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Strong local connections bring national impact in patient safety

In 2013, Elly Salisbury went into labour with twins at just 27 weeks. It was a difficult and anxious time. As part of the care she received at St Michael’s Hospital in Bristol, Elly was offered magnesium sulphate, a drug known to reduce her babies’ chances of developing cerebral palsy by as much as 30 per cent.

Elly was one of the first people to benefit from a programme called PReCePT, a partnership between the West of England AHSN and University Hospitals Bristol, to make the drug more widely available.

Sadly her son Jay died a few days after birth; but Cormac has grown into a healthy and happy five-year-old. “Cormac is an amazing little boy, he has no signs of cerebral palsy at all,” Elly said, “I truly believe that the magnesium sulphate was part of that.”

Having started life in the West of England, PReCePT is now one of the seven programmes being adopted and spread by all 15 AHSNs, funded by NHS England. Meanwhile Elly has become a patient representative, sharing her story to encourage greater take-up.

“I think it’s incredible that across the country all mothers in my situation will be offered magnesium sulphate,” she says. “It will make such a difference to thousands of babies, and that in itself is just so completely worth it.”

Ellie Wetz manages PReCePT at the West of England AHSN. She’s passionate about achieving equitable access to the treatment. “When we started PReCePT, it was a simple quality improvement project to try and increase the number of eligible mothers being offered magnesium sulphate. Children aren’t actually tested for cerebral palsy until after their second birthday, so it can take a while to see results.

“It’s now developed into a national improvement programme with standardised resources which each trust can tailor for their local circumstances. Where we’re seeing PReCePT being really successful is in bringing the whole perinatal community together – obstetricians, midwives and neonatologists – in giving the mother a drug for the benefit of their preterm baby.”

NEWS – the National Early Warning Score – provides a well-established tool to assess the risk of a deteriorating patient deteriorating, making handovers quicker and more effective through the use of a single score. It’s another project which started in the West of England and is now being adopted in hospitals and ambulance trusts across the country.

Successful projects take on a life of their own spreading organically into different sectors. NEWS is making inroads into primary care, care homes and the community. People with learning disabilities die 16 years earlier than average, with many of these deaths from avoidable causes such as sepsis. NEWS was chosen as one of three interventions to improve their health outcomes by a newly established West of England Learning Disabilities Collaborative.

NEWS is one example of the many patient safety improvements that are being implemented through the West of England Patient Safety Collaborative (PSC). Commissioned by NHS Improvement and hosted by the West of England AHSN, it acts as a bridge between frontline staff, system leaders, commissioners, researchers and innovators.

West of England AHSN Chief Executive, Natasha Swinscoe also takes a role as the AHSN Network’s lead chief officer for patient safety. She says the West of England Patient Safety Collaborative has gained momentum in its first five years.

“It’s the frontline staff in our member organisations who make the changes that deliver a real impact for patients. Our collective achievements only happen because of fantastic engagement from people across the system,and their willingness to get involved and give it a go.”

The power of building strong relationships is particularly evident in the South of England Mental Health Quality and Patient Safety Improvement Collaborative, which the West of England AHSN co-funds. It is the largest and longest running NHS collaborative in mental health, bringing practitioners together from Cornwall to Kent.

Sally Ashton, Programme Lead for the collaborative, says the learning culture is incredible. “Our learning events are very well-attended and after six years it’s interesting to see how people have become less focused on organisational issues and are more concerned with the bigger picture.”

She’s proud of their work on learning from deaths related to mental health and suicide, and improving end of life care, and how they’ve been able to increase involvement in the collaborative from people who have lived experience of mental ill-health. It’s an approach Sally could see working in other areas too.

“It’s quite a unique forum in some ways, but is entirely transferable anywhere within the NHS. It’s simply tapping into people’s natural passion and enthusiasm and giving them the space to come together. You have to invest the time and do it for the long-term.”

For Natasha Swinscoe, this shift from supporting the progress of individual services to improving how different services work together in local and regional systems is key. “Effecting lasting, significant change to the way people think about and work in relation to safety is a big ask,” she said. “We are operating as trusted partners in a fast changing landscape. The more closely we can all work together towards these shared goals, the more confident NHS patients can be that they’re being cared for in one of the safest healthcare systems in the world.”

To find out more, visit the West of England Patient Safety Collaborative web pages ■

Read more in our Innovating Together magazine – a look back at the work of the West of England AHSN in the year 2018-19, and a look ahead to some the work we have planned. Download it here as a PDF or read it below via Issuu