Improving patient outcomes: non-invasive ventilation

In this blog, project Clinical Lead and Respiratory Consultant at the Royal United Hospital Bath, Dr Rebecca Mason, looks forward to the launch of a new West of England collaborative to reduce mortality following non-invasive ventilation (NIV). A design and launch event is being held on 9 December. Here Rebecca explains more…

Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in type 2 (hypercapnic) respiratory failure.  In 2000 a research study showed that effective NIV use reduced mortality in type 2 respiratory failure from 20 to 10% but by 2013 the British Thoracic Society (BTS) NIV audit had recorded that mortality rates had risen to 34% and change was needed.

These results prompted a 2017 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and ultimately the report entitled ‘Inspiring change’. This report focussed on patient selection and the standard of NIV care delivered in hospital trusts across the country and the results made for stark reading. In 2019, a BTS audit on adult NIV care reported the inpatient mortality rate was now 26%. This was an improvement on previous audits however mortality rates remained higher than in other countries.

The ‘Inspiring change’ report galvanized a group of South West Respiratory doctors, nurses and physiotherapists with a special interest in NIV to join together in October 2018 to establish a Quality Improvement (QI) network with the aim to drive change within their own trusts and across the region. Although enthusiastic and full of ideas, without the structure and support of a full QI team, and then with the arrival of the Covid pandemic, the group’s work halted.

However, I am extremely excited that with the fabulous support, structure and guidance of the West of England AHSN, and the enthusiasm of many NIV physicians, nurses, physiotherapists and AHPs across the South West, we have been able to reinvigorate this project.

This new pan-regional QI project will seek to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials.

I am really looking forward to working alongside my respiratory colleagues across the region and with the expert support of the AHSN to deliver this important and exciting QI project.  With the hosting of our design and launch event on 9 December we’ll be stepping up activity, and as a first step gathering baseline data and agreeing our implementation plan.

Flu resources launched: People with a learning disability are at greater risk of developing serious illness

The national flu campaign to encourage uptake of the free flu vaccination, particularly amongst at risk groups, has launched.

Individuals with a learning disability are identified as an ‘at risk’ group and are therefore entitled to a free flu vaccine. As are their carers, whether that is a family member or paid support staff who care for the individual day-to-day.

As such, the West of England AHSN and our Learning Disabilities Collaborative will be continuing to share advice and raise awareness of the importance of individuals with a learning disability, their families and carers, getting the flu vaccination throughout winter.

On behalf of the NHS, Misfits Theatre Company have created a great video which tackles the misinformation surrounding the flu vaccination head on and urges people with learning disabilities and their carers (family member or support worker) to not delay in getting their free flu vaccine.

You can watch the video here.

People who have a learning disability can be more susceptible to the effects of flu and are therefore at increased risk of developing complications such as bronchitis or pneumonia. As the NHS emerges from the covid pandemic, anyone with a learning disability is encouraged to get their free vaccination and annual health check to help stay well this winter.

Carers of anyone with a learning disability are also entitled to the free vaccination. All carers (family member or support worker) are urged to ensure they are registered at their local GP practice as a carer of someone with a learning disability. Individuals should also be on their GP Learning Disability Register to access the very best care.

Now is the time that GP practices and community pharmacies are carrying out vaccinations for those at risk. The vaccine offers the best level of protection from the flu virus, and it’s important to have the vaccine every year, especially as the flu virus strain changes every year. Anyone who is defined as being in an ‘at risk’ group should contact their surgery and arrange an appointment to have the vaccine.

Having the vaccine sooner provides the individual with protection over a longer period of time; it also helps reduce the chances of spreading the virus to family and friends.

Watch this NHS England and Improvement video where Camilla, who has a learning disability, talks about getting her flu jab. 

Hannah Little, our Patient Safety Improvement Lead and Senior Project Manager said:

“Flu is a very unpleasant illness. The symptoms can be miserable for many of us, but it can lead to more serious complications for those who fall within certain clinical ‘at risk’ groups. Some people with a learning disability can be more susceptible to flu and can go on to develop more serious complications like pneumonia. Respiratory conditions remain the most significant causes of premature mortality for people with a learning disability where deaths have been reviewed as part of the LeDeR programme.

I’d urge people to make sure they have the vaccination as soon as possible. They should also ask to have their Annual Health Check, which our Learning Disabilities Collaborative discussed at our September 2020 webinar. Carers of anyone with a learning disability should also get the free vaccine from their GP surgery or community pharmacy, the sooner the better to get the best possible protection.”


The full pack of winter flu resources for people with learning disabilities and their carers (which includes high resolution resources for social media, communications toolkit and grab pack for professionals) is available on the NHS England and Improvement website.

