The impact phase in the innovation journey happens when we start changing systems and helping innovations take root, such as through the Innovation Technology Payment programme.
As innovations are adopted as part of wider health and care services, they develop and change the system around them. This can be seen in the work of our Patient Safety Collaborative, particularly through our support for safer care of deteriorating patients and national use of NEWS (the National Early Warning Score), which we championed in the West of England.
The effectiveness of implementation, combined with the ongoing building of an evidence base, contribute to the wider spread and sustained use of the innovation, as our PReCePT programme has demonstrated through its nationwide roll-out, helping it to become ‘business as normal’.
Through PReCePT we are working with maternity hospitals to increase use of magnesium sulphate to prevent cerebral palsy in very premature babies – born before 30 weeks. It is the first ever perinatal quality improvement programme delivered at scale in England, bringing together midwives, obstetricians and neonatologists across the country.
Every year around 4,000 women in the UK give birth very early because of complications with their pregnancy. While the survival of babies born preterm has improved, there has been an increase in the number of preterm babies developing cerebral palsy.
Use of magnesium sulphate in preterm labour reduces the risk of cerebral palsy by 30% and costs from just £1 a dose.
PReCePT was originally developed by the West of England AHSN in collaboration with University Hospitals Bristol and Weston NHS Foundation Trust, involving both patients and staff. The intervention was adopted by all five maternity units in the West, using a quality improvement approach to support uptake.
As a result of our work in the region, NHS England selected PReCePT as one of seven programmes to be spread across the country by the AHSN Network during 2018-2020, led by our AHSN.
Neonatologist Dr Karen Luyt has been the national clinical lead for PReCePT and we also recruited a clinical lead for each AHSN region, as well as midwife champions in all 156 maternity trusts.
At the end of the two-year programme, we are celebrating some brilliant achievements by teams across England, with an additional 1,106 mothers receiving magnesium sulphate and an estimated 30 cases of cerebral palsy avoided through PReCePT. This represents a potential lifetime health and social care savings in the region of £23.9 million. Variation in uptake of magnesium sulphate has also been positively impacted – all maternity units across the England now ensure mothers in preterm labour are offered the treatment where it is clinically possible to administer it.
Elly Salisbury received magnesium sulphate when she went into labour in her 27th week of pregnancy and has been involved as a patient representative in PReCePT. She commented:
“I think it’s incredible that across the country all mothers in my situation will be offered magnesium sulphate. It will make such a difference to thousands of babies, and that in itself is just so completely worth it.”
Safer care of the deteriorating patient
Recognising when a person’s health is deteriorating and taking the right action is critical. To support healthcare systems and improve patient safety, we encourage the use of the National Early Warning Score (NEWS2) at each interface of care across the healthcare system.
Following the successful implementation and use of NEWS2 in all of the acute trusts in the West of England region, our Patient Safety Collaborative is supporting the adoption and spread of this tool into wider community settings.
This includes a focus on care homes with training being delivered using the RESTORE2 and RESTORE2 mini tool, which includes NEWS2, co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative.
In the autumn of 2019 we developed free training videos, based on the RESTORE2 tool, in collaboration with Wessex AHSN. These are hosted by Health Education England and are available on YouTube. Within a month of launching them, each of the 14 videos had been seen on average 808 times per day.
We have also developed and delivered face-to-face training for care home staff to use RESTORE2 to recognise the physical deterioration of residents and how to best escalate this information. Ten care homes were trained to use RESTORE2 last year, and during the COVID-19 response this training has been adapted to be delivered entirely virtually.
“Since my team completed the RESTORE2 training they have gained confidence to recognise and report soft signs of deterioration in the people we support. The training was informative and interactive, allowing my team the opportunity to really understand and put it into practice. Since completing the training my team have used what they have learnt to put across the information in order for a prompt, efficient response.”
Local care home manager
Innovation and Technology Payment
The AHSN Network is a member of the Accelerated Access Collaborative (AAC), bringing together decision-makers from across the health service together with innovators from industry to accelerate uptake of impactful and cost-effective products.
As part of our support, AHSNs are delivering the Innovation and Technology Payment (ITP) programme in partnership with NHS England. The ITP aims to remove financial and procurement barriers to support the NHS to adopt innovative medical devices, diagnostics, and digital products.
Our team has been working with NHS trusts and commissioners in the West of England to support the uptake of a wide range of products offered through the ITP programme. These include SecurAcath, a device to secure catheters and reduce risk of infection; Placental Growth Factor (PlGF) based testing to help diagnose suspected pre-eclampsia in pregnant women; and HeartFlow, which helps detect coronary artery disease.
Five hospital trusts in the West are now using HeartFlow, including Royal United Hospitals Bath NHS Foundation Trust (RUH). NICE has published shared learning on the adoption of HeartFlow at the RUH.
Consultant Radiologist, Dr Ben Hudson at the RUH, said:
“We’ve had over 500 patients use the new technology. It means that we are able to diagnose potential obstructive coronary disease earlier, and those patients that do not have a narrowing of their arteries no longer have to go through any unnecessary and invasive tests.
“The HeartFlow analysis also helps us to determine whether or not the insertion of stents or surgical bypass is likely to relieve symptoms and improve a patient’s longer-term outcomes.”
Consultant Radiologist, Dr Jonathan Rodrigues, added:
“Heart disease remains the biggest killer in the UK. This new technology helps us work closely with our cardiology and cardiac surgical colleagues to identify upfront the best treatment for each individual patient.”