As an Academic Health Science Network (AHSN), we have a leadership role to play in championing and developing diversity, inclusivity and equality within our NHS innovation pipeline and our own organisation. To continue to celebrate the diversity of the region in which we live and work and ensure inclusive work programmes that have equality as a core value, we have signed the Bristol Equality Charter. Whilst this charter focuses on the city of Bristol, the AHSN covers a regional footprint and will therefore be working to ensure these principles guide our work across the region.
The AHSN Network (which is made up of the 15 AHSNs across England, of which the West of England is one) has also committed to a series of Diversity Pledges, and we are now developing an action plan setting out how we will achieve these goals.
Chief Executive and chair of the West of England AHSN’s Diversity and Inclusivity Steering Group, Natasha Swinscoe said:
“Support for signing the Bristol Equality Charter was unanimous with a sense that this was an early step on an important journey for our organisation. Along with our core values, the pledge that “everybody counts” is at the heart of what we do, from patient safety, our learning disability collaborative through to digital inclusion.
We intend to become an active voice in the Bristol Equality Network and work with Inclusivity and Diversity experts to ensure we are taking every step we can to promote equality and ensure all our communities have an active voice and visibility”.
About Bristol Equality Charter
The Bristol Equality Charter is a city-wide initiative co-designed by private, public and voluntary sector organisations, committed to improving equality of opportunity for everyone in Bristol and to eliminating discrimination in all its forms.
Bristol is a vibrant city with a growing diverse population. As citizens and partners we share an ambition to create a fairer, safer, inclusive city where everyone can feel that they belong, have a voice and an equal chance to succeed and thrive. We acknowledge that we all have a part to play in promoting equality for the city by working towards good practice and making continuous improvements.
Individuals and any type of organisation can sign up to the principles of the Bristol Equality Charter. Signing the charter is a voluntary action to promote and work towards equality in Bristol. Organisations are free to set their own specific priorities and goals for improvement.
Whilst there are already several more specific charters and manifestos in existence, the Bristol Equality Charter is unique to our city and addresses all aspects of equality in one document. The charter invites signatories to work together towards continuous improvement.
The development of the charter has led to the formation of a Bristol Equality Network. This is a group of individuals representing the equalities agenda within their organisations. The network meets regularly to support new organisations that sign up to the charter, and share information and good practice.
Local people and organisations can help to promote the Bristol Equality Charter by sharing what equality and the charter mean to them, using the hashtag #BristolEqualityCharter.
For more information about the Bristol Equality Charter and how to get involved please visit the council’s website or email firstname.lastname@example.org.
An accessible video of the Bristol Equality Charter with BSL translation, subtitles and voice over is available here.
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.
Wessex and the West of England Academic Health Science Networks (AHSNs), and West Hampshire CCG, funded by Health Education England, have collaborated to produce a series of free videos and e-learning materials to support staff working in care homes to care for residents who are at risk of deterioration.
As recognised in a recent paper supported by North East and North Cumbria AHSN, identifying acute illness, including sepsis, amongst older adults in care homes can be difficult, and opportunities to initiate appropriate care may be missed, if illness is not recognised promptly.
The short videos describe how to take measurements from residents correctly (such as blood pressure and oxygen saturation), spots the signs of deterioration, and prevent the spread of infection.
You can access them via Health Education England’s e-Learning for Healthcare (e-LfH) Hub, an educational web-based platform that provides quality assured online training content for the UK’s health and care workforce here.
Natasha Swinscoe, national lead for patient safety for the AHSN Network says:
“Patient safety is a guiding principle for all AHSNs. Our care homes report highlighted numerous successes that AHSNs have had working with care homes across the country. Collectively, these have the potential to save many lives and tens of millions of pounds. I am excited to see the launch of these videos, which will support care home staff to be trained in a consistent way to recognise and respond to the soft signs of deterioration”.
This is one of a range of tools which AHSNs are supporting to provide training materials to up skill people who work in care homes, which will be published on our website over the coming weeks. This follows the AHSN network report, which highlighted over 30 examples of projects delivered by England’s 15 Patient Safety Collaboratives (PSCs) and the AHSNs which host them, published in September 2019.
Guidance for care home staff to register for an account
Select the ‘Register’ button. Select the option ‘I am a care home or hospice worker’ then enter your care home / hospice name or postcode and select it from the options available in the drop-down list. Finally enter your care home / hospice registration code and select ‘Register’. You may need to see your employer to get this code.
If your employer does not have a code, then they need to contact the e-LfH Support Team. The Support Team can either give the employer the registration code or arrange a bulk upload of all staff.
An online citizen innovation platform has been launched to bring together members of the public living with different health conditions to share ideas and help develop the next generation of healthcare products.
Design Together, Live Better connects citizens (patients, carers, family members, friends or anyone interested in health) with companies and entrepreneurs to co-create new healthcare solutions based on real needs.
