ambulance service, hospices and voluntary organisations.

The COVID-19 pandemic brought with it extra resonance for the ReSPECT programme. During the pandemic, registered nurses in nursing homes received online ReSPECT conversation training sessions and so they were able to have individualised ReSPECT conversations and complete forms for residents unable to see their GP. A training package was also created for RESTORE2 and developed for care homes which included awareness of ReSPECT. This package has so far been delivered to 2,375 care home workers from 255 care providers by the West of England AHSN.

In September 2021, One Gloucestershire and the AHSN ran online learning sessions for paramedics in the West of England to help them to better use and understand the ReSPECT process.

The West of England AHSN has continued advocacy of ReSPECT, with BSW ICS implementing ReSPECT in October 2021.

The ReSPECT process was amended to reflect use during the COVID-19 pandemic.

The AHSN created a suite of resources for healthcare systems including implementation and training toolkits. The AHSN  has also worked with the Resuscitation Council UK to produce two animations, one for patients and the public and one for healthcare professionals, telling the story of Joe and how his ReSPECT form improved communication and coordinated personalised, individualised care across the health and care system.

“What has been incredible is how the whole of the health and social care community within Gloucestershire have come together and driven this project. The cross boundary working, shared learning and respect literally for each other’s roles has been really fantastic to see.”

A social care provider in Gloucestershire

Impacts to date

Impacts for the project relate to quality of care and relationships built between organisations. The implementation standardised multiple processes reducing duplication, improved access to information, and encouraged earlier conversations with individuals and families. The project was not intended to save money, however it was cost effective as substituting one process with another required no financial investment; apart from events and project management funded by the West of England AHSN.

15,000 ReSPECT forms have been completed across the region (to September 2021).

A unique output from this project was a digital ReSPECT template created by a local GP and approved by the Resuscitation Council. The South West CIO network successfully lobbied for an opt-out policy for additional information  in the Summary Care Record , which was implemented during COVID-19 allowing ReSPECT decisions to be visible digitally to South West Ambulance Service first responders.

The AHSN also set up an online workspace on the FutureNHS collaboration platform to share resources and learning.

“I can’t remember the last time I’ve had to flick through the notes of a deteriorating patient urgently searching for discussions about treatment escalation recommendations. Now I can just find the decisions easily at the front of the clinical records and give the patient the care that the team who knows them best, has agreed.”

A nurse practitioner

Next steps

After the successful adoption and spread of ReSPECT, the West of England AHSN are conducting a qualitative evaluation of the ReSPECT process in care homes in collaboration with the Applied Research Collaborative (ARC) West.

ReSPECT continues to inform our patient safety work to manage deterioration and support care homes. For instance, the West of England Learning Disabilities Collaborative continues to advocate use of ReSPECT and the AHSN now offers free training to care providers to detect and respond to the soft signs of deterioration alongside the importance of advance care planning.

Our involvement in the ReSPECT project started in 2018 and is ongoing.

Find out more about ReSPECT or email: weahsn.transformation@nhs.net

PreciSSIon (Preventing Surgical Site Infection across a region)

PreciSSIon (Preventing Surgical Site Infection across a region) is a double award-winning collaborative involving all hospitals in the West of England. The aim was to reduce incidence of surgical site infection after elective colorectal surgery by implementing a four-point evidence-based bundle of care developed at North Bristol NHS Trust in February 2013.

This became a West of England AHSN project in November 2019 and the AHSN supported adoption and spread to other hospital trusts (Royal United Hospital Bath, University Hospitals Bristol and Weston, Gloucestershire Hospitals Foundation Trust and Great Western Hospital Swindon) through project management, provision of resources, and funding of collaborative events.

The project almost halved SSI with a reduction of 47 % by March 2021. It is estimated that the project saved 115 patients from developing an SSI, with an associated cost saving of £566,720. This result was achieved despite the COVID response causing major disruption in hospitals.

Watch our PreciSSIon bundle video.

The challenge

Surgical site infection (SSI) refers to wound infections following invasive surgical procedures. SSI arises from contamination of the wound site during or after surgery. The development of SSI is complex with many contributing factors.

