• Dr Julie Barker, GP, End of Life lead and member of Care Home cell. Clinical Design Authority clinical lead for Nottingham Nottinghamshire Integrated Care System (ICS)
• Joanne Taplin, GP Partner – Abbey Medical Centre, Beeston, Nottinghamshire. GP team member working with NottsWest PCN Advance Care Planning Nurses.
• Jane Borland, Care Home Manager Rathgar Care Home, Northamptonshire
• Patient story (anonymous).

• ESCAPE – pain 374 people received life-changing rehabilitation helping them to live with osteoarthritis.
• Focus ADHD – East Midlands ADHD programme to improve ADHD diagnosis for children and young people selected for national adoption and spread.
• ChatHealth – Secure health messaging service reaches 100% coverage for young people in the East Midlands. 
• Digital outpatient appointment follow up – Trust’s Oncology clinical specialty reduced unnecessary follow up appointments by 97% in one pathway using digital approach.
• Transfers of Care Around Medicines – Over 12,000 at-risk patients received additional support with their medications when leaving hospital.
• Patient safety work with care homes – Commitment by East Midlands care homes to their residents’ safety applauded by national health and care system leaders.
• Atrial Fibrillation – 220 strokes avoided and 73 lives saved across East Midlands.

• Reviewed more than 300 innovations and supported the adoption of 50 of them.
• Prevented 30 strokes per year through atrial fibrillation initiatives in primary care.
• Met 500 companies and established 30 industry partnerships.
• Leveraged £123m to improve health in our region and support economic growth.

Key local projects

• Mental health: Relapse prevention following psychological therapy – includes launch of Paddle smartphone app providing ongoing support for patients.
• Heart failure: Improving treatment in primary care – working with Novartis to deliver better patient outcomes and reduce hospital admissions.
• Sleep improvement: Enhancing mental health and self-care at scale – real-world evaluation of the experiences of thousands of people who used the Sleepio online digital support programme.
• Maternity: Developing an e-learning package for fetal heart rate monitoring – helping midwifery colleagues deliver an award-winning tool developed in Reading/Oxford.

Key national programmes

• Reducing stroke risk: Working with all clinical commissioning groups and primary care, sharing learning and spreading best practice to reduce strokes related to atrial fibrillation, diagnosing 3,000 more patient.
• Better outcomes following emergency surgery: Working with the five acute NHS trusts in the Oxford AHSN region which perform emergency laparotomy surgery, reducing mortality and length of stay for more than 800 patients.
• Preventing cerebral palsy: Promoting the adoption and spread of magnesium sulphate in pre-term labour through the ‘PReCePT’ initiative, sustaining uptake at over 85% and improving life-chances of more than 100 babies.
• Reducing medication errors: Working with all CCGs, pharmacists and GPs to train almost 200 practices in our region through the PINCER programme.

• Recognise when a resident may be deteriorating or at risk of physical deterioration
• Act appropriately according to the residents care plan to protect and manage the resident
• Obtain a complete set of physical observations to inform escalation and conversations with health professionals
• Speak with the most appropriate health professional in a timely way to get the right support
• Provide a concise escalation history to health professionals to support their professional decision making.

The full series of six videos about implementing and using RESTORE2 in care home settings, together with some case study based scenarios can be viewed below.

Some patients leaving hospital need advice and support to help them take their medicines correctly and safely. Around 60 per cent of patients have three or more changes made to their medicines during their stay in hospital, and only 10 per cent of older patients are discharged with the same medication they were taking before they went into hospital. 

In some cases, errors or unintentional changes to a patient’s medication can occur because of miscommunication. This can lead to patients becoming unwell and being readmitted to hospital, causing unnecessary distress to the patient and placing an avoidable burden on NHS resources. 

It is estimated that 6.5 per cent of emergency admissions are a result of adverse drug reactions, of which it is estimated that 72 per cent are avoidable. 

Actions taken

In 2016, NHS England in Cheshire and Merseyside, in partnership with the Innovation Agency, received funding from NHS England to support the implementation of systems enabling the transfer of care from hospitals to community pharmacies. Soon afterwards, the initiative was adopted nationally by all Academic Health Science Networks and is one of the AHSN Network’s key innovation programmes. 

A secure digital system enables a hospital’s pharmacy team to inform the patient’s local pharmacy of the patient’s medicines on discharge, so the pharmacist can follow up with advice and services. 

