Celebrating SHarED: a positive impact on patients and ED staff

As the Supporting High impAct useRs in Emergency Departments (SHarED) project comes to a close the collaborative are celebrating the interim results for patients and staff. The project aimed to pilot a High Impact User (HIU) service in each Emergency Department (ED) in the West of England in order to better manage and support a cohort of patients that frequently attend EDs. Before being chosen for regional adoption and spread as one of two successful 2019 Evidence in to Practice applications, a HIU model was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years.

Why is supporting HIUs so important?

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.

The impact on patients

Whilst working on a new project during the COVID-19 pandemic offered a series of challenges, collectively the five ED teams across the West of England have supported over 140 patients.

Interim data demonstrates:

  • a 44% reduction in the number of 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 a number of trusts demonstrates that where attendance had increased, the impact and cost of each attendance had reduced.

Dr Rebecca Thorpe, the Clinical Lead for SHarED said:

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 Emergency Departments 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.

Clare Evans, the Programme Manager for SHarED said:

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.

The impact on ED staff

Throughout the funded period of the project, the ED teams have delivered training to over 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 department.

Feedback from a recent staff experience survey included:

  • “Dedicated HIU teams are making a real difference to the appropriate management of these patients.”
  • “Great to have agreed (HIU) plans that are regularly reviewed with opportunity for patient input.”
  • “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”
  • “The (HIU) support plans in place currently are really helpful. Keep it up!”

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

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.

What’s next?

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

We are now 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.

Read more about the SHarED project. Our free resources include an implementation guide to support trusts and systems outside the West of England to review, adopt and spread the model.

Marking World Mental Health Day – reflecting on our mental health training for care home managers

In this new blog to mark World Mental Health Day, our Programme Assistant, Millie O’Keeffe talks through the journey she and Bristol Mind took as they worked together to build a free mental health focused training package for care home managers across the West of England. Millie picks out some of the feedback the training (which ran in cohorts from January to June 2021) received and why working on this project was so important to her, our care homes programme and the care home managers who attended.

From a seed

The journey started when some of our key stakeholders in local systems told us about the significant challenges staff in care homes were facing around high COVID rates, deaths of residents, PPE and staff shortages, and isolation – we’d heard about these challenges in the news too – and the effect this was having on care staffs’ wellbeing and mental health. We knew our colleagues in social care were struggling and so wanted to support them somehow. Line managers at the West of England AHSN had recently been trained by Bristol Mind in mental health awareness, and we had heard good feedback from those sessions, so we reached out to Bristol Mind who were happy to work with us to tailor the line manager session for a care home manager audience.

Pulling the jigsaw together

The content of the free training focused on supporting the wellbeing of managers so they were able to better support their staff. There was a lot of ground we could have covered but the fantastic team at Bristol Mind focused on the stress curve, tools like STOPP, how to have a sensitive conversation, and advice on supporting staff who are grieving or anxious about COVID. We also shared lots of resources, including a workbook, and signposted to local support organisations after the training.

Suzanne Pearson, a mental health trainer and consultant and BABCP Accredited Cognitive Behavioural Therapist, worked with us to adapt the content and deliver the training.

How did it go?

I am really proud to say we received incredibly positive feedback from the managers about Suzanne and 97% of attendees said they would recommend the training to a colleague.

“I found it calming, almost therapeutic, I know that may sound odd but just listening to others’ experiences made me feel connected.”

Thanks to the efforts of our contacts in regional systems, provider organisations, primary care, councils (and more) in promoting the training to their local care homes, over two busy cohorts we trained 159 care home managers from across the West of England region.

What did the data look like – how did the training make a difference?

I’m always keen to dig into the data and understand what changed because of the training we provided. Prior to the training, managers cited they were most concerned about their staff’s own mental health and wellbeing, with fear of spreading COVID to residents coming in second. When asked how concerned they were about their staff’s wellbeing, zero responders chose ‘I am not concerned at all’ – that showed me just how much stress each and every care home was dealing with. However, most (59%) managers believed themselves to be fairly confident in supporting their staff, and following the training, their confidence improved even further. A follow up survey showed a third of responders use the tools and tips from the training regularly (a few times a week), and that the training has changed how they support their own (76%) and their staff’s (94%) wellbeing for the better.