“We need to make better use of people’s insights into their own conditions and lives; they are the experts in what would make life easier and, more specifically, what’s missing and what could be created to help.” Lars Sundstrom, Enterprise Director
Two healthcare projects are already live on the platform and seeking citizen input: a speech therapy app called ‘Intelligent Sounds’, which could be used by people who have suffered strokes or head injuries or have Parkinson’s disease, cerebral palsy or multiple sclerosis; and the ‘Music Memory Box’ which helps people with dementia to recall memories.
The Design Together, Live Better platform has been developed by the West of England AHSN and was launched at the ‘Wisdom of the Crowd’ event in Swindon in April.
The event explored and celebrated the increasing role members of the public play in the co-design and co-production of new products, as it is being recognised that people living with challenging health conditions are best placed to see what features are needed in new products and technologies.
Hilary Newiss, chair of the health and social care charity coalition National Voices, was the event’s key note speaker. Hilary has been central to developing recommendations as part of the NHS Accelerated Access Review on putting patients at the centre of health care.
Three patients-turned-innovators also shared their inspiring stories of designing new products in response to their own health conditions.
Michael Seres invented the Ostom-iAlert after receiving a bowel transplant and discovered a need to improve how he monitored and shared data on his condition with health professionals.
Kevin Mashford was born with congenital heart disease and has spent all his life in and out of hospital. Kevin developed Mi Heart, both a patient app and clinician platform enabling the efficient communication of symptoms, appointments, vital statistics and medication.
Iain Stevenson has type 2 diabetes and has used his IT background both to manage his condition and develop his technology, Soupdragon, the Trustwall API which enables individuals to securely manage their digital identity and personal data, and choose how to share this with health professionals.
However not everyone living with a health condition is in a position to develop their own solution, which is why the West of England Academic Health Science Network has developed the Design Together, Live Better platform to facilitate meaningful dialogue between patients and companies and gather user input.
Delegates at the event were given the opportunity to help share their ideas to shape and develop this new platform, which is currently at beta-testing stage.
Lars Sundstrom, Enterprise Director at the West of England AHSN, says: “We need to make better use of people’s insights into their own conditions and lives; they are the experts in what would make life easier and, more specifically, what’s missing and what could be created to help.
“Our new innovation platform will do exactly that by putting people in touch with each other, to co-design and co-create the next generation of innovative healthcare products so that they precisely match currently unmet needs. I am really excited about this – it could be a real game changer!”
We are keen to work with innovators looking to co-design and test their innovators with users. If you are an innovator with a new concept or product being developed, find out more about connecting with the Design Together, Live Better community at designtogetherlivebetter.org/innovators.
In partnership with Sirona Care & Health and North Bristol NHS Trust, our Human Factors programme offers tailored training to support staff working in community health settings. A toolkit has been developed, supported by face-to-face train-the-trainer sessions and collaborative events for shared learning and problem solving.
Stephen Early is a service user and volunteer with Sirona who has been actively involved in the development of this training programme, from designing scenarios to reflect realistic situations that staff might encounter to giving talks at staff inductions.
This is Stephen’s story, introduced by Karen Gleave, Project Lead for Sirona Care & Health.
Stephen is a service user living in one of our Extra Care Services, and currently is a volunteer with Sirona Care & Health and sits on the service user panel/forum.
I met Stephen just over a year ago when I approached members of the panel about working with me to provide a service user’s perspective for the Sirona support worker induction on what it is like to receive a service.
Once Stephen started it became quickly apparent that he was a “natural” talking with people and able to get his message across about how important communication and human factors are when supporting people. Stephen is able to bring the scenarios alive for the audience, has made people laugh and at times brought people to tears.
Stephen is a very inspirational person and has touched the lives of many. The feedback we receive after each induction is really very positive…
It really shows the great value that service users can make to organisations and how they can help to shape future services.
Unfortunately I’ve caught pneumonia about six or seven times, and on about four or five occasions I’ve been took into hospital…
… because I was living by myself I’ve had problems with eating for about six years.
… one of the things they do here is try and make me eat and drink so they make me a sandwich now and then, or every time they come in, no matter what they’re going to do they always make me a cup of tea and put it in front of me, and I feel if they’ve made me a cup of tea, then I should drink it, even thought I don’t feel thirsty if that makes sense, and when I go up to Karen’s they the same, everyone does the same. “Tea Steve!” and it’s great.
So one day the doorbell went and the lady came in and she was a support worker. I think she was, I’m not sure now. She came in and said [grunting] “Alright.”
Well, straight away you know that you were not going to have a conversation with this lady about anything and the worst thing is that these sort of five, ten minutes ones which you might get spread out between the day, maybe three times, maybe four, not sure, all depends on what your needs are, are very important to everyone because it’s communication. It’s talking to someone.
And loneliness in these sort of places is quite bad actually because you know it has an effect on them and on their health as well. Because if you’re feeling down, you’re more likely I feel to get things wrong with you and depressed and things like that, so it’s quite important when people come in that they’re a bit… and say things. So when she came in I knew straight away I wasn’t going to have a conversation with her.
