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Welcome to our annual review 2019/20

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Introduction

We began last year with a new vision statement, co-designed by the whole HIN team, that starts with the aspirational line:

“We want a future where health and care innovation spreads fast.”

Looking back on what we have achieved, it does feel that this ambition has been guiding our work. Our programmes and projects have supported health and care staff to find more effective ways of working, delivered positive outcomes for south London residents and supported companies to navigate the NHS so many more people could benefit from innovation.

From educating people to better manage their diabetes, helping an SME to develop a digital health business, or enabling a physiotherapist to deliver evidence-based care for people living with chronic pain, this annual review provides just a few examples of what we are able to achieve. We have done this through advising, connecting and supporting others to get the best out of innovation. All our successes are delivered through close collaboration with our members and partners, and we are grateful to the many committed individuals and creative teams from south London who we have worked with over the past year.

None of us could have predicted the position we are in currently nor the scale of the impact of the coronavirus pandemic. However, each of these projects has made a contribution to creating a more resilient health and care system, better able to benefit from innovation. We will continue to bring colleagues, members and communities together, to share knowledge, expertise and ideas, as we move towards recovery.

Zoë Lelliott, CEO
Professor Richard Barker OBE, Chair

Creating a future where health and care spreads fast

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This year 2019-2020 was the end of our first set of national AHSN Network programmes. The seven selected innovations, which spanned a range of disciplines, from maternity to physiotherapy, medicines safety to stroke prevention, were implemented locally by all 15 AHSNs over a two-year period from April 2018 – March 2020.


ESCAPE-pain

Chronic joint pain affects nine million people in the UK. It has a huge impact on individuals and society and its prevalence continues to increase as people live longer, become more inactive and gain weight. ESCAPE-pain is a rehabilitation programme for people with chronic joint pain of the knees and hips that integrates education, self-management and coping strategies, with an exercise regime individualised for each person to improve their health. Originally designed to be delivered by physiotherapists in hospital outpatient departments, it is now also offered to people in leisure centres, gyms, church halls and community centres.

In 2019/20, thanks to support from NHS England, Sport England and other industry and charity partners, as a national network we scaled the programme to 295 sites, allowing for nearly double the number of participants to benefit in England. Locally, a further 1,045 patients participated in the programme, an increase of 114 per cent the from previous year (891).


Serenity Integrated Mentoring (SIM)

Across the UK, emergency and healthcare services respond every minute to people in mental health crisis. In a typical policing district, a very small number of people with complex needs regularly create up to one third of crisis mental health demand. This not only places operational pressures on police officers, but on other emergency and health care teams too. SIM is an innovative approach that brings together policing skills with the knowledge of community mental health services, to better support these “high intensity users”. In 2019/20, we continued to work across all three south London mental health trusts, the Metropolitan Police and London Ambulance Service to successfully implement the programme across all 12 south London boroughs.


Pharmacist-led Information technology INtervention for the reduction of Clinically important ERrors in medicines management (PINCER)

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect one in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions. The PINCER project trains primary care pharmacists and pharmacy technicians in how to search GP clinical systems using computerised prescribing safety indicators so they can quickly identify and rectify any problems with patients at risk from their medications.

In 2019/20, we worked with 10 south London CCGs to successfully implement PINCER in 211 GP practices. 53 per cent of the total number of practices in south London have received system training and implemented the project and 70 GP practices completed their first audit cycle of their practice records.


Transfers of Care around Medicines (TCAM)

The transfer of care process is associated with an increased risk of adverse effects, which can result in unintentional changes to treatment and errors made as a result of a miscommunication. The TCAM project identifies patients who need extra support and signposts them to a local community pharmacist for advice and review of their entire medication needs once discharged.

In Lewisham and Greenwich NHS Trust, where 44 hospital pharmacists have been using the pathway since its launch in August 2018. Last year, 563 referrals were made by the hospital’s pharmacists to community pharmacists and an intervention completed for 62 per cent of those referrals.