SSI is the third most common hospital acquired infection in the UK accounting for 14.5% of all HC AI affecting 250 000 people a year in England with an estimated 34-226% increase in associated costs.

SSI causes pain for patients, can increase hospital stay and readmission and increase antibiotic use. When severe it can lead to intensive care admission and rarely, death.

SSI is more common after colorectal surgery where wounds can be contaminated by bowel content, but most hospitals do not know their SSI rates. Rates of between 8-30% have been reported based on in-hospital SSI and readmissions. However, the prevalence is likely to be underestimated because SSI frequently presents after the patient has been discharged from hospital.

View the PreciSSIon implementation toolkit.

Our approach

The PreciSSIon project had 2 clear aims:
1. To establish reliable SSI measurement after elective colorectal surgery using a validated patient reported outcome questionnaire at 30 days.
2. To implement an evidence-based 4-point care bundle. The PreciSSIon bundle, includes: 2% chlorhexidine skin preparation; a second dose of antibiotics after 4 hours operating; use of dual ring wound protectors; antibacterial sutures for wound closure.

The West of England AHSN supported the PreciSSIon collaborative using the IHI Breakthrough Collaborative model. The West of England AHSN produced resources and materials to aid data collection and implementation of the PreciSSIon bundle. These included QI (quality improvement) resources, an implementation toolkit, posters, and videos. The AHSN also ran ‘learning and sharing’ events for the collaborative which were an opportunity to meet and share successes, challenges, and discuss data collection. One face to face meeting occurred before the pandemic but then all subsequent events were virtual.

“The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference.

“We had our challenges, including standardising measurement, procurement of antibacterial sutures and sustaining measurement during the pandemic, when staff were redeployed to other roles, but despite this we have demonstrated that a care bundle developed in a single hospital can be adopted and spread. Also that the original outcome of a 50% reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within just 18 months.”

Dr Lesley Jordan, Consultant Anaesthetist and Patient Safety Lead, Royal United Hospitals Bath NHS Foundation Trust

Impacts to date

The regional average baseline SSI rate was 18%. Implementation of the bundle in all trusts between November 2019 and May 2020 resulted in a 47% improvement in SSI rate, leading to a regional average of 9.5% by March 2021. This relates to saving 115 patients from an SSI, a significant improvement in patient experience. Compliance with bundle was 87% for chlorhexidine, 79% for antibacterial sutures, 68% for wound protectors and 92% for antibiotics.

A UK study demonstrated that the cost of a SSI after elective colorectal surgery is £4,928 equating to a regional cost saving of £566,720. 3 hospitals also implemented the bundle after emergency abdominal surgery leading to a reduction in SSI from 22.5% to 12.5%.

PreciSSIon was shortlisted for two 2021 HSJ Patient Safety Awards, winning the Infection Prevention and Control Award. PreciSSIon also won Quality Improvement Team of the Year at the BMJ Awards, both in September 2021.

In March 2022, the Journal of Hospital Infection published a study by surgeons and trainees who formed part of the PreciSSIon project team. This evidenced the value of SSI bundles to patients and the NHS. Read the journal article.

Next steps

The project team are currently exploring other ways of measuring SSI such as e-PROMS and primary and secondary care data linkage to facilitate adoption and spread. We are considering expanding the project to vascular surgery, urology and caesarean section.

The project results have been shared with the Royal College of Surgeons and the results have been presented at the Association of Surgeons of Great Britain and Ireland with the aim of sharing more widely.

The project launched in November 2019 and is ongoing, although West of England AHSN project management has ended.

Project leads:
Anne Pullyblank, Medical Director, West of England AHSN
Dr Lesley Jordan, Consultant Anaesthetist and Patient Safety Lead, Royal United Hospitals Bath NHS Foundation Trust

Find out more about PreciSSIon.

 

SHarED (Supporting High impact users in Emergency Departments)

The SHarED (Supporting High impact users in Emergency Departments) project aimed to improve outcomes for the most frequent users of Emergency Departments (EDs). High impact users (HIU) of EDs suffer some of the most severe health inequalities in the UK. There is also a significant financial impact on the NHS with some HIU costing £30,000 per year in ED attendance and hospital admission alone.