It was great to see such positive data from the surveys, but what really hit home to me and the rest of the care homes team were the comments from managers:

“I was really interested in the approach of asking the care home managers how they were feeling and giving them a voice. This was a powerful and quite shocking start. The look on 25 participants faces at the thought of focusing on themselves instead of on their staff. The shock came from the understanding that with COVID we have all just kept going and going, the instruction ‘right, now stop, what about you’ was bizarre.”

Making connections

A positive by-product of the training was that a large number of attendees mentioned they felt the session provided valuable time and space to connect with other managers who have experienced similar pressures over the past year, especially managers from different organisations, and specifically managers in social care.

Suzanne also offered some valuable insight from discussions in the sessions, including a fear that the sector could not influence decision makers and was at risk of being forgotten about. Many managers described burn out, exhaustion, and weariness, and shared concerns around staff recruitment.

These key messages and the evaluations have been shared with our regional stakeholders and internally with colleagues across the Care Homes Programme, so we hope that the training has not only supported managers and staff in care homes but will also go towards illuminating the wellbeing needs of the sector going forwards.

Talk ‘ain’t’ cheap

As I reflected on the training programme and World Mental Health Day, I considered that making time and listening and learning from all our colleagues across the whole health and social care spiderweb is vital – talking is so important and sometimes we forgot to do it.  Mental health has always been something I’ve felt should be spoken about more honestly and openly, so as I bid farewell to the AHSN in the weeks to come I remain proud to have coordinated this positive training programme.

Read more about the free resources, support and training available to social care staff across the West of England here.

Free care homes manager mental health awareness training continues

During January and February 2021, we trained 48 care home managers in mental health awareness. The free training was delivered virtually by Bristol Mind with 94% of care homes managers who completed our post-training survey telling us it was helpful in supporting them to address their biggest concern around their staff’s wellbeing.

We have reflected on the positive feedback from cohort one and are now launching cohort two with six sessions available between 28 April and 28 June.

Find out more and book your space on our upcoming free mental health awareness training for care homes managers.

“This was a breath of fresh air, people wanting to engage, and talk about common situations, and positive ways to reduce risk and stress in the future. I have not really been asked how I was coping thorough this pandemic, so was initially difficult to answer.”

Clare Evans, Deputy Director of Service and System Transformation said:

“We know that the COVID-19 pandemic has put extraordinary pressure on care staff and that many are struggling with the effects of the ongoing response. We know that care home managers and deputy managers care about their staff and may have already developed some initiatives to support their wellbeing. Our free training from Bristol Mind can expand and build up those initiatives and support managers and their teams.”

The online workshop will cover the following topics:

  • Looking after ourselves as managers and how we encourage others to do the same in the workplace
  • Starting a sensitive conversation about mental health and well-being
  • Recognising when self or employee getting overly stressed, anxious or low in mood
  • Coping with loss
  • Wellness action plans
  • Signposting to community based services for staff and the wider community

“Great to speak to other people going through the same situation, and who understand the reality of the situations faced on a daily basis”

This training is for managers and deputy managers. Please ensure only one booking per care home, thank you. If you are a manager in supported living or domiciliary care, please contact ps@weahsn.net to discuss booking.

If you have any queries, or are experiencing any barriers that may prevent you from signing up, please do contact us at weahsn.transformation@nhs.net and we will try to help.

We are running a free programme of initiatives to support care homes in Bath, North East and North Somerset, Swindon, Wiltshire, Bristol, South Gloucestershire and Gloucestershire. We are also offering free training on recognising deterioration in care settings through tools like RESTORE2 – find out more and book here.

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.

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.

Working together to improve babies’ lives

This week (6-10 June 2016) is the UK’s inaugural Infant Mental Health awareness week: #IMHAW16.

Did you know that babies’ brains develop rapidly after they are born? In the first critical 1,001 days of life, the environment and the caring relationships surrounding the baby help to build the brain, by creating new neural pathways.

A baby forms approximately 700 new neural connections per second in the first years of life. If these connections are used repeatedly they become strong ‘traits’, whereas the ones that are rarely used fade away.