The flu vaccine is also free for patients in the following at risk groups:
• Those aged 65 years or over (including those becoming age 65 years by 31 March 2021)
• Those aged from 6 months to less than 65 years of age with a serious medical condition such as:
• Chronic (long term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis.
• Chronic heart disease – (such as heart failure).
• Chronic kidney disease (at stages three, four or five).
• Chronic liver disease.
• Chronic neurological disease such as Parkinson’s disease or motor neurone disease
• Diabetes
• Splenic dysfunction
• Reduced immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)
• Morbidly obese (defined as BMI of 40 and above)
• All pregnant women (including those women who become pregnant during the flu season)
• All children aged 2 and 3 years

• All children in school years R through to year 5
• People living in long-stay residential care homes, or other long-stay care facilities where rapid spread is likely to follow the introduction of infection and cause high morbidity and mortality.
• People who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill
• Consideration should also be given to the vaccination of household contacts of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable

Building strong foundations to support the most vulnerable in society

The West of England AHSN held a meeting recently, marking the first steps towards building a valuable partnership with the regional voluntary and community sectors.

The aim was to build relationships with organisations that could help us effectively engage with the most vulnerable groups in society, those who are isolated, housebound, the frail and elderly. Organisations that attended were Age UK, LinkAge, the Red Cross and West of England Care and Repair.

Two of our workstreams found the meeting particularly useful in terms of informing and supporting future areas of work.

Our Enterprise team is keen to make sure they are reaching people who might want to get involved in the next phase of our Design Together, Live Better project. This is providing the opportunity for people living with long-term health conditions, carers, family, friends and anyone else interested in healthcare, to suggest or give feedback on product ideas that might improve quality of life and independence. Last year, the first phase of the project developed three product prototypes, based on the experiences of people that attended a series of workshops and crowd-sourcing activities across the region. This next phase is looking to widen and increase our reach, and so voluntary and community organisations, through their membership and users, are extremely well placed to help us do that.

For some time, our Patient Safety Collaborative has been aware that its focus has been on acute care. With an increasing emphasis on healthcare in the community, it is important for us to influence those who have a role to play in safety in the home. Organisations like the Red Cross and Care & Repair often go into people’s homes and provide support to vulnerable people who might be just under the radar of health professionals. The role of staff in these organisations could be vital in improving patient safety and preventing avoidable Emergency Department admissions.

By the end of the meeting, there was great excitement about the potential for working together. A start was been made at the recent ‘Wisdom of the Crowd’ event to launch phase two of Design Together, Live Better, attended by several voluntary and community sector organisations. The Patient Safety team is also planning to offer SBAR (Situation, Background, Assessment, Recommendation ) training to several of the organisations.

People in Health West of England goes from strength to strength

People in Health West of England (PHWE) was established to promote innovative and effective public involvement in health research and evidence-based service improvement, and works with four core partners: the West of England AHSN; Bristol Health Partners (BHP); the NIHR Clinical Research Network (CRN): West of England; and CLAHRC West.

Here are some highlights of its work over the last year.

PHWE continues to provide a shared resource for its partners and for the West of England generally. In the last year it launched its website, which aims to provide a central hub for accessing resources and information on training and events relating to public involvement. Their fortnightly Newsflash distribution is up by 59% from May 2015 and now reaches 585 subscribers, and advertised 68 involvement opportunities for people locally.

Over the past year PHWE held a range of workshops to raise awareness and skills in health research. Topics covered research question generation, using and understanding research evidence, and building research partnerships. Geared towards both healthcare professionals and the public, they were held in the four main population centres of Bath, Bristol, Gloucester and Swindon. To date their training programme has attracted 390 attendees coming from across the region.

The practicalities of working with members of the public in the spirit of co-production is one that has challenged all our partners and PHWE has benefited from having a specialised team to put in place the thought and mechanics needed to make this successful. One example of this way of working has been the consultation carried out with members of the public on BHP’s strategic aims. This involved staff and the two public contributors on the BHP Executive working together to run a workshop to listen to the views of a range of people attending.

PHWE offers support for co-production based on an approach that is proven to work. Over the past year they have developed a shared approach to the selection and management of public contributors, helping to co-produce the work in their partners’ organisations. Guidance for managing volunteer payments, codes of conduct and sample role descriptions are all freely available on their website.

PHWE now has a team of nine, located with their various partner organisations, as well as centrally in Whitefriars. This sharing of experience and expertise is already demonstrating the benefits of the initiative. For example, many of the Health Integration Teams (HITs) are at the early stages of involving public contributors in their work. They are able to build on the networks, experience and resources outlined above to put this in place without having to re-invent the wheel.

The training course ‘Building Research Partners’, which PHWE had already started to run, is also one of the CRN’s national objectives.

For the West of England AHSN, it was involvement by team members in their ‘Design Together, Live Better’ ideas generation workshops that led to the suggestion for a portable bidet for people with disabilities, which is now at design prototype stage.

PHWE is able to offer access to the views of children and young people though the BHP-funded Young People’s Facilitator. Because of the support of BHP, PHWE is able to continue to support the Young People’s Action Group that meets at the Bristol Children’s Hospital and was set up by the CRN.

PHWE recently held a review of current working and governance arrangements of partners. This confirmed the current approach to drawing up a shared work programme. Plans for next year include carrying out an evaluation of PHWE so that they can ascertain the sustainability of this model and its viability for replication elsewhere.

For more information, contact Hildegard Dumper, PHWE Manager: or visit