Health Innovation Network Publishes Anti-Racism Evaluation

In 2020, in response to the murder of George Floyd and the stark health disparities highlighted by the Covid-19 pandemic, the Health Innovation Network embarked on a programme of organisational change to become an actively anti-racist organisation.

This aimed to create a psychologically safe environment that increases staff confidence in having conversations about race and racial inequality, and in knowing how to speak up and address concerns of racial inequality and discrimination.

To evaluate the success of this activity an independent evaluation was commissioned. The evaluation aimed to establish the overall impact of the project, identify where it saw the most impact, judge the extent to which HIN staff members feel confident in talking about race and racism, and understand whether the organisation is positively impacting on the experience of staff within the organisation and race-related health inequalities.

The evaluation used a qualitative approach of semi-structured interviews. The feedback received suggested a positive response to the anti-racism programme, agreement that it had created open spaces for dialogue and a strong desire to continue the work in future.

However, continued challenges were identified. This included discomfort and emotional exhaustion caused by some of the discussions, concerns that the leadership team is still predominantly white and continued experience of microaggressions within the organisation.

In total, 21 interviews with 18 members of HIN staff were conducted between March and May 2023. Ten of the interviewees were white and eight were members of the global majority, and they reflected all hierarchical levels of the HIN, male and female staff and a variety of age groups, years of service at the HIN, teams and roles.

Read the full evaluation report

Know Your Numbers: The Crucial Role of Community Pharmacies in Detecting High Blood Pressure

Know Your Numbers Week (4 - 10 September), aims to raise awareness of the risks around hypertension (high blood pressure). To mark the occasion, Dina Thakker, Community Pharmacy Clinical Lead for South West London ICS, writes about the role of community pharmacies in hypertension detection and management.

No matter what stage of life you are at, it is important to know your blood pressure numbers. Hypertension (high blood pressure) is a major cause of heart attacks and stroke, but doesn’t usually show symptoms until it is too late. As a result, getting a blood pressure check is often not prioritised, but knowing your numbers means you can make lifestyle changes or take preventative medicine to get your blood pressure to a healthy level.

As Community Pharmacy Clinical Lead for South West London ICS I oversee nationally commissioned community pharmacy services. One of the most important of these services is hypertension case finding, which helps us to detect hypertension throughout the region.

Community pharmacies are uniquely positioned to play a critical role in hypertension detection and management. In south west London, we have an extensive network of 293 pharmacies, out of which 223 are delivering the hypertension case finding service, ensuring good coverage across the region. Here's how community pharmacies are key to detection:

  • Accessibility and trust

    Pharmacies are easily accessible to the public and are regarded as trusted healthcare providers. Patients often feel at ease getting their blood pressure checked at their local pharmacy, making it a vital setting for early detection.

  • Comprehensive checks

    Pharmacies can conduct initial blood pressure checks and, if needed, follow up with ambulatory blood pressure monitoring (ABPM) to get a more accurate assessment of a patient's blood pressure over waking hours or 24 hours.

  • Target population

    Pharmacies can identify individuals aged 40 years or older, or at the discretion of the pharmacist, people under 40, with high blood pressure who have not received a confirmed diagnosis. These individuals are then referred to general practice for further evaluation and appropriate management where needed.

  • Supporting general practice

    Pharmacies can also support general practice by undertaking ad hoc clinic and ambulatory blood pressure measurements for undiagnosed hypertension cases.

  • Promoting healthy behaviours

    Community pharmacies offer a unique opportunity to engage patients in discussions about their health, providing valuable advice and support to promote healthy behaviours.

But there’s more we can do. As a participant in the HIN’s Cardiovascular Disease Prevention Fellowship, I am developing a project focusing on supporting the development of community pharmacy hypertension case finding. The project will aim to:

  • develop digital pathways that streamline communication between community pharmacies and general practices, enabling smoother referrals and follow-ups;
  • improve awareness of the community pharmacy hypertension case finding service among colleagues and patients in primary care;
  • optimise service use such as by upskilling pharmacists in the use of ABPMs and helping other healthcare professionals, such as technicians, to provide the service effectively.

By improving care pathways I hope to further expand and improve the detection of hypertension in south west London, helping more patients to make choices and access treatment to reduce their risk of cardiovascular disease. I am looking forward to completing the project and sharing the results with you in future.

Find out more

Find out more about Know Your Numbers Week.

Visit Blood Pressure UK

HIN Publishes Anti-Racism Toolkit

In 2020, the HIN embarked on a journey to becoming an actively anti-racist organisation. This was sparked by the racist murder of George Floyd, which led to global outrage, and was exacerbated by the stark race and health disparities highlighted through the Covid-19 pandemic.

The topic of racism alone is sensitive, interpersonal, and can challenge our traditional ways of thinking. As such, many people find conversations around racism uncomfortable, and it can be difficult to know where to begin.

That is why, following three years of listening and learning, we have published our anti-racism toolkit. The toolkit is aimed at people looking to make changes within their organisation or workplace, and individuals looking to improve their own understanding of racism and take steps to become anti-racist.

