Bringing together mental health teams to improve patient safety and health equity

On 30 November the South of England Mental Health Quality and Patient Safety Improvement Collaborative (known as the MHC) held an all-day learning event for mental health teams across the South of England. The event – held online – was an opportunity for sharing learning and networking, which has been particularly challenging for large geographic collaboratives during the pandemic.

Hosted by the West of England AHSN, the collaborative was created in partnership with the South West AHSN, and now includes Kent, Surrey and Sussex AHSN, Oxford AHSN, and Wessex AHSN alongside 16 mental health trusts across the south of the country. The MHC aims to improve the quality and safety of services for people with mental health conditions.

MHC learning events enable collaboration across the mental health sector in order to foster quality improvement (QI) approaches to patient safety, drive health equity and review progress against the ambitions of the NHS England Mental Health Patient Safety Improvement Programme (MHSIP), which includes reducing restrictive practice.

The event was chaired by Dr Helen Smith, chair of the MHC and National Clinical Lead for MHSIP with around 90 people joining the event from project teams across the South of England.

The event began with a presentation on experiencing, challenging and addressing inequalities from Chris Lubbe, NHS England. Chris was previously an anti-apartheid activist and acted as Nelson Mandela’s bodyguard. He therefore offered a unique insight into inequalities.

Sussex NHS Foundation Trust then presented on delivering a reducing restrictive project as part of the National Collaborating Centre for Mental Health.

This was followed by a World Café where colleagues from four mental health teams shared their experiences of reducing restrictive practice. This offered a vital opportunity to share learning and consider different approaches.

Presentations then followed from Cornwall NHS Foundation Trust on Reducing Restrictive Practice:  Drivers linked to ‘Seni’s Law’; Creating conditions for learning, and finally QI approaches focused on the live, learn and lead methodology.

Following this event, members of the MHC will continue to meet regularly for QI coaching sessions and all-day learning events.

Feedback from attendees:

“Thank you for such a thought provoking presentation. The take home message for me is to dig deep and speak up and say something”.

“Really good ideas – we will be shamelessly stealing the calm cards in particular! Thank you”.

“What went well? Chris’ presentation to start off the day – an inspirational speaker. Amazing and really highlighted the inequalities within everyday life, including our own services. Also the interactive break out activities”.

If you would like to find out more about the MHC please email weahsn.transformation@nhs.net.

AHSN Network’s COVID Oximetry @home programme wins at the HSJ Awards 2021

England’s 15 AHSNs and the AHSN Network celebrated a win at the prestigious HSJ Awards ceremony in London on 18 November.

The team were successful in the patient safety category for the significant support Patient Safety Collaboratives and AHSNs provided to implement COVID Oximetry @home and virtual wards. The programme was delivered in partnership with NHS England and NHS Improvement, NHS Digital and NHSX, and helped thousands of people most at risk from COVID-19 to be safely supported at home, through remote self-monitoring of their oxygen saturation levels.

By May 2021 over 2000 patients in the West of England had been enrolled on either COVID Oximetry @home or COVID virtual wards. Read about our rapid and collaborative implementation of pulse oximetry services across the region, as well as our local case study.

The judges said:

“The judges felt that this was an outstanding example of a true system wide collaboration. This project not only touched the UK but positively impacted people’s lives across the world. The outcomes were positively overwhelming in relation to lives saved, bed day reduction and early admissions which improved mortality and morbidity rates. It was clear that this approach contributed heavily to the prevention of the NHS becoming overwhelmed during the pandemic. The patient testimonial demonstrated the real impact to individuals and added value to the presentation coupled with the passion and authenticity of the presenters.”

Natasha Swinscoe, Chief Executive Officer at West of England AHSN and national patient safety lead for the AHSN Network said:

“We are delighted to receive this award on behalf of all our partners, frontline staff and patients.

The AHSN Network was proud to lead the rapid implementation of the COVID Oximetry @home and COVID virtual ward programmes during the coronavirus pandemic. Success would not have been possible without our partners NHSX, NHS Digital and sponsors NHS England and NHS Improvement, who fully supported this innovative and novel pathway of care.

This award recognises collaborative working across health and care systems and we share this with NHS England and NHS Improvement, particularly the NHS@home team, regional and local CCG teams, NHSX, NHS Digital, our Patient Safety Collaboratives and clinical leads.