Through a collaborative case management approach, significant improvements have been recorded through project SHarED for both EDs and patients.

These include:

  • Improved patient experience
  • A 44% reduction in the number of attendances following the first month of engagement for 89% of the patients engaged
  • Improved staff experiences as measured through a series of staff surveys
  • Collaborative working between multi-disciplinary teams.

The project was proposed by Dr Rebecca Thorpe and the team at University Hospitals Bristol as part of the West of England AHSN’s Evidence into Practice Challenge 2019. The model had been running successfully there for five years before being adopted and spread by the West of England AHSN throughout the region.

“Taking part in SHarED allowed our HIU Team the time, support and resource to really address the underlying issues which can drive patient requirement for large amounts of unscheduled care. By developing Personal Support Plans, in collaboration with patients and other professionals, we managed to reduce attendance rates, reduce admission rates to hospital and smooth the path of patients when they did attend the Department, thereby supporting our staff in dealing with these patients who often have complex health needs. Feedback from our ED staff was extremely positive. Looking to the future, with thanks to SHarED, we’re continuing to develop our HIU service.”

Dr Sarah Harper, Pain Consultant and HIU Team Lead, Gloucestershire Hospitals NHS Foundation Trust

Watch our SHarED project video. 

The challenge

HIU of EDs suffer some of the most severe health inequalities in the UK. HIU and ‘super-users’ are defined as those who attend the ED more than five and 20 times respectively each year. As a patient group, HIUs experience exceptionally high rates of mental health challenges; learning disability; homelessness; substance misuse; domestic abuse and safeguarding concerns. HIUs often attend the ED as they have nowhere else to go.

As well as the negative outcomes for HIUs attending ED when that service may be unsuitable for their needs, and the resulting strain on ED staff to manage high levels of repeat attendances, there is also a significant financial impact on the NHS. Some ‘super-users’ cost £30,000 per year in ED attendance and hospital admission.

Our approach

In 2019, Dr Rebecca Thorpe of University Hospitals Bristol put forward SHarED for The West of England AHSN’s Evidence into Practice Challenge; an open call to healthcare professionals in the region with an evidence-based idea for an initiative or project that would improve healthcare. The initiative has been running at Dr Thorpe’s hospital for five years and had achieved great success in reducing attendances to the ED, as well as supporting users to seek healthcare and support in a more appropriate way. It was one of two programmes selected for adoption and spread across the West of England.

The West of England AHSN worked collaboratively to spread SHarED to all five EDs in the region. The West of England AHSN also developed a thorough SHarED Implementation Guide, run and managed ED staff surveys and created communications including videos .

All teams from across the region joined a monthly call to share progress, challenges and to discuss clinical case studies. They have since been supported in developing their business cases for ongoing service funding.

The HIU teams’ triage and prioritise patients based on multiple factors, including the number of attendances in the last 3 months, the impact on the department when they attend and a number of social factors. Once prioritised, patients are contacted and asked to contribute to a Personal Support Plan written by the HIU co-ordinator and the Multidisciplinary Team. The Personal Support Plan is then used by members of staff in the Emergency Department to provide a consistent approach to assessment and management. Additionally, the Multidisciplinary Team also seek to address any underlying issues through a holistic approach.

“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. It’s a fantastic example of cultural change across the whole patch.”

 Dr Rebecca Thorpe, Clinical Lead for SHarED and ED Consultant, University Hospitals Bristol NHS Foundation Trust

Impacts to date

Throughout the funded period of the project, the ED teams have delivered training to more than 360 members of staff to raise awareness of the service and best practice guidance on how to manage HIUs, ultimately seeking to improve the culture in the departments. Whilst working on a new project during the COVID-19 pandemic offered a series of challenges, more than 140 HIU have been engaged across the five adopting EDs.

Interim data demonstrates the following impact on patients:

  • A 44% reduction in the number of ED attendances following the first month of engagement for 89% of the patients engaged.
  • The remaining 11% of the patients saw a significant escalation in their behaviour, however it is broadly acknowledged that the highly complex nature of these individuals often means that where attendances cannot be reduced, the teams are there to provide appropriate support and improve the experience of the patients and staff members alike.