It provides practical guidance and support for individuals, organisations and communities who are tackling racism in all its forms. It includes a brief history of racism in the UK, guidance on how to have open and honest conversations about race, what sustainable steps can be taken to tackle racism in your community or workplace and a glossary of key terms.

It follows our organisation-wide anti-racism project which aimed to shift the culture in our work individually, within our teams and ultimately within the communities we serve. You can find out more about our anti-racism project and its outcomes, and access more resources on our anti-racism webpage.

HIN CEO Rishi Das-Gupta said: "We are delighted to publish this toolkit which, builds off our own internal anti-racism program, to help promote anti-racist ways of working in the south London health and care landscape and beyond. I would encourage you to take a look, share with your networks and organisations, and consider what steps you can take to combat racism in your area of work."

Working Together to Tackle Racism in South London

We recently hosted a roundtable event with south London stakeholders on tackling racism in the health and care sector. HIN anti-racism leads Pearl Brathwaite, Adam Ovid and Catherine Dale write about the key themes from the discussion

While racism is unfortunately not a new phenomenon, since 2020 there has been increased attention paid to structural inequalities, the impact of colonialism and the racism experienced by people who are part of ethnic minorities in white-majority countries.

As an academic health science network (AHSN) much of our work involves tackling the health inequalities which exist – and which were highlighted during the pandemic. As such we are in quite a unique position of having a view which cuts across south London’s health and care sectors.

That’s why we brought together people from this community, in particular leaders with health inequality, clinical and managerial roles to discuss opportunities in tackling racism in south London. Organisations represented included South London and Maudsley NHS Foundation Trust (SLaM), Guy’s & St Thomas’ NHS Foundation Trust, Mabadaliko, the Greater London Authority GLA), NHS England London Region, and South East and South West London ICSs. Here are some of the examples of what they shared about the work they are doing.

  • South London and Maudsley NHS Foundation Trust (SLaM) has developed its Patient and Care Race Equality Framework in partnership with Lambeth Black Thrive and Croydon BME Forum. This framework exists to eliminate the racial disparity in patient access, experience and outcomes. The initial focus of the work has been on issues which Black communities face. The framework aims to significantly improve trust and confidence in mental health services.
  • Mabadaliko is working with senior leaders and management teams to provide advice and guidance on strategic initiatives in equality, equity and anti-racism objectives and spaces. It supports organisations to develop cultures and programmes aiming to reduce racial and ethnic inequalities in the communities that they serve.
  • The Greater London Authority (GLA), in partnership with the Race Equality Foundation, is establishing a peer learning network ‘Anti-Racism Practice Learning Hub’, involving peers and organisations sharing practice, resources, and support  becoming an effective anti-racist organisation. The GLA has also developed a strategic framework to support London health and care partners to progress towards being anti-racist as an approach to address ethnic disparities.

Thank you to everyone who came and shared their views. Here are just some of the main takeaways.

Bringing in external voices

Bringing together people from outside your organisation can be a highly valuable way of gaining perspective on how your organisation is doing and what can be improved. It provides fresh perspectives, highlight blind spots, and encourage critical self-reflection.

These voices can include expert consultants, community leaders, and individuals with lived experience of racism. The HIN’s work in shaping the discussions we had internally benefited from advice from external sources such as a clinical psychologist specialising in anti-racism and a workforce development consultancy, and other participants reported similar benefits.

These can help challenge existing ways of working. It is often easier for an external expert to be direct and honest about how an organisation is doing. It can be a particularly valuable way of bringing diverse voices to white-led organisations.

However, risks were also identified – external input must be balanced with internal expertise and knowledge to ensure their recommendations are relevant to your organisation. It is also essential to ensure that the involvement of external voices does not become counterproductive. But getting the balance right can provide perspectives which are instrumental in driving change.


Notice who is not in the room

It is crucial to acknowledge who is not present in discussions about anti-racism, as well as who is. Status threats, privilege, and discomfort often prevent people without personal experience of racism from participating.

To overcome these barriers, efforts must be made to notice who is not present and encourage them to become involved – only by doing this can we escape echo chambers and create genuine understanding between people with different experiences. Creating safe spaces, addressing power imbalances, and fostering open dialogue can help bridge this gap and ensure that all perspectives are included.


Reaching beyond your organisation

To make anti-racism efforts impactful, it is crucial to extend beyond one’s own organisation. This requires fostering an appetite for collaborative working and using existing tools and platforms.

Creating sounding boards, which provide opportunities for diverse voices to be heard, can be an effective approach. As can shadow boards, which mirror the work of decision makers and give individuals from underrepresented communities access to important discussions and decision-making processes from the start.


Power and balance

When implementing anti-racism organisational programmes or workforce strategies, it is important to strike a balance between empowering colleagues from ethnic minorities to speak about their experiences and challenge the way things are done, without burdening them with the difficult challenge of tackling institutional racism in addition to their normal work function. To do this there must be an environment where colleagues feel supported and included, with active participation and input from leaders and white colleagues.


Getting names right

Individuals with uncommon or hard-to-pronounce names are often “othered” by having to repeatedly explain how to pronounce their name. But there are simple steps which can be taken to address this.