Learning from this innovative pathway has led to the development of other pathways such as a blood pressure at home initiative, part of our cardiovascular disease management portfolio of programmes in the AHSN Network.”

Cheryl Crocker, AHSN Network Patient Safety Director, said:

“We entered this award to showcase the extraordinary achievement of multiple partners, supported by regional Patient Safety Collaboratives, who came together to respond to the pandemic and keep patients safe. This national programme is estimated to have benefitted in excess of 40,000 people.”

The West of England and South West AHSNs were also shortlisted for Provider Collaboration of the Year award for PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth).

PERIPrem is a perinatal care bundle to improve the outcomes for premature babies across the West and South West regions. The bundle consists of a number of interventions that will demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

Welcoming Chief Executive Officers appointed to lead our new Integrated Care Boards

NHS England and NHS Improvement are recruiting new Chief Executive Officer (CEO) designates for all 42 Integrated Care Boards (ICBs) around the country. The three ICBs in the West of England region have recently made these appointments, and the West of England AHSN are delighted to continue working with our local systems, their boards and the new designate CEOs.

Shane Devlin has been announced as the Chief Executive designate of the new ICB for Bristol, North Somerset and South Gloucestershire (BNSSG).

Sue Harriman, CEO of Solent NHS Community and Mental Health Trust in Hampshire, has been appointed designate Chief Executive of the NHS Bath and Northeast Somerset, Swindon and Wiltshire (BSW) ICB.

Mary Hutton, currently One Gloucestershire Integrated Care System (ICS) lead, has been appointed as CEO designate of the new Gloucestershire ICB.

Tasha Swinscoe, Chief Executive Officer for the West of England AHSN said:

“I would like to congratulate the three designate CEOs on their appointments. Here at the AHSN we’re looking forward to working with Shane, Sue and Mary and their teams to continue to support ICS priorities and the transition to the new ways of working with ICBs.

The AHSNs priorities are closely aligned to our member and system priorities – by working together we’ll continue to support ongoing system transformation and adoption of proven innovations around tackling health inequity, providing more integrated, patient-centred care and the Sustainable NHS agenda”.

What is an Integrated Care Board (ICB)?

At the end of March 2022, the functions of all Clinical Commissioning Groups (CCGs) will transition to ICBs. This is part of the Health and Care Bill, currently going through Parliament, which sets out plans to put Integrated Care Systems (ICSs) on a statutory footing, empowering them to better join up health and care services, improve population health and reduce health inequalities.

Each ICS will be led by both an ICB (the organisation with responsibility for NHS functions and budgets, formerly the CCG), and an Integrated Care Partnership (ICP), a statutory committee bringing together all system partners, including local authorities, to produce a health and care strategy. Find out more on the NHS website.

The ICB will work collaboratively with partner organisations including the AHSN, VCSE sector and people and communities in each Integrated Care System (ICS).

Read more about the membership of the AHSN here. 

Spotlight on Inclisiran

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

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

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

CVD is a health equity issue

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

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

So where does Inclisiran come in?

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

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

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

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

What’s next?

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

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

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

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

How do I get involved?

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

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

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

AHSN Network has benefited more than 479,000 patients and generated £322.3 million inward investment for UK economy

The innovation delivery arm of the NHS, the AHSN Network, has released its Impact Report 2018-2020. The report highlights outstanding impacts achieved by AHSNs, including the West of England, and evidences how they are driving adoption and spread in healthcare innovation, transforming patient outcomes, enabling efficiencies, saving the NHS money, generating economic growth and attracting millions of pounds of investment for the country’s economy.

The report also details how AHSNs have mobilised quickly to COVID-19 to support the NHS and health and social care response.

National programmes

Commissioned by NHS England, England’s 15 AHSNs delivered seven programmes during 2018-20, developed regionally and selected for national adoption and spread, which are benefiting more than 479,000 patients: Atrial Fibrillation, Emergency Laparotomy, ESCAPE-pain, PINCER, Prevention of Cerebral Palsy in PreTerm Labour (PReCePT), Serenity Integrated Mentoring (SIM) and Transfer of Care Around Medicines (TCAM).