Parents and carers can help to positively support their baby’s mental health by connecting with them and mirroring social and emotional behaviours. A positive mental health infancy has been shown to have a long term positive impact   on a person’s health, wealth, educational attainment and relationships.

There is a growing body of science that supports the power of positively connecting with babies. If you want to know more about how brains are built then check out the NSPCC video Brain Builders or watch this video from Zero to Three.

Ann Remmers (Patient Safety Programme Director) and Anna Burhouse (Director of Quality) both work at the West of England Academic Health Science Network (AHSN) but also have careers working with infants and their parent/carers.

Ann is a midwife and leads the South West Maternity and Children’s Strategic Clinical Network. Anna is a Consultant Child and Adolescent Psychotherapist and supervises the Infant Mental Health Service in Gloucestershire. Ann and Anna are both passionate about improving perinatal and infant mental health.

Happily their clinical knowledge about infants is also be used to good effect when running patient safety and quality improvement programmes in the AHSN.

So far the West of England AHSN has helped to:

  • Run quality improvement masterclasses on perinatal and infant mental health (see our latest annual report).
  • Coordinate a quality improvement programme across five NHS Trusts to help prevent Cerebral Palsy in preterm labour.
  • Co-create a mental health quality improvement toolkit called MINDSet with a section devoted to how to improve perinatal mental health care.
  • Develop an innovative citizen led design process which has led to a prototype baby seat that can be fastened with one hand, making it easier for parents with disabilities or those with more than one child.

National Positive Practice in Mental Health Awards 2016

The West of England AHSN is pleased to be supporting the MINDset Quality Improvement Award as part of the National Positive Practice in Mental Health Awards 2016.

Celebrating teams, individuals and services in 15 different categories, you have until Sunday 22 May to submit your nominations.

The MINDset Quality Improvement Award is for individuals, teams, organisations or health or social care systems that have used a robust quality improvement methodology to make a sustainable difference to mental health outcomes.

Find out more and submit your nominations at positivepracticemh.com/positive-practice-awards-2016

AHSN collaborations around mental health and dementia

In March 2016, the AHSN Network ran its first intra AHSN learning event focussing on Mental Health.

The need for collaboration and knowledge mobilisation was identified by the AHSN Network’s Managing Directors group to:

  • celebrate the breadth of work being undertaken across the country
  • share best practice
  • collaborate with the relevant National Clinical Directors
  • support the adoption of innovations across AHSNs by raising awareness and sharing resources.

This first event on Mental Health included a presentation from Dr Geraldine Strathdee, National Clinical Director for Mental Health, on the most important areas of need for innovation and improvement, as well as a call from patient representatives to celebrate positive practice.

The event also piloted a model consisting of 10 micro presentations from AHSNs combined with an open dialogue space to allow networking and knowledge mobilisation across the AHSN network. See the full  programme here.

Examples of AHSN work showcased

  • The use of checklists to improve the quality of physical health checks for people with serious and enduring mental illness (the Bradford toolkit: Yorkshire and Humber AHSN)
  • A comprehensive new approach to child and adolescent mental health services ( iTHRIVE: UCLP)
  • DeAR GP and House of Memories (two approaches to improve training, screening and empathy in dementia care HIN and North West Coast AHSNs)
  • A high fidelity approach to reduce variation in the treatments and outcomes for anxiety and depression (Oxford)
  • Work to improve outcomes for people diagnosed with psychosis as a young adult (Wessex and Imperial AHSN)
  • An effective whole system approach to prevention of mental health crisis (Raid: West Midlands AHSN)
  • A quality improvement toolkit for Mental Health (MINDSet: West of England AHSN)
  • A person centred and innovative approach to individual placement and support (East Midlands AHSN).

Key learning from the event

  • The many examples of best practice, already developed by AHSNs and their members, which are now ready to be adopted by other AHSNs
  • The plentiful opportunities to collaborate and align innovations, such as the DeAR GP (a tool to identify residents in care homes showing signs of dementia and referring them to a GP for diagnosis) with House of Memories (an app for people who suffer from dementia and their carers)
  • The importance of service push and citizen pull for products, pathways and new ways of working
  • The importance of economic evaluation to aid adoption and spread.