A number of the participants identified time spent by colleagues understanding how to pronounce people’s names as a way of fostering a culture of respect and inclusivity. Some mentioned a specific workshop where staff discussed their names, correct pronunciation, and shared their experiences as a way of creating a conversation and improving awareness.

Another approach is to implement phonetic pronunciation guides as standard – for example to name badges and pronunciation guides in email signatures – to make things easier for everyone and reduce feelings of exclusion.


Working towards substantive change

To ensure the effectiveness of anti-racism programmes, initiatives should start with self-reflection and dialogue to highlight the problem, clarify the focus and specificity of planned work and garner support for change. To convert this into meaningful long-lasting progress, it is essential to maintain momentum and enthusiasm. To keep the focus on substantive change organisations should set clear goals and time-bound, measurable objectives wherever possible.


Conclusion

Structural and institutional racism in the health and care sectors is not a problem which can be solved overnight, but it is clear there are actions we can all take within our areas of work to create an environment which is inclusive, open and focused on tackling racism.

There was a strong desire among the group for further inter-organisational work to share learning and collaborate on the wider issues of racism, and we look forward to exploring these opportunities. Racism is a current and ongoing problem, and creating an environment where we can have open and honest conversations about it is a crucial first step in changing the culture of our organisations.


What can I do?

  • Engage in conversations in your organisation around race and racism to raise awareness and think about the impact this has on your people and the work that you do.
  • Consult experts to support you, such as Mabaliko, anti-racism experts and internal or external Equality, Diversity & Inclusion consultants who have a particular focus on racial inequality and inequity.
  • Generate commitments for your organisation or teams through engagement with your colleagues. Consider what resources and action you need to develop and sustain these commitments and how you will get there.
  • Read our toolkit for support on how to take action and top tips for keeping focused on change.

Contact Us

Contact us for more information about the journey we are on as we aim to be an anti-racist organisation.

Get in touch

Health Innovation Funding Opportunities

Health Innovation Network funding opportunities

The latest funding opportunities and grants for innovation in healthcare.

We update this page monthly so check back for the latest opportunities or subscribe to our newsletter for updates.

Featured Funding Opportunities

Future Leaders Fellowships: round 9, business and non-academic Deadline: 25 June 2024
UK registered organisations can apply for a share of up to £110 million for ambitious research and innovation projects in any sector, and tailored support to develop careers for future leaders. This funding is from UKRI.

Design Foundations Round 5. Deadline: 26th June 2024
UK registered organisations can apply for a share of up to £2 million for people-centred and systemic design projects, across a range of themes and innovation areas. These are to influence, inform and de-risk their future R&D activity.

Women in Innovation Award 2024/25. Deadline 10th July 2024
Women within UK registered micro, small and medium-sized enterprises (SMEs) can apply for a share of up to £4 million to develop their exciting and innovative ideas. The £75,000 grant also includes bespoke business support.

Funding for early stage development of new healthcare interventions. Deadline: 10 July 2024
Apply for funding to generate critical preliminary data to build confidence in the development strategy for a new medicine, repurposed medicine, medical device, diagnostic test, or other medical intervention development.

UK-Taiwan CRD 2024 Deadline: 17 July 2024
UK registered businesses can apply for a share of up to £5 million for the purpose of developing innovative proposals with Taiwan. You must collaborate with at least one Taiwan business applying under the equivalent DoIT programme.

ARIA Activation Partners. Deadline: 19th July 2024 (with non-mandatory EOI deadline of 29 May 2024)
Looking for proposals for Activation Partners who will unlock latent ideas, empower talent, support new ventures, and provide insights and connectivity across our opportunity spaces.

Design Exchange Partnerships: design the green transition round three . Deadline: 12 September 2024
Apply for funding to develop design–led solutions to address specific challenges around the theme of more-than-human design. You must be based at a UK research organisation eligible for Arts and Humanities Research Council (AHRC) funding.

Canada-UK: Biomanufacturing of Biologics & Advanced Therapies Round 2. Deadline: 16th October 2024
UK registered organisations can apply for a share of up to £3 million for collaboration with Canadian SMEs on joint R&D projects, for enabling technologies and innovations in biomanufacturing of biologics and advanced therapies.



General health innovation funding opportunities:

INNOVATE UK:
Innovate UK is part of UK Research and Innovation, a non-departmental public body funded by a grant-in-aid from the UK government. 

Innovate UK Investor Partnerships: SME round 7. Deadline: 19th June 2024
UK-registered SMEs can apply for grant funding alongside private investment from selected investor partners.

Future Leaders Fellowships: round 9, business and non-academic Deadline: 25 June 2024
UK registered organisations can apply for a share of up to £110 million for ambitious research and innovation projects in any sector, and tailored support to develop careers for future leaders. This funding is from UKRI.

Innovate UK innovation loans future economy: round 15. Deadline: 26th June 2024
UK registered businesses can apply for loans for innovative projects with strong commercial potential to significantly improve the UK economy.

Innovate UK Smart Grants: April 2024 Deadline: 24 July 2024
UK registered organisations can apply for a share of up to £25 million for game-changing and commercially viable R&D innovations that can significantly impact the UK economy.