Additional data collected by several trusts demonstrates that where attendance had increased, the impact and cost of each attendance had reduced.

Feedback from a 2021 staff experience survey included:

  • “Dedicated HIU teams are making a real difference to the appropriate management of these patients.”
  • “Our HIU team are brilliant and have made a huge impact on not only the number of attendances but patient outcome and reduction in violence and aggression cases.”

A project evaluation, which will seek to fully understand the effectiveness of the SHarED model is expected in Autumn 2022.

“The West of England AHSN are proud to have supported the adoption and spread of the HIU model across our region. The project has flourished despite the challenges presented by the pandemic and that is a testament to the dedication and hard work of everybody involved – especially the staff in ED teams. The commitment to appropriately supporting this most vulnerable of patient groups has been exemplary.”

 Clare Evans, Programme Manager for SHarED and Deputy Director of Service and System Transformation, West of England AHSN

Next steps

While the West of England AHSN funding has now ceased, the ED teams are working with their trusts to secure ongoing support. Each team are passionate about continuing the important work that has been started by the SHarED project.

The West of England AHSN are looking forward to the seeing the full project evaluation, which will seek to fully understand the effectiveness of the SHarED model. We expect to receive the completed evaluation in Autumn 2022.

The majority of the West of England AHSN involvement in the project was from 2019 to 2021.

Find out more about SHarED on our website or by contacting Megan Kirbyshire, Senior Project Manager, West of England AHSN

PReCePT – preventing cerebral palsy in preterm babies

Every year around 4,000 women in the UK give birth very early because of complications with their pregnancy. Being born too early is the leading cause of cerebral palsy, which has a lifelong impact on children and families.

Magnesium sulphate (MgSO4) given during preterm labour reduces the relative risk of cerebral palsy in very preterm infants by 30% and costs from just £1 a dose.

To increase uptake of MgSO4, the PReCePT programme was developed by the West of England AHSN with University Hospitals Bristol and Weston. As a result of its regional impact, PReCePT was selected as an AHSN Network national adoption and spread programme from 2018 to 2020.

PReCePT was the first ever perinatal quality improvement (QI) programme delivered at scale across the whole country, bringing together midwives, obstetricians and neonatologists.

By March 2020 all 152 maternity units in England had adopted PReCePT, significantly reducing variation in administration rates of MgSO4 and achieving the national target of 85% uptake.

An estimated 48 cases of cerebral palsy were avoided as a result of PReCePT, saving around £38.4 million in lifetime health and social care costs.

“Patient safety has always been at the centre of my work. PReCePT allowed me to take some new evidence, some new research, to put that into practice, to disseminate that to the staff, and to see the benefits and outcomes improving for these women, their babies and their families.”

Claire Edward-Few, Practice Development Midwife, Stoke Mandeville Hospital

PReCePT: ingredients for success: In this short film, members of the PReCePT team from around the country share their experiences and learning as part of the national AHSN Network adoption and spread programme.

The challenge

Around one in ten babies of very low birth weight develop a form of cerebral palsy. The lifetime cost per patient with cerebral palsy, including health care, productivity and social costs, is estimated to be around €830,000 (1).

In 2015 NICE (NG25) recommended administration of magnesium sulphate (MgSO4) in very preterm births as a core part of maternity care to substantially reduce the risk of cerebral palsy by 30%, based on accumulating evidence in support of its brain protective potential (2).

For every 37 mothers below 30 weeks gestation who receive magnesium sulphate, one case of cerebral palsy is prevented.

However, the uptake of MgSO4 in the UK remained relatively low, compared with the rest of the developed world. The National Neonatal Audit Programmes report demonstrated an uptake of 44% for eligible babies in England in 2016, and 60% in 2017 (3).