Now if I was feeling a bit unwell or anything like that, or had troubles or things, I wouldn’t have talked to her about it because I knew she wasn’t in the right mood to receive any sort of information. And then she came and said, “Got to make you a drink.” Now “got to”, so that hit me home that “got to” is not “Oh, I’m going to make you a…”, “Got to make you a drink. Can’t understand why you can’t do it yourself.” That was a little whisper underneath the voice.
And then the sandwiches… “What do you want in your sandwiches?” I said, “Well anything please” and then again I heard her say, “Can’t understand why you can’t do it yourself” and then she left. And as soon as she left I got up and I chucked the tea down the sink, and I put her sandwiches in the bin because I wasn’t going to eat or drink anything from someone who didn’t’ want to do anything for me and it made me feel really bad.
So that went on for about six or seven weeks. I stopped taking food, and when they did make me food I just tipped in the bin, and the drinks, because I felt like no one wanted to do it and they didn’t understand me. They didn’t’ understand my problems. They just thought I was lazy. So it didn’t matter if they came in happy or joyful, I would still do it. That was quite a bad experience.
And then a good experience was one lady come to see me, well lots of them. And they come in and ring the bell [brightly] “Hi Steve!” Straight away you know you’re going to have a positive talk to that person and positive reaction. And you’re going to say to that person if there is something troubling you, you’re going to mention it to them, you know, “Oh I don’t feel too good today… Oh I’ve got this problem” or whatever.
And the other thing is they come in and say, “What have you been up to today? What’s been going on? What are you going to do this afternoon?” All them little things, you know, it helps the conversation to go through and it is brilliant. “Oh,” she said, “Is it two sugars, Steve, innit? It’s two innit?” Them little things, it’s not like “Oh, I gotta make you a cup of tea” or anything like that. It’s “I’m going to put in two sugars.” Some don’t even talk about it they just do it and bring it out and put on the table which is brilliant so it’s them sort of things…
…unfortunately the people, some of the residents we have here, I call them my family because they are they’re all my family, and I tell them that. Anyway, they’ve got problems some of them and some of them suffer with memory loss, Alzheimer’s, so they’re not able and some of them can’t speak properly and they cannot relay to the support workers what it means, what they mean to us and they mean everything.
I call all of my support workers “my ladies” because that’s what they are. They’re my ladies. And they’re here… if it wasn’t for them I wouldn’t be here, they mean so much. Doesn’t matter if they come in and make me a cup of tea or just the simplest of things like help me taking off my shoes. My legs swell up around about half past two in the afternoon. They come in and take my shoes off and they always make me a cup of tea when they do it, and they have a little chat whilst they do it, and it means so much.
And I’m able when I go on my induction days to translate to them what they actually mean to people like me and the rest of the residents what they’re doing. Their job’s just as much important as a doctor or anyone like that because they’re doing something to help and they’re not only helping in the sense of doing something like giving someone tablets at the right time or doing some domestic or whatever or making sure someone eats. They’re actually talking to that person, which is fantastic, which makes them feel good.
… if I can hit that one person at induction day and she stays doing caring for maybe ten years? So she might see thousands and thousands of people on her journey through her career. If she carries that through, with all of them, what a magnificent difference that’s going to make! So that’s how I think of it.
Stephen was the winner of Sirona Volunteer of the Year 2015 for his work on the project:
The West of England AHSN is awarding £65,000 in funding to four community organisations to support the roll-out of Human Factors training for support staff.
Communication and team working are recognised to have significant impact on the quality of safe services for patients. Following the Cavendish Review, the Care Certificate specified standards for support workers (Bands 1 – 4) working in all NHS and social care settings.
Although an appreciation of the principles of Human Factors has been implemented in acute care services in recent years, it has been found that training packages and resources are less applicable to the community health and social care context.
Health Education South West has therefore funded the West of England AHSN to develop an intervention using the SBAR tool (situation, background, assessment, recommendation) to support Human Factors training in patient safety focussing on support works in community settings.
The curriculum for this training was developed by Sirona Care & Health and North Bristol NHS Trust. It is based on how teams communicate and uses communication tools such as SBAR to develop a baseline awareness, which is built upon and embedded during the training using different scenarios. These scenarios were co-designed by the programme lead and service user representative to reflect realistic scenarios that staff might encounter.
To date, 435 staff from community organisations have already received Human Factors training. The West of England AHSN is now providing £65,000 funding to Bath & North East Somerset CCG, Bristol Community Health, Gloucestershire Care Services and North Somerset Community Partnership, which will enable a further 2,500 staff in community settings to receive training.
Train the Trainer
In conjunction with North Bristol NHS Trust and Sirona Care & Health, we are also training up to 45 facilitators across the region in order to create a faculty with specialist knowledge and experience in Human Factors training for community services.
Organisations that have been successful in their bid for West of England AHSN support are invited to book training dates for facilitators to build the faculty in their organisation skilled in delivering Human Factors training. In order to book you will need a code for access. If you have not received your code, please email email@example.com.
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