Key national programme findings from the report show that 13,387 fewer patients are at risk from harm from medication errors as a result of PINCER. The Network’s atrial fibrillation work has helped prevent 11,734 strokes and saved 2,933 lives. Whilst 8,472 people with chronic joint pain have participated in ESCAPE-pain courses.

AHSNs also play a key role in supporting the NHS to adopt new, better and more effective technologies through playing a leading role in supporting the NHS Accelerated Access Collaborative (AAC), by operation as the local agencies to drive adoption of Innovation and Technology Payment (ITP) and Rapid Uptake Products (RUPs).

Economic growth

From 2019-2020, the AHSN Network has generated almost £322.3 million inward investment for our nation, and created and / or protected over 1,000 jobs during this time.

The AHSN Network helps mobilise the value that the NHS can add as an economic asset to the UK economy. AHSNs broker access to a range of expert support and services across the health and care sectors that support NHS innovators and companies to realise the commercial and economic potential of their ideas.

The latest round of company surveys conducted by the AHSN Network show remarkable progress in the health innovation sector. Find out more about how the AHSN Network has attracted millions of pounds of investment for the country’s economy.

Patient safety

England’s 15 Patient Safety Collaboratives (PSCs) have significantly contributed to the NHS Patient Safety Strategy through their work on managing deterioration, maternity and neonatal safety, and adoption and spread programmes.

PSCs play an essential role in identifying and spreading safety improvement programmes (SIPs) to create sustainable and continuous improvement in settings such as maternity units, emergency departments, mental health trusts, GP practices and care homes.

Successes include spreading the National Early Warning Score (NEWS2) to 99% of all acute hospital trusts, a 92% uptake of a discharge care bundle for patients with chronic obstructive pulmonary disease (COPD), and more than 120,000 views of a series of training films developed for care home staff.

Review our regional Patient Safety programme here.

COVID-19

To support the COVID-19 response AHSNs pivoted their expertise and resources, highlighting their unique ability to be able to work with regional health systems to spread innovation, whilst collaborating across England to drive rapid transformative change across large geographies.

Key examples of AHSNs responding to the pandemic include; providing expertise to NHS regions, by embedding staff in regional COVID-19 response cells, which was equivalent to 157 full time staff. And working with NHSX and NHS Digital, AHSNs help to drive digitisation of primary care, achieving a near-total uptake of video and online consultations in two months across GP practices in England. We also published a rapid-learning report on our patient safety work, ‘Safer care during COVID-19’.

By autumn 2020, AHSNs were continuing to support the COVID-19 response whilst providing expert input to regional NHS planning around the restoration and recovery of services. Nationally, AHSNs have also been leading the NHS ‘Reset’ campaign with NHS Confederation and the Health Foundation and have been playing a key supporting role in the NHS Beneficial Changes Network, focusing on ‘locking in’ learning from the pandemic.

Find out more about how we are working with health and social care colleagues across our region to keep people safe during and after COVID-19.

Piers Ricketts, Chair of the AHSN Network and Chief Executive of Eastern AHSN said:

“We are achieving results that make a real difference for patients and service users, as well as healthcare professionals, innovators and NHS organisations. These strong foundations make us ideally placed to help all those involved in improving and innovating health and care to tackle together the challenges that lie ahead.

The AHSNs’ response to COVID-19 has highlighted how our core strengths and ways of working have proved a valued asset to our partners. AHSNs are agile and well connected organisations, and we were able to mobilise and respond to this new crisis almost overnight, providing additional support and brokering relationships across health and care, research and academia, industry and the voluntary sectors.”

New national programmes

From April 2020, AHSNs are working on three new national programmes;

  • Focus ADHD; a number of AHSNs are working with mental health trusts and community paediatric services to improve the assessment process for Attention Deficit Hyperactivity Disorder (ADHD) using computer-based tests (measuring attention, impulsivity and activity).
  • Early Intervention Eating Disorders; a number of AHSNs are supporting mental health teams across England to speed up diagnosis and treatment of eating disorders in young people aged 16 to 25.
  • Lipid management and FH; AHSNs are scoping a national programme of work around cardiovascular disease (CVD) prevention, which is anticipated to start in autumn 2020.

Review our regional work on FOCUS ADHD and Early Intervention Eating Disorders.