BIOTECHNOLOGICAL AND BIOLOGICAL SCIENCES RESEARCH COUNCIL:
Biotechnology and Biological Sciences Research Council, part of UK Research and Innovation, is a non-departmental public body and is the largest UK public funder of non-medical bioscience. It predominantly funds scientific research institutes and university research departments in the UK.

BBSRC standard research grant Deadline: Open call

You can apply for research grants at any time in any area within the remit of BBSRC. BBSRC funds research in plants, microbes, animals (including humans), and the tools and technology underpinning biological research from the level of molecules and cells to tissues, whole organisms, populations and landscapes.


NATIONAL INSTITUTE FOR HEALTH AND CARE RESEARCH:
The National Institute for Health and Care Research is the British government’s major funder of clinical, public health, social care and translational research. Its mission is to “improve the health and wealth of the nation through research”. 

NIHR i4i Launch dates: Product Development Award
i4i Product Development Awards (PDA) support collaborative research and development of medical devices, in vitro diagnostic devices and high-impact patient-focused digital health technologies for use in the NHS or social care system. The expected focus of a PDA is product development required to enable a technology for clinical use or use in social care and/or the clinical development of a laboratory-validated technology or intervention. The research proposals may address any area of unmet need. Projects must have a clear pathway towards adoption and commercialisation. 

Product Development Award Call 28: Launch 10 April 2024 / Deadline: 29th May 2024.
Product Development Award Call 29: 10 October 2024 / Deadline: 5th December 2024

DEFENCE AND SECURITY ACCELERATOR (DASA) Deadline: Open call
DASA aims to find and fund exploitable innovation to support UK defence and security quickly and effectively and support UK prosperity. 

Open Competition 
The Open Call is one of the funding competition mechanisms DASA uses to find proposals that address challenges faced by government stakeholders. It gives bidders the opportunity to present their ideas to defence and security stakeholders at any time, without waiting for a relevant Themed Competition.


MEDICAL RESEARCH COUNCIL (MRC)
The Medical Research Council (MRC) improves the health of people in the UK – and around the world – by supporting excellent science and training the very best scientists.


ECONOMIC AND SOCIAL RESEARCH COUNCIL (ESRC) Deadline: Open call

ESRC Research Grant 
If you have an excellent idea for a research project, the ESRC have their Research Grants open call. Awards ranging from £350,000 to £1 million (100 per cent full Economic Cost (fEC)) can be made to eligible institutions to enable individuals or research teams to undertake anything from a standard research project through to a large-scale survey and other infrastructure or methodological development.


NC3RS:
The NC3RS is a UK-based scientific organisation dedicated to helping the research community worldwide to replace, reduce and refine the use of animals for medical testing.

CRACK IT challenges 
Funding of £4M is available through the 2023 CRACK IT Challenges competition* to solve four Challenges, providing academics and SMEs based in the UK and Europe** with the opportunity to deliver scientific and 3Rs benefits through the development and commercialisation of 3Rs products and services that are tailored to end-user needs.



Trusts and Charities

The Health Foundation (HF)
HF’s aim is a healthier population, supported by high quality health care that can be equitably accessed. HF learns what works to make people’s lives healthier and improve the health care system. From giving grants to those working at the front line to carrying out research and policy analysis, they shine a light on how to make successful change happen.

The British Heart Foundation (BHF)
BHF provide personal support for clinical and non-clinical cardiovascular researchers at all stages of their career. They also provide grants for short and long term research projects, essential infrastructure and strategic initiatives.

Association of Medical Research Charities
Over 30 years ago a small, diverse group of medical research charities form the Association of Medical Research Charities (AMRC) to unite the sector and provide it with a leading voice. Since then their membership has grown to over 140 charities. In 2018, these charities invested £1.3 billion in medical research.


Other UK Government, Seed Funds & Loans

The British Business Bank Deadline: Open

BBB are a government-owned business development bank dedicated to making finance markets work better for smaller businesses. Whether you’re looking for finance to start a business, grow to the next level, or stay ahead of the competition, they say that they can deliver greater volume and choice of finance.


Small Business Research Initiative (SBRI) funding. General ‘collection’ of news and funds

Information about SBRI for businesses and public sector organisations that might want to use the scheme.


UK Innovation & Science Seed Fund Deadline: Open

The UK Innovation & Science Seed Fund (formerly known as The Rainbow Seed Fund) is a £27.1m early-stage venture capital fund building and growing technology companies stemming from the UK’s research base.


Creative England Investments Deadline: Open

Creative England is supporting SMEs by providing competitive loans to digital businesses in order to make their growth plans a reality. The investments on offer are intended to fuel this fast-growing sector by financing business expansion and new products, leading to the creation of new high-quality jobs and Intellectual Property (IP). Loans from £50,000 – £250,000 are available with repayment terms ranging from 3-36 months. Interest rates range from 5% to 10%, depending on the risk profile of the applicant. This includes companies from within the digital healthcare sector.