Impacts

Of all referrals from hospitals to community pharmacies through Transfer of Care Around Medicines, around 40 per cent require follow-up action from the pharmacist. It is estimated that for every 10 completed referrals, eight avoidable bed days are saved for the NHS. 

As of March 2019, Transfer of Care Around Medicines in Cheshire and Merseyside has been implemented in 10 trusts, including 11 hospitals, two mental health trusts and all 635 community pharmacies in the region – the fastest adoption and widest spread of the initiative in any region in England. 

There have been 14,853 referrals to community pharmacists at March 2019, of which 6,224 have been completed with further actions from the pharmacist, resulting in calculated savings of 5,103 bed days, or £9.5 million, to the NHS as well as improved patient safety and quality of care.

Testimonial

Una Harding, pharmacist at Day Lewis Pharmacy in Aintree, said: “We now get notifications on our system on a daily basis, it’s a platform we use every day. New discharges or referrals are the first thing you see when you log on. If we see a patient has recently been in hospital we can make a note to speak to them about their medication when they next come in."

"Patients now understand we can deliver more for them. There’s a culture now where people are realising that their GP doesn’t always have to be the first port of call. They know now that if they come into the pharmacy we can talk to them about the changes to their medication."

"It’s fabulous. Finally we’re getting more information so we can make more clinical decisions without having to hunt for information from different sources.”

Hassan Argomandkhah, Chair of Pharmacy Local Professional Network NHS England Cheshire and Merseyside, said: “What started as an idea – we’ve managed to achieve it, and even if we’ve made just one small change in the quality of life of one patient in the past two years it’s been well worth it. None of this would have happened without the dedication of the pharmacists and their teams – whether in NHS England, in the community pharmacies, or in the hospital pharmacy teams – and all the other ancillary staff surrounding them. Without that support and encouragement we wouldn’t have achieved this.”

Sharon Mcloughlin, Ward Manager, Dott Ward:

"The Innovation Agency gave us the dialogue to engage with staff and address concerns objectively, without staff taking anything personally. I was able to say this is an outside organisation, and with them we’re going to look at how our team could improve."

“It’s been about empowering staff, and staff realising that change has to come from all of us. I’ve gained skills to help staff feel more empowered and get on board, and see it as their responsibility to improve things too."

“Hopefully as a result we’ve improved safety for patients as well. I’m more confident now that I know everybody on the team knows which patients need turning, which patients are at risk of a fall, which patients are suffering from an infection – and if staff don’t know, they need to take some accountability for that now.”

Kate Wallworth, Sister, Dott Ward:

"After the Coaching Academy we've now got a structure in place – we’re organised, very organised. We introduced our Safety Huddle where all staff come in and listen while we run through all the main points on the ward. That’s before every shift. Going forward everyone is aware of what’s happening on the ward that day. If a visitor comes onto the ward, any member of staff would be able to answer their questions. We all know which patients are suffering from an infection, which patients are going into theatre. It just helps the running of the ward. It’s a more pleasant ward to work on.”

Lisa Clark, Sister, Dott Ward:

"We had to try and figure out a way to measure if teamwork was improving or not. We introduced a simple box where staff can post a smiley face or an unhappy face, or a comment card – it was just trying to make it as easy as possible. At the beginning we’d see a lot of sad faces going into the box and not many suggestions."

“Now it takes me longer to type up because there’s so many suggestions. People mention staff who’ve really put themselves out to help out, just to say thank you. You can see a lot more positive feedback, and everyone who sees their name on the board gets a positive feeling."

“I don’t think people realise how powerful and uplifting it is to hear how to be positive – that there is a way to think positively, and there are solutions to problems. That’s something we’ve tried here with the team – if things aren’t going in the right direction, why don’t you think of an idea? How could you fix it yourself?”

The Coaching Academy

The Innovation Agency’s Coaching Academy is a programme that enables health and care professionals to improve culture, quality and safety of health and care through structured, focused interactions.

Coaching for a safe and continuously improving workplace culture is a one-year programme for clinical teams focused on developing safe, high-quality and compassionate services. The programme includes accredited coaching training for team leaders; a collaborative action learning programme with other teams, creating a community of practice; an accredited team culture diagnostic to identify key areas of focus; and quality improvement and innovation practical knowledge and skills.

• Culture
• Deterioration
• Maternal and Neonatal Care