Prevention of Cerebral Palsy in Preterm Labour (PReCePT)

  • Increased neuroprotection for pre-term babies
  • Reduced risk of cerebral palsy

Magnesium sulphate is shown to be an effective neuroprotectant for babies delivered prematurely. At the cost of just £1 per dose, antenatal administration reduces the risk of cerebral palsy by around 30 per cent. Developed in the West of England by a team of midwives and the AHSN Network, PReCePT is a quality improvement project focussed on raising awareness and improving uptake of magnesium sulphate in preterm labour, so that all eligible women and babies would benefit. In 2019/20, all south London maternity units implemented PReCePT.

Watch midwife Danielle explain how she implemented PReCePT on her maternity ward:


Stroke prevention

  • Increased detection rates
  • Raised public awareness of Atrial Fibrillation (AF)

Stroke is the fourth leading cause of death in the UK with approximately 100,000 people suffering a stroke each year. Atrial Fibrillation (AF) contributes to one in five strokes nationally, so by improving the detection and treatment of AF, we are improving the population’s health. While two thirds of people with AF experience symptoms, one third do not, with many only becoming aware they have the condition when they have a stroke. It is estimated that up to 500,000 people in the UK have undiagnosed AF.

In 2019/20, our AF programme focused on innovative technologies for 14-day ECG monitoring and improving the care of older people with AF, including in care homes.


Emergency Laparotomy Collaborative

  • Reduced mortality rates
  • Reduced complications
  • Shorter hospital stays

Emergency laparotomies are a reasonably common major surgical procedure, with 30,000 to 50,000 performed every year in the UK. However, around 15 per cent of patients are reported to die within 30 days of surgery. Funded by the Health Foundation, the Emergency Laparotomy Collaborative was established in 2015 to use a quality improvement (QI) approach to tackle this high mortality rate. The collaborative has worked to improve standards of care for patients undergoing emergency laparotomy surgery, by individuals from different trusts learning from each other and variation in practice, and by embedding the culture and skills of quality improvement to ensure sustainability of change.

One example of this is Queen Elizabeth Hospital (QEH), Woolwich, a district general hospital in south east London, which had an average of 154 National Emergency Laparotomy Audit (NELA) cases per year. Although relatively busy compared to some other London hospitals, the number of NELA cases and predicted mortality were close to the national average. The team wanted to do better, so after seeking appropriate approvals, they modified their Trust’s World Health Organisation (WHO) safety surgical checklist to introduce specific NELA prompts at sign in, time out and sign out. They also introduced regular stakeholder meetings and ensured backing from clinical directors. These changes resulted in a decrease in mortality falling from 15.1% to just 8.3% in 12 months which was sustained a year later.

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Connecting people with great ideas

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Innovation Exchange

  • Supports innovators to better understand NHS and social care challenges
  • Demonstrates solutions to health and care staff
  • Brings industry and health and care professionals together to solve NHS problems

We don’t just support innovative minds within the NHS— we stimulate economic growth by enabling commercial innovators to navigate the system by providing practical advice, connections and support. Over the past year we have brought together health, social care, charity and industry colleagues from across south London and wider regions to demonstrate a wide range of solutions to defined groups.  

In 2019/20, our innovator clinics saw 101 new innovators receive advice and guidance on navigating the NHS and our showcasing events tackled the regional challenges and clinical specialties of digital workforce, urgent and emergency care and the need for a digital revolution in adult social care.


Diabetes in Pregnancy Communities of Practice (CoP)

Bringing people together around a complex problem is at the heart of our Communities of Practice. Our Diabetes in Pregnancy CoP brought together colleagues from across diabetes and maternity services to connect and collaborate on ways in which to improve care and services for women and babies affected by diabetes in pregnancy. One example is the development of the Diabetes Specialist Midwives Group. Before its inception, there was nowhere for these professionals to come together. The group currently share experiences, job descriptions and working practices and are working to support the introduction of continuous glucose monitoring for pregnant women with Type 1 diabetes.

One of the biggest successes for the community has been helping trusts introduce technology to support the management of gestational diabetes remotely. Over the last year, over half of the trusts in south London have adopted an evidence-based innovation that enables women to take her own blood glucose measures at home with the support of the clinical team.

Inspiring people to think differently

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Zero Suicide


The number of suicides in Britain has reached record levels. Office of National Statistics (ONS) data for the most recent period 2018 shows that England registered 10.3 deaths per 100,000 (5,021 deaths). In London, the rate is 8.4 per 100,000 people.