International Grants

UK – Germany Bilateral: Collaborative R&D Round 3 Deadline: 3 June 2024
UK registered organisations, collaborating with at least one German SME, can apply for a share of up to £4m for projects in emerging technologies.

UK-Taiwan CRD 2024 Deadline: 17 July 2024
UK registered businesses can apply for a share of up to £5 million for the purpose of developing innovative proposals with Taiwan. You must collaborate with at least one Taiwan business applying under the equivalent DoIT programme.

Global Innovation Fund Applications: Open
GIF focuses on solutions that have the potential to address an important development problem more effectively than existing approaches and can come from anyone, anywhere.
They seek out innovations they believe have the greatest potential to improve the lives of millions of people living in poverty.

The EIC Accelerator: Open Competition (Grants only)
The EIC Accelerator supports individual Small and Medium Enterprises (SMEs), in particular, Startups and spinout companies to develop and scale up game-changing innovations. 


Other international funds of interest:

The Global Challenges Research Fund
The Newton Fund

Taking Action on Sickle Cell Disease

To mark World Sickle Cell Day HIN project manager Iona de Wet writes about the impact of sickle cell disease on those who have it, and what is being done to improve care.

It is difficult to talk about sickle cell disease (SCD) without reflecting the frustration, anger and sadness of the communities who live with this inherited genetic disorder. If you haven’t read No One’s Listening I urge you to do so. It is a report commissioned by the All-Party Parliamentary Group on Sickle Cell and Thalassaemia (SCTAPPG) in response to avoidable deaths and long standing failures of care for sickle cell patients. It is a sobering read.

I became aware of SCD through my work as a project manager, supporting improvements in treatment through the MedTech Funding Mandate, a policy vehicle that has seen funding released for automated red blood cell exchange, using the innovative technology Spectra Optia. I say ‘aware’, because the cursory nod given to the condition in textbooks cannot even begin to address the challenges faced by people living with SCD: rigid, sickle shaped red blood cells, that are not great at carrying oxygen, and have a tendency to ‘stick’ together. This can lead to, amongst a number of other symptoms, distressing sickle cell crises, causing unimaginable pain. But the fact I found hardest is that, as it stands, our healthcare system fails to adequately support patients.

"We need your help to continue changing the narrative."

Contributing to efforts to improve care, therefore, feels good. South London, our ‘patch’, is home to the largest number of people of African and Caribbean heritage in the UK, a community disproportionally affected by SCD. We are working with specialist centres called Hemoglobinopathy Coordinating Centres (HCC) to improve access to automated red blood cell transfusions for these communities. Whilst this work is important, it is only a part of a much larger landscape of care.

We want to join national efforts and contribute to telling a different story about SCD, one where positive experiences become the norm rather than the exception. We recognise that this a huge job but we want to bring our skills in building and nurturing connections, implementing change and accelerating innovation to this important challenge.

What you can do

  • If you are a systems leader, I urge to read this report and be an advocate for action.
  • Visit the Sickle Cell Society website and learn about the experiences of people living with SCD.
  • If you are an innovator with innovations that can support SCD, please get in touch.
  • And if you work in the system doing work to support SCD, we are well placed to convene ideas.

We need you help to continue changing the narrative.

Work With Us

If you would like to work with us to tackle SCD get in touch with project manager Iona de Wet.

Add button text

Applications Open for Second Cohort of the HIN’s Cardiovascular Disease Prevention Fellowship

Doctor checking patient with stethoscope

Applications for the 2023 cohort have now closed. For more information contact hin.cvd@nhs.net.

We are launching the second cohort of our Cardiovascular Disease (CVD) Prevention Fellowship Programme to develop clinical skills and knowledge to help improve outcomes for patients across south London who are at risk of CVD.

With six million people living with CVD in England with a combined cost of £16 billion every year improving outcomes for at risk patients is an NHS priority. This programme will help to speed up the adoption of innovative initiatives to help prevent CVD across south London.

This free programme builds on the first cohort which took place in 2022. It is aimed at nurses, GPs, clinical pharmacists, and other healthcare professionals working in primary care in south London who are keen to develop their skills and knowledge, and champion CVD prevention in their practice or wider Primary Care Network. The Fellowship aligns to local priorities, and supports practices and PCNs in meeting contract requirements (eg Quality Outcomes Framework).

Find out more about last year’s fellowship or watch the video below.

The programme content was very beneficial and helped to focus on the improvements that are required and how I am able to assist in making these improvements. I was able to develop some of my project managing skills.2022 Fellow

What does the fellowship involve?

The fellowship is Continuing Professional Development (CPD) accredited and provides free expert clinical advice and quality improvement support to help fellows become CVD Prevention Champions. It will also help fellows to deliver a quality improvement project focused on CVD in their practice or primary care network (PCN). See examples of 2022 projects here.

Running from July 2023 to February 2024, the fellowship will consist of:

  • A series of lunchtime webinars led by experts in a range of areas including lipid management, hypertension, atrial fibrillation, chronic kidney disease and obesity;
  • An in-person day to help develop your CVD Improvement project on 8 September;
  • Ongoing peer and expert sessions to support you in delivering your project, which will run September to December 2023;
  • A final in-person event in to celebrate the work of the Fellowship on 9 February 2024.