AHSNs continue to support national NHS initiatives such as the National Innovation Accelerator (NIA), Small Business Research Initiatives (SBRI) and Clinical Entrepreneurs programme and developing work on new and emerging NHS priorities such as workforce innovation.

Read the full AHSN Network Impact Report 2018-2020.  

Applications for the NHS Innovation Accelerator are now open!

The NHS Innovation Accelerator (NIA) – an NHS England initiative supported by England’s 15 Academic Health Science Networks (AHSNs) and hosted at UCLPartners – has launched its call for applications representing high impact, evidence-based innovations. Successful applicants will become 2021 NIA Fellows.

The call is open to local, national and international healthcare innovations supported by passionate individuals from any background, including SMEs, clinicians, charity/third sector and academics.

In alignment with the current NHS priorities of COVID-19 Reset and Recovery, innovations put forward this year must address at least one of the following themes:

  • NHS response to COVID-19
  • Mental health
  • Supporting the workforce

The application period is open until 16 October 2020 at midnight.

This list of Frequently Asked Questions explains the NIA in more detail, who can apply, the selection process, what support an NIA Fellow 2021 can expect. We recommend reading this document before applying to the NIA or contacting us about your application.

Interested in applying?

Visit the NIA website to learn more about the application criteria and process, register for informational webinars, and access the online application portal. Webinars will be held on 8, 9, 22 September and 8 October.

Our Business Development team are available to support you and answer any questions you may have. Please do not hesitate to contact us, you can email:  innovation@weahsn.net

Read about a local 2020 NIA Fellow

On 5 March 2020, the NHS Innovation Accelerator (NIA) announced 11 high impact innovations joining the national accelerator in 2020, including one developed here in the West of England: The WaterDrop. Read more about The WaterDrop and their journey to becoming an NIA 2020 Fellow.

About the NHS Innovation Accelorator (NIA)

The NIA is an NHS England Initiative highlighted in the NHS Long Term Plan. It accelerates uptake of high impact innovations for patient, population and NHS staff benefit, and providing real time practical insights on spread to inform national strategy.

The NIA supports individuals (‘Fellows’) with a set of values and passion for scaling evidence-based innovation to benefit a wider population, with a commitment to share their learnings.

Since launching in July 2015, the NIA has delivered the following (these stats do not include data from the latest rounds of Fellows, unveiled in March 2020):

  • 2,214 additional NHS sites using NIA innovations
  • £134.8m external funding raised
  • 486 jobs created
  • 113 awards won
  • 45 innovations selling internationally
  • NIA innovations save the health and social care system £38m per annum, according to conservative figures from independent evaluations by York Health Economic Consortium.

Sharing learning from our QI Summer Series

During July and August 2020 the West of England Academy, aided by guest facilitators and speakers, held weekly Quality Improvement (QI) webinars. This season of learning, known as the QI Summer Series, was fully booked with a lengthy waiting list. We are also delighted to say the series received 100% positive feedback from attendees, no mean feat in a world where virtual fatigue is setting in.

Before and during the series our Academy team compiled their thoughts and tips on hosting learning sessions via webinar:  To download the slides as a PowerPoint, please click here

In the coming weeks, our Academy team will also be sharing a Getting Started with QI Guide alongside a blog about their experiences organising and leading the QI Summer Series.

The West of England Academy will be hosting further QI webinars, alongside other virtual events.

You can browse the full range of AHSN events here.

Industry roundtable discussions inform AHSN Network support offer

The AHSN Network, of which the West of England AHSN is a member, is planning a series of “Bridging the gap” events this autumn aimed at providing support, information and advice for innovators across industry. The plans have been developed following a roundtable discussion hosted by the AHSN Network to listen to the experiences and challenges faced by industry during the COVID-19 pandemic.

The roundtable, titled Lessons learned and lived experiences of industry during the pandemic – how these can help us reset health and care together, was primarily an opportunity to hear from industry. The group discussed how the views and experiences of industry could be taken forward and inform the NHS Reset process as we move into “phase 3” of the response to the pandemic. You can watch a short film summarising the event here.

In essence, the key themes of discussion around actions that need to involve industry insights to support reset included:

  • Effectively embedding new care/service models that have developed during the pandemic
  • Getting rapid evaluation and reimbursement models working more effectively, building on the lessons learned in recent months
  • Managing the consequences of the dramatic decrease in non-COVID care and considering digital interventions that can help manage patient care and outcomes.