Sources: 

  1. Kruse M, Michelsen SI, Flachs EM, Bronnum-Hansen H, Madsen M, Uldall P. Lifetime costs of cerebral palsy. Developmental Medicine and Child Neurology. 2009;51(8):622-8.
  2. 2015 NICE Guideline 25: Preterm labour and birth. National Institute for Health and Care Excellence (Available from: https://www.nice.org.uk/Guidance/NG25)
  3. National Neonatal Audit programme (NNAP) 2017 and 2018 [Available from: http://www.rcpch.ac.uk/improving-child-health/quality-improvement-and-clinicalaudit/national-neonatal-audit-programme-nn-3)

Our approach

The West of England AHSN developed PReCePT with University Hospitals Bristol and Weston NHS Foundation Trust to help reduce cerebral palsy in preterm babies by optimising administration of MgSO4 to eligible women in preterm labour (less than 30 weeks), using a quality improvement (QI) approach.

Following successful rollout of PReCePT across all five maternity units in the West of England in 2014-15, PReCePT was selected as one of the AHSN Network’s seven national adoption and spread programmes during 2018-2020, funded by NHS England. The West of England AHSN led on this programme.

Delivered through the 15 AHSNs, the PReCePT programme used standardised QI resources such as toolkits, implementation guides and dashboards. Midwife champions were funded to deliver PReCePT in each maternity unit and regional clinical leads supported delivery across each AHSN geographical area.

PReCePT also benefitted from £0.5 million in ‘Scaling Up’ funding from the Health Foundation to run a cluster randomized trial nested within the national programme. Known as the PReCePT Study, this aimed to assess whether an enhanced QI intervention improved the uptake of MgSO4 in preterm births over and above the national PReCePT programme.

“As a mother who has gone through pregnancy and preterm birth, it is inconceivable to me that there wouldn’t be a joined-up approach across the whole perinatal team. It’s any mother’s expectation that the care she receives during her pregnancy and preterm birth and the subsequent care of her baby are delivered seamlessly.”

Monica Bridge, Parent Partner

Impacts to date

PReCePT has led to improved compliance with NICE guidance, increasing awareness of the use of MgSO4 as a neuroprotector, developing care pathways and support through a range of QI tools and training.

By the end of the AHSN Network national programme in March 2020, all 152 maternity units in England had adopted PReCePT. The programme achieved its aim of 85% uptake and variation in administration was significantly reduced.

An estimated 48 cases of cerebral palsy were avoided as a result of PReCePT, saving an estimated £38.4 million in lifetime health and social care costs (figures from 2018-2021).

Feedback from midwives in lead or champion roles demonstrated that PReCePT enabled them to develop their units, themselves and each other in QI skills and thinking, supporting greater collaboration.

An important outcome of the programme was increased accuracy in reporting and collection of MgSO4 administration data, data monitoring, and follow-up of missed cases.

“I was fortunate and privileged to partner first with the West of England AHSN and then the AHSN Network to scale up PReCePT into every maternity unit in England. I was tasked with leading the clinical leadership for the national programme. There was no blueprint or roadmap for this sort of intervention, and we had to come up with an innovative model. I believe that a key ingredient in our success was enabling clinicians to lead. It was about enabling perinatal team leadership, bringing together obstetricians, neonatologists and midwives. Leadership is about creating more leaders, rather than followers.”

Dr Karen Luyt, Neonatologist, University Hospitals Bristol and Weston NHS Foundation Trust

Next steps

The administration of MgSO4 as a neuroprotector has been included in the NHS Long Term Plan, the national Patient Safety Strategy as well as Saving Babies Lives v2. It is a key component of the national Maternity and Neonatal Safety Improvement Programme’s Optimisation and Stabilisation of the Preterm Infant primary driver.

The West of England AHSN, on behalf of the AHSN Network, is exploring the opportunity to collaborate with NIHR ARC West, industry and voluntary sector partners on a research project that links patient level MgSO4 administration data with cerebral palsy diagnosis. Further information on whether this project progresses will be available in 2022.

“I believe strongly that every woman who goes into labour under 30 weeks should have the chance to have this medicine because it’s a no-brainer really. It’s easy to do and it doesn’t cost a lot and you can just see that it can transform lives for both children and all of their families.”

Elly Salisbury, Parent Partner

The information in this case study is based on these time periods:

  • West of England: March 2014 – March 2015
  • AHSN Network national adoption and spread programme: April 2018 – March 2020
  • Health Foundation PReCePT Study / ‘Scaling Up’ project: April 2018 – November 2020

Find out more on the AHSN Network website or email weahsn.transformation@nhs.net.