How to apply

The fellowship is free. Please ensure you are able to attend all events.

Before applying please read our flyer for more details including requirements of the Fellowship and dates.

To apply please complete this form.

Applications close at 5pm on Monday 3 July 2023. Please note that places are limited and applications may close early if all spaces are filled so do not delay in applying.

Apply Now

The quality improvement training and part of the HIN staff time to support the Fellows in the delivery of an improvement project are funded via a Daiichi-Sankyo grant. The HIN is also applying for further grants/non-promotional funding from other companies to support the final event of the Fellowship programme. 

Accelerating FemTech: Women’s pain and pelvic health tech

The first webinar in the Accelerating FemTech: Inspire series was hosted by South West Academic Health Science Network (SWAHSN) and was on the topic of women’s pain and pelvic health tech.

The webinar was led by Dr Kelly Pickard-Smith who delivers the South West AHSN Programme for Femtech, research and evaluation. Kelly introduced the webinar and passed on to Natasha Curran, Medical Director at the Health Innovation Network and co-lead of the Implementation and Involvement team of the Applied Research Collaboration South London.

Natasha spoke about the Accelerating FemTech initiative before speaking from her experience as a Consultant in Pain Medicine at University College London Hospitals and an Expert Adviser to NICE and journals such as BMJ Open. Natasha shared that 40 per cent of women in the UK experience pain and up to 25 per cent of female population have pelvic pain.

Dr Amy Bonsall is a Gender Fellow at Royal Holloway University and joined the webinar panel to talk about her experience of living with endometriosis. Amy shared her experience of living with pain throughout her young-adult life and her difficulties in accessing care, with many healthcare professionals dismissing her symptoms. She also discussed the challenges that FemTech innovators faces and the importance of using technology to give power back to women.

Dr Naomi Tyrell and Isabelle Fielding spoke about evaluation, impact and real-world validation in developing FemTech.

Naomi is the Founder and Managing Director of Research Your Way and Isabelle is an accredited coach, trainer, psychologist and business owner. They gave an overview of the questions FemTech innovators should ask when evaluating impact, the theory of change process and systematic data analysis.

Isabelle described how they used these methods in evaluating the Balance App – a perimenopause and menopause tracking and information app. This evaluation looked at introducing the app into clinical care pathways, exploring feasibility and practicalities of using the balance app in real-world settings and understanding the wider context of potential app users and the challenges they face in managing their symptoms and accessing good quality care.

If you found these clips interesting, be sure to sign up to attend upcoming Accelerating FemTech webinar on how FemTech can help reduce inequalities in maternity care. You can also express an interested in attending our in-person Accelerating FemTech events happening in Manchester, London and East Midlands.

Applications are also open to Accelerating FemTech: Accelerate, a 10-week support programme is for small / medium-sized companies (SMEs) from across the UK, that have early-stage innovations addressing current challenges in women’s health.

Find out more

Find out more about Accelerating FemTech

Visit the Accelerating FemTech Webpage

Making Diabetes Self-Management Accessible Across South London

As part of Type 2 Diabetes Prevention Week, Faye Edwards, Senior Programme Manager for diabetes at the HIN, writes about the HIN-backed services which are helping improve access to essential support for people living with diabetes.

For those working in the NHS, particularly primary care, the ever-increasing number of people diagnosed with type 2 diabetes can feel like an uphill climb that just keeps getting higher. Across south London around 180,000 people are living with diabetes, over 120,000 have non-diabetic hyperglycaemia (pre-diabetes), and many more people are undiagnosed.

"For those newly diagnosed with diabetes it can feel overwhelming, confusing and even isolating."

For those newly diagnosed with diabetes it can feel overwhelming, confusing and even isolating. As with any new diagnosis it can take a while for people to understand the implications, and how they should manage their future health. Diabetes education and personalised, supported self-management are vital in the prevention and long-term management of type 2 diabetes, which is why they are priorities for the NHS.

The Health Innovation Network has had a focus on diabetes since 2014 and during our work with local people the importance of access to diabetes education and peer support became really clear. In 2017 the HIN convened the 12 south London clinical commissioning groups to collaborate and create Diabetes Book & Learn, a service to help people access diabetes education wherever they choose in south London. This cross-boundary working is a great example of how commissioning can enhance patient care and deliver a wide choice of options, achieving an economy of scale that would be impossible to deliver alone.

Across south London the Diabetes Book & Learn service provides people with type 2 diabetes with a wealth of education options, including group sessions led by a specialist diabetes dietician or nurse, delivered in person or online, depending on individual preference. These group courses include the DESMOND and X-PERT HEALTH programmes, both of which are well established, quality assured  type 2 diabetes education programmes delivered by trained educators. It also includes HEAL-D, which is a culturally-tailored type 2 diabetes education course for people of African or Caribbean heritage, created in partnership with members of the African and Caribbean communities in south London.

Book & Learn Digital also has a range of options that provide diabetes education and self-management support via a mobile app or telephone. These include the Low Carb Program, which provides structured education, coaching and support on how to self-manage your type 2 diabetes and uses AI to provide personalised recipe and exercise suggestions; and Second Nature, which uses behavioural insights to support people with type 2 diabetes to make lifestyle changes and gain knowledge of self-managing the condition.