Key follow up actions for Mental Health / Dementia

  • 34 offers of intra AHSN collaboration
  • 27 offers of links to other ASHN projects
  • An offer to compile case studies for wider circulation
  • An offer to compile list of potential collaborations and links
  • Great Manchester volunteered to host a follow up event

Find out more about the various opportunities for collaborations here.

The event was deemed a success with all 15 AHSNs represented and it was agreed the approach would be used as a model for future learning events.

Next steps

  • All Improvement Directors to follow up progress on collaborations expressed at the March event with their own participants
  • ‘Offering’ AHSNs to contact ‘interested’ AHSNs and share details of their innovation and arrange a webex to discuss adoption
  • Schedule a follow-up event (hosted by Greater Manchester AHSN) to include a review of the progress of adoption
  • Agree focus of next learning event and members of the planning group.

The image above is a still taken from a short film about the ‘My House of Memories’ app, designed by and for people living with dementia. Find out more here.

Mental Health Quality and Patient Safety Improvement Collaborative

The ninth learning session for the South of England Mental Health Quality and Patient Safety Improvement Collaborative took place in March in Bristol. The event saw 73 delegates from across the member organisations come together.

The two day learning session was a mixture of plenary presentations, world cafes, and active participation sessions on the implementation of quality improvement methodology and quality improvement workshops. Participants had the chance to network, share and explore in more detail any subjects that had been raised over the two days.

The session resulted in a total of 143 innovations and the aim is now for delegates to take these innovations back to their provider organisations to test, adapt or abandon.

The learning session focused on:

  • Building capability in quality improvement using the 3Ls framework (learning, living, leading)
  • Coaching improvements in workstream specific subjects
  • Sharing innovations and difficulties amongst peers
  • Setting up co-production workshops
  • Learning about a ‘continuous learning system’
  • Networking
  • Commencing the region-wide approach to reduction of violence and aggression.

The plan for the Collaborative’s year ahead was shared with the members, and additional support was agreed, consisting of:

  • Development sessions for programme managers
  • Quality improvement webinars
  • Workstream specific coaching clinics
  • Site visits from faculty members for in-action coaching
  • Life system migration support
  • Co-production coaching.

The next learning session is planned for 5 and 6 July 2016 in Reading. One of the main areas of focus for this next event will be the use of measurement in quality improvement work.

For more information, contact Heather Pritchard, Programme Lead for the South of England Mental Health Quality and Patient Safety Improvement Collaborative at heather.pritchard1@nhs.net.

Intra-AHSN learning event on mental health

The improvement directors from the 15 AHSNs across England are looking forward to hosting the first intra-AHSN learning event on Mental Health in London on Wednesday 2 March.

This will be a unique opportunity to hear about the innovative work that AHSNs are supporting in the field of mental health.

The day will allow AHSNs to showcase their work, share best practice and learning points, form natural collaborations and have time to discuss key national next steps with Dr Geraldine Strathdee NHS England’s National Clinical Director for Mental Health and patient representatives from Positive Practice in Mental Health.

Anna Burhouse, Director of Quality for the West of England AHSN, worked with the northwest Coast and West Midland AHSNs to design the format of the event.

The West of England AHSN will be presenting their work on a new national quality improvement toolkit for mental health, which celebrates best practice, mobilises knowledge and shares tools and resources for change. This work is a collaboration with many mental health trusts, NHS England, Monitor, ImROC and NHS Confederation. It will be launched in the spring and fellow AHSNs will have sneak preview of it at the March learning event.

Anna said: “As a passionate mental health clinician I believe we have to innovate and improve mental healthcare to make it more person-centred and increasingly focused on how to support important life outcomes for people, as well as the reduction of their symptoms.

“We need new ways of designing and delivering systems that are preventative, effective and recovery orientated. Increasingly, we need to ensure the expertise of people with lived experience of mental illness comes together with academics, health and social care professionals and business to generate fresh ideas and thinking.

“Choosing mental health to be the subject of the first intra-AHSN learning event demonstrates the AHSN’s commitment to this process and their positive role as catalysts for change.”

To see more of the quality improvement work Anna helps to support as a mental health clinician alongside her role as Director of Quality for the West of England AHSN, watch the Health Foundation’s Power of People film, The Recovery College.