Health Innovation Network is a member of the Zero Suicide Alliance (ZSA) and was commissioned by Mersey Care NHS Foundation Trust on behalf of the ZSA to undertake national engagement with key leaders and stakeholders involved in suicide prevention, to gather information to inform the production of a new digital resource intended to become the ‘go-to’ source for accessible and evidence-based examples of training, interventions, research and statistical information for all sectors involved in suicide prevention.

We engaged close to 1,000 national stakeholders over six weeks in the summer of 2019, including NHS providers and commissioners, local authorities, charities, police, universities, schools, government departments, housing associations, corporate firms and finance companies nationally through face-to-face workshops (London, Bristol and Leeds in July 2019) and via a survey, to support the design and production of the resource content.


Reducing Polypharmacy in Care Homes

  • Increased confidence and knowledge in care home staff identifying risk of polypharmacy
  • Encouraged education of patients and their relatives around polypharmacy and self-management

Polypharmacy, literally meaning ‘many medicines’ is a global patient safety challenge, defined by the World Health Organisation (WHO) as the routine use of four or more medicines including those that are prescribed or bought in a pharmacy (this includes herbal medicines). In 2019/20, it was the focus of our HIN Darzi Fellow, who explored ways to reduce inappropriate polypharmacy in care homes.

On average, care home residents in the UK take seven medicines a day. This number of medications, sometimes prescribed by different clinicians, comes with an 82 per cent risk of adverse drug reactions. The project focused on reducing the use of anticholinergic medicines (often prescribed for various conditions such as hay fever and depression), which can block the beneficial effects of medicines used for dementia, as well as cause a number of uncomfortable side effects such as constipation, dry mouth, dry eyes and confusion. Different approaches were trailled at four care homes in south London, from educating residents and relatives on the risks of polypharmacy, to giving nurses and carers the information and confidence to highlight to doctors when people living with dementia are on medications that have high anticholinergic activity. Their effectiveness was compared and learnings shared across all south London care homes.

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Giving practical support to do something new

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Innovation grants

NHS teams often struggle to find the initial funding to pilot new ideas in real-world settings that help them to demonstrate the kind of results that they need to gain support for wider implementation. We believe helping great ideas prove themselves in real-world settings before spreading across the NHS, is a crucial role for AHSNs to play.

In September 2019, we awarded 10 hand-picked innovations up to £10,000 each to kick start innovation projects that promised to address health inequalities and provide real-world validation and were aligned with HIN’s clinical themes. But our practical support was not limited to that vital funding; we also provided advice and guidance utilising our connections across healthcare, encouraging cross-boundary working in areas of research, education and improvement services.

A wide range of innovations that received support to be piloted or spread, including apps to help women in pregnancy to understand the risk of preterm birth or managing diabetes, as well as new devices to detect dangerous bleeding, the use of virtual reality on acute mental health wards to reduce stress and new ways of accessing mental health support that take pressure off primary care. One of the projects is also developing mobile simulation labs for the NHS to test and improve technology.


Diabetes Book & Learn

Diabetes Book & Learn is a technology-led service that offers people living with diabetes increased choice and access to vital education, enabling them to take control of their diabetes through learning more about their condition and integrating effective self-management into their daily lives. Since the Diabetes Book & Learn service launch, almost 13,000 patients have been referred by a healthcare professional and over 800 have self-referred. In 2019/20, the launch of self-referral meant that people with Type 2 diabetes living anywhere in south London, could book themselves on a structured education course without having to go through their usual care provider.

Structured education is clinically proven to have positive impacts on people’s health outcomes. However, attendance at structured education courses in south London has traditionally been shockingly low (and similar across England). Diabetes Book & Learn addresses the barriers to attendance that people with diabetes have reported in the past by offering greater choice of course type and venue across all 12 south London boroughs, as well as providing evening and weekend courses. There is also the option to complete a course entirely online and receive 1:1 telephone support from a qualified professional throughDigitalHealth.London Accelerator alumni companies Oviva and Second Nature. To date, 1,292 people living with Type 2 diabetes have attended one of the new digitally-enabled self-management programmes.

As well as project managing the implementation of the service, engaging and supporting local CCGs and primary care referrers to understand the benefits of the project, we worked with partners to deliver an engaging and targeted Facebook campaign to promote the site to south Londoners.

Speeding up the best in health and care, together

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DigitalHealth.London Accelerator (Accelerator)

The DigitalHealth.London Accelerator programme aims to speed up the adoption of technology in London’s NHS, relieving high pressure on services and empowering patients to manage their own health. Now in its fifth consecutive year, the Accelerator works with up to 20 high-potential SMEs over a 12-month period, giving bespoke support and advice and a programme of expert-led workshops and events, as well as brokering meaningful connections between innovators and NHS organisations with specific challenges. 2019 saw the Accelerator finalise support for cohort three and welcome their fourth cohort of digital health companies. Innovations supported include an app to improve the health of patients with diabetes, cutting edge technology that makes brain surgery safer and products that support better care to older adults.

The DigitalHealth.London Accelerator Launchpad was piloted in 2019-20 to support earlier stage digital health companies and we supported 13 additional companies through this programme.


Covid-19 response

In March 2019, along with the rest of the country, we had to pivot our plans as a result of Covid-19. Prioritising the safety of our people, we undertook our own digital transformation, moving our entire organisation to remote working before immediately setting about finding ways to support our health and care colleagues to respond to the crisis, in particular our local care homes and south London GPs.

Change is often slow for good reason, so in these times of fast-paced transformation, communicating across systems and working together across boundaries is more important than ever, and AHSNs are perfectly placed to support in bringing people together. In addition to helping our health and care colleagues with immediate needs, AHSNs also continue to have an important role in looking to the future and sharing learning across the system. There is no doubt that this pandemic is fast-tracking the use of digital solutions and supporting our members and partners to ensure that this is done safely and sustainably remains crucial to our work.

To find out more about how we are supporting health and care teams during Covid-19, contact hin.southlondon@nhs.net

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Finance and people

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Finance Table - HIN Annual Report 19/20

Our financial position results from a deliberate and effective financial management strategy enabling a planned surplus. Going into 2020/21, this will allow us to:

  • Focus on continuing to deliver value for money to our members and funders in the current, challenging environment
  • Continue to engage across the system, building on past success and seeking new funding, as a number of key existing projects come to an end
  • Closely monitor our cost base to ensure that we continue to be sustainable long term.

Our gender equality information

In line with our values, we are committed to being open with our employees, partners and stakeholders and choose to report our gender pay gap annually.

At Health Innovation Network:

  • The mean hourly rate for women is 4.9 per cent more than men. This is a change from last year when the mean hourly rate for men was 6.3 per cent higher for men than women.
  • The median hourly rate for women is 2.6 per cent more than men. This is an increase from last financial year, when the median hourly rate for women was 0.2 per cent higher.

 


Our people

At Health Innovation Network, our people are our greatest asset.

“At HIN, we know we can’t achieve the impact that we do without making the happiness and psychological safety of our employees a top priority.”

Dr Natasha Curran, Medical Director

In 2019/20, we demonstrated our commitment to making HIN a joyful place to work by welcoming our first-ever People Lead, Rayvathi John to work with our staff and senior management to offer HR advice and to support HIN in aspects of governance, culture, and organisational development.

We continued to actively engage staff in our health and wellbeing activities and thanks to the passion and willingness of our staff health and wellbeing group, we increased our activities offer to include yoga, rock climbing, mindfulness, meditation and book and chess clubs.

Throughout September 2019, the whole organisation participated in an ‘Identity season’, during which individuals from across the organisation facilitated a series of activities, talks, discussions and written content exploring the identities and diversities of its staff.  The in-house HIN Academy also successfully delivered internally resourced training to support staff learning and development on a variety of topics, including evaluation, project management, quality improvement and communications. We also extended this knowledge-sharing opportunity to our colleagues at King’s Health Partners.

At the end of 2019/20, we procured a specific external surveying tool to support us to monitor satisfaction and happiness in the workplace with fortnightly surveys. Whilst the HIN staff satisfaction rates are very high, we hope this will enable us to track staff engagement and happiness, and also be alert to, and prevent, any bullying and harassment.

As an organisation, we are also committed to investing in and developing the future of the NHS today through the Graduate Information Management and Technology Fast Track scheme (Grad IM&T Fast Track scheme).

Our greatest achievement of last year was moving the majority of our staff to permanent contracts, offering them greater commitment and stability.