Image

Image

Image

Image

Image
Screenshot of diabetes book and learn homepage. Large header image of South London overlaid with a search box. Main text reads: delaying your diabetes education means delaying better health. Book your covid-friendly type 2 course today.


Since the launch of Diabetes Book & Learn in 2018 the we have continued to support its development. During the pandemic we support the ICBs with the procurement of new digital services and facilitated the switch of in-person sessions to online delivery, keeping the service going when many other similar services in the NHS had been temporarily stood down. Since Diabetes Book & Learn began, over 14,000 people with type 2 diabetes have been booked into a diabetes education course, with over half of these people choosing our digital or online options.

The establishment of Diabetes Book & Learn at scale across south London provides an unrivalled choice of education options for people with type 2 diabetes. It is playing a vital role in simplifying access to key self-management support and encouragement, and is equipping people with type 2 diabetes to take control of their future health and wellbeing. No one with a diagnosis of type 2 diabetes in south London should feel overwhelmed, confused or isolated by their diagnosis: Diabetes Book & Learn is here to help.

Find out more

People with type 2 diabetes who are registered with a south London GP practice can self-refer at the link below or call our friendly call centre team on 020 3474 5500. Any health care professional can make a referral via our website, call centre or via their practice IT system.

Diabetes Book & Learn

Making time: using technology to make clinicians’ days better

HIN Chief Executive Rishi Das-Gupta writes about the potential of technology to reduce pressure on the NHS workforce.

The current industrial action by doctors and nurses is a symptom of a much deeper underlying problem which goes beyond pay, and the workforce crisis isn’t just that we don’t have enough staff. Our jobs have become much less human and ironically the way out may be through using technology better (and making it more fun) – giving us back time to care and improving our experience at work.

Workforce challenges

There are several complex factors that I think have led to a reduction in satisfaction, but among them are changes in working patterns and teams, increased workload and the need to use non-intuitive technology.

Firstly, we have been successful over 20 years in reducing the number of hours worked by clinical staff but often this has meant moving to a much more fragmented way of working with less continuity of care for patients and less satisfaction for medical staff. In addition, clinical staff now work with an ever-changing team and it’s harder to form the deep-peer support relationships.

Secondly, the workload has been increasing and we’ve had a 40 per cent productivity increase over the last 20 years in some areas.

Finally, poor interfaces for medical technology mean that new products and devices require training to use. This means that, rather than making clinicians’ lives easier from the outset, their adoption can be a struggle. Having spent some time looking at technology to support clinicians I believe that the next generation of technology can support our workforce in all three of these factors.

The four most promising uses of technology in my opinion are:

  1. Intelligent automation of note-taking and transcription tasks to make time to think;
  2. Scheduling staff and working patterns to make time for our lives;
  3. Remote working and communications technology to help at times of overload; and,
  4. Training and wellbeing support to prepare us to make the most of our time.

I will now briefly highlight the potential of each area with an example and I’ll expand each area in future blogs (depending where you’re interested)!

1. Intelligent automation

Firstly, the way we interact with computers to do day-to-day tasks is changing rapidly and some of the technology suppliers are using data from systems to improve the usability and staff satisfaction with their products – but this will take a product cycle (several years) to come to market. However, many of the processes we have are repetitive and require high levels of attention to do well. This is where we should be applying supervised intelligent automation (IA).

An example of this is automated note-taking in outpatients. I recently saw a prototype from Nuance for listening to a consultation in the background, transcribing this and using the transcript to populate a clinical note in an outpatient setting. This means talking as if there is an AI assistant in the room supporting us to write a clinic note. Voice interfaces and large language models (LLMs) are developing fast and have got a lot of press recently, but I think that the first application to clinical practice might be in note taking.

If we do this early, we’re likely to end up with products that suit our practices in the UK, and I can see advantages in partnering across the NHS with a tech provider to develop something to suit our needs. My hope is that if I’m a patient sitting opposite a doctor using this type of technology, they’ll look me in the eye and have time to think and to focus on me during a consultation.

2. Working patterns

Secondly, having moved to shift patterns and rolling-rotas, our ability to plan our lives has reduced. If I’m invited to wedding in December, I don’t know if I can attend. I recently saw a new product from Lantum designed to use artificial intelligence to fit rotas based on local rules to generate compliant rotas and enable swaps between people on the rota. Technologies like this offer the promise of more control over the trade-offs we make in our work-live balance.

3. Remote working

Thirdly, remote working and communications technology offers the ability to support us in real time but also the risk that we’ll always be working/available. We’ve all got used to zoom and phone calls for support but there is more we can do to have integrated communications that route calls to the right person to support us and to others if they are busy. The opportunity I see here is to support each other when the workload is really high or we need help to know what to do. This technology has been around for a while, but I’ve previously thought it suitable for deployment only by large organisations. At the Health plus Care show in April there were several companies with products addressing this including in assisted living facilities and care homes where I saw a demo of the Ascom solution which integrated an easy patient interface (using Amazon Alexa devices) with a clinician platform that meant that all calls can be prioritised. This need is reflected in the fact that a requirement for improved communications platforms has also been included in the new contract for GPs for this year.

4. Training and wellbeing

Fourthly, during the pandemic we saw a lot of training move online and we’ve been learning from this experience and adding well-being support to our staff development and support offers. Online and hybrid training can be delivered on-demand or at specified times in groups or alone. However, in addition to traditional training we’re also seeing other staff offers being delivered using non-face to face platforms such as mental fitness by Fika or meditation through apps like Headspace which were made available to NHS staff over the pandemic period.

This list isn’t exhaustive but I think outlines why I have hope that we could improve staff experience using technology that exists now… and the even bigger potential win would be embedding all this in a universal NHS staff app I could carry in my pocket that would integrate these features and my staff passport documents!

Staff experience impacts patient safety and evidence shows that Trusts delivering the best care have tended to also record high performing staff survey results. With tools like this I think that staff satisfaction can be impacted in months – and we need to measure it during that timeframe. NHSE has launched a shortened quarterly (NQPS) and monthly versions of the staff survey it used to publish annually (we are trialling the monthly people pulse survey at HIN) and I think it’s time we reframe the conversation about our work to bring staff experience and staff satisfaction to the forefront, alongside patient outcomes, and that we use metrics like productivity/throughput as measurable by-products of happier staff.

Although it’s easy to highlight shortfalls in the current approach I think we are at a point where we can see concrete ways to improve staff experience and to demonstrate the impact of this (and spread learnings fast) to improve the lives of hundreds of thousands of people working in health and care over the next year.

Can we help you tackle a workforce challenge?

The Health Innovation Network works closely with health and care teams in south London and across the country to develop skills and capabilities through a variety of programmes.

Get in touch

Putting LGBTQIA+ Service Users First: What we learnt from our queertech roundtable

The Health Innovation Network recently hosted a roundtable event bringing together leaders from the health and tech sectors to discuss the challenges and opportunities in designing health technology for the LGBTQIA+ community. Karla Richards, Innovation Project Manager at the HIN, writes about what we learned.

The potential of new technology to widen and improve access to healthcare can barely be overstated, but in a fast-moving world there is a tendency to create solutions which work for the “average” person, meaning minority groups with specific health or access needs can be overlooked.

This is particularly true for the highly diverse LGBTQIA+ community, which encompasses a broad range of identities and cuts across nearly all sections of society. If the tech sector mantra is “move fast and break things” then we need to ensure LGBTQIA+ people are included from the outset.

In March 2023 the Health Innovation Network hosted a roundtable event with leaders from the health and tech sectors with an interest in queertech to share learning and best practice in designing queer-focused services and overcoming the challenges faced by innovators in this sector.

Attendees from the NHS included senior leaders from trusts and integrated care boards, and representatives from local authority public health teams. We were also joined by representatives from the third sector, LGBTQIA+ mental wellbeing apps Kalda and Voda, and LVNDR Health, an LGBTQIA+ platform offering sexual healthcare and wellbeing services.

Here are some of the key themes to come out of the discussion:

    1. Using language appropriately

    The terminology around sexual orientation and gender identity is constantly evolving and there is no universally-accepted term for LGBTQIA+-focused technology - even the term queertech is off-putting to some. This can lead to a fear among some service providers of getting it wrong and causing offence, but there was recognition that this is a complex area, with a considerable degree of personal preference, and that it’s not possible to get it right all the time. Positive engagement with the community and person-centred service design is more important than getting the language exactly right.

    2. The importance of data

    Data is the lifeblood of the digital economy, and reliable, consistent, and thorough data allows services to precisely meet the needs of populations and improve efficiency. However, some patient management systems do not accommodate all identities, or produce errors when combinations of data are provided that don’t meet hetero or gender-normative standards. On occasion this can lead to individuals being refused access to the care they need without being misgendered or misrepresented on clinical systems; for example trans or non-binary individuals who may need to access gynaecological and breast care services.

    Cyber-security is of course always essential, but an additional level of sensitivity is needed when asking about and storing information linked to sexual orientation and gender identity. However, this can also mean that data collected at sexual health services may be difficult to access for population health databases and that research linking specific health risks to sexual orientation or gender identity may be limited.

    3. Queer services are not just for cisgender white men or sexual health care

    When considering the needs of the LGBTQIA+ community, there is a tendency for health care commissioners to focus on cisgender white men and limit their considerations to sexual health services. This perpetuates stigma and stereotypes of sexual promiscuity amongst gay men and continues a lack of visibility and understanding of the unique health needs and experiences of the wider LGBTQIA+ community. When services are only designed for one part of the population this sends a message that other populations are not valued or welcomed in the health care system. This can discourage people from seeking out the care they need and exacerbate existing health disparities.

    4. Co-design

    The only way to ensure services meet the full needs of LGBTQAI+ people is to ensure they are involved in iterative design of services from the start. This include reaching a broad spectrum of LGBTQIA+ people which cuts across other demographic groups to ensure specific needs are met.