Organisations joining the AHSN Network in this virtual roundtable included:

  • the Association of the British Pharmaceutical Industry (ABPI),
  • the British In Vitro Diagnostic Association (BIVDA),
  • the Digital Health and Care Alliance (DHACA),
  • the Association of British Health Industries (ABHI),
  • Health Foundation,
  • Accelerated Access Collaborative (AAC),
  • NHSX,
  • the Office for Life Sciences (OLS),
  • Spirit Health Group, and
  • the NHS Confederation.

Niall Dickson, Chief Executive of the NHS Confederation, said:

“The NHS has been through the most traumatic period in its history – we have seen some of most awful consequences of this terrible pandemic and some of the most fantastic responses from both health and care staff.

“We have seen innovation and its implementation at an unimaginable speed and scale that’s never been seen before, and we now urgently need to review what has happened and make sure we capture the positive transformations have been made possible by working with industry.

“We are keen for these relationships to continue and for us all to work hard to maintain this momentum.”

Read more about the event here.

This event forms part of the AHSN Network work on supporting the health and care reset, ensuring that we work across both NHS and industry to sustain and maximise on potential advances and transformative ways of working.

HSJ Patient Safety Award Nominations

Two of the West of England AHSN’s member organisations have been nominated across five categories in the 2020 HSJ Patient Safety Awards.

Avon and Wiltshire Mental Health Partnership Trust (AWMHP) received three nominations:

    • Learning Disabilities Initiative of the Year (Improving Patient Safety on the Daisy Unit),
    • Mental Health Initiative of the Year (Reducing Restrictive Practice on a Medium Secure Unit) and
    • Quality Improvement Initiative of the Year (A Collaborative QI approach to improving the quality of care on the Daisy Unit).

Royal United Hospitals (RUH) Bath received two nominations:

      • Deteriorating Patients & Rapid Response Systems Award (Improving Patient Outcomes from Sepsis and Acute Kidney Injury) and
      • Patient Safety Team of the Year (The Sepsis and Kidney Injury Prevention (SKIP) team improving outcomes for patients).

In a news release, Dr Lesley Jordan, RUH Consultant Anaesthetist and Patient Safety Lead at the RUH, said: “We’re very proud to be shortlisted and recognised for our continued work in improving outcomes for patients with sepsis and acute kidney injury.

“Sepsis is a life-threatening reaction to an infection, when a person’s immune system overreacts and starts to damage the body’s tissues and organs. Acute kidney injury is when a person’s kidneys suddenly stop working properly, usually as complication of an acute illness, and this can range from minor loss of kidney function to complete kidney failure.

“These can have serious consequences and early detection of both conditions is really important to improve outcomes for patients. We have focused on identifying the conditions as early as possible, introducing process and tools to enable our frontline staff to implement treatment promptly and improve the care we deliver. We have also established a new senior nursing support team, the Sepsis and Kidney Injury Prevention (SKIP) team, to continue to drive this work and support frontline staff.”

Nominees will be presenting their work virtually to a panel of judges to decide the category winner, which will be announced at a virtual awards ceremony in November. You can read the full list of award categories and nominations here.

The West of England AHSN wishes both AWMHP and RUH every success with their nominations.

Quality Improvement in the age of COVID – launching PERIPrem

Noshin Menzies, Senior Project Manager, shares her experiences of launching a Quality Improvement programme during COVID.

If you’d told me 4 months ago we would be where we are today with PERIPRem, I’d have wondered what planet you were from. This exciting, ambitious care bundle, the vision of two extraordinary neonatologists, was going to launch in April and change the way that perinatal care is delivered across the entire South West region. It was a seed reliant on collaboration. However, 2020 had other plans…

The fundamentals of PERIPRem – nurturing a regional clinical community dedicated to improving outcomes for our most vulnerable babies and working side by side with women and their families – were, in an instant, stopped in their tracks.

Pre-COVID, I had been lucky enough to attend the Royal College of Obstetrics and Gynaecology’s “Let’s Talk about Race” event for International Women’s Day. The stories I heard further cemented the commitment we had to reducing inequalities.  We could not deliver a perinatal quality improvement project without ensuring that we were actively listening – and considering how to chip away at the barriers that result in Black and Minority Ethnic women being 5 times more likely to die in childbirth and their children to experience poorer outcomes. This was even before we knew the increased risk of COVID to people of colour and the raised chance of preterm labour for those women unfortunate enough to contract the virus whilst pregnant.

Just as we finalised plans for launch, and to get out into the communities and find every opportunity to involve those who lives are imprinted by the experience of preterm birth, COVID hit. Our PERIPRem teams were now on the battle lines, and we were nestled behind our laptop screens, shell shocked. Our ability to be agile and adapt to novel ways of working mattered now more than ever.

I’ll admit, I was sceptical how we could launch what was still a seedling of a programme to twelve units across the whole of the South West, when we were unable to leave our kitchens, let alone realise our plans to provide fertile ground for the creation of a regional PERIPRem clinical community. Without a physical launch, how could we provide space for those small but mighty moments, that when cultivated, have more of an impact than any toolkit or presentation?

I often struggle when I have to describe QI; in my experience it is much bigger than a framework or a process by which you can input your problem and wait for gold-standard results. For me, QI has its foundations in the people, the team and the culture. It is the introductions to new faces, teams huddled together around meeting tables, clinicians whispering to colleagues they had not seen for years and the camaraderie brewed alongside the substandard coffee.  We grow highly functioning teams, and the most exciting part of any QI project, on these blocks. It was boom or bust but I needn’t have worried.

We have formed strong bonds as a PERIPRem team; we have even managed a team social. My treasured counterpart in the South West AHSN and I have never met, we joke that we do not know what each other look like from the shoulders down. We have bonded over the many cameos from the PERIPRem teams’ children – or Assistant QI Coaches as they are now known.

Most importantly, the PERIPRem perinatal teams have flourished. Whilst in the pressure cooker of the pandemic, we gave space and time to focus on delivering patient care – when they got a handle on what it meant for them as clinicians, they came back raring to go.  We have digitised all of our resources and are now holding webinars on each of the bundle elements – they are so well attended we cannot fit on a screen!

People have pushed through discomfort to record themselves sharing the clinical fundamentals and to provide the presence (all be it through a screen) we all miss. We are exploring new ways to engage with the women we were so keen to meet and listen to, and we are forever indebted to our patient representatives who are now pillars of our PERIPRem team.

The takeaway message from that tired trope of “these unprecedented times” is that we are stronger than we think. At the end of each exhausting day, when we have had our fill of fighting for bandwidth with Xboxing teenagers, with tired mouths from calmly saying, “you’re on mute”, we have been and will continue to be successful. More significantly, we have supported frazzled teammates, butted horns and laughed until we cried.

There is a sense of freedom this way of working has granted us. Whilst before, there was a tendency to stick to the tried and tested method of engaging and working with our clinical communities, COVID allowed us to think again. We used technology to enable hospital teams scattered across the entire southwest to meaningfully engage in PERIPRem without ever having to leave their wards. I was worried connecting through screens and keyboards would reinforce the distance between us all, but I am surprised to realise that it has in fact accelerated relationships and in turn progress.

Having to rely on the written word in email has meant that tone and intonation have been more carefully considered and the periods of chat offered through video calls means each sentence really counts. Of more significance, is a flattening of the hierarchy within our team. Each person no matter what their seniority is vital in keeping the PERIPRem wheel turning – be it because they know how to record a MS Teams meeting, or because they have the complex clinical knowledge of a perinatal intervention.  It is not that we did not appreciate this before, but the situation forced us to see beyond the limitations of a job description.

I have reflected on whether, upon return to ‘normality’, if we as a team will revert to the pre-COVID way of working. Whilst I would like to think there would be a time when we are able to sit in offices and meet with units, I do not think that is the whole question. I can honestly say I hope we do not – I do not want to forget our swift response to the restrictions placed on us, or our unwavering faith in our ability to make improvements.

I believe that we have fundamentally changed the way we will approach projects such as this in the future. We are braver in our ways of facilitating community, we have lived experience of delivering change programmes utilising technology rather than travel and we know that when needed, we can free ourselves of the legacy of traditional and more restrictive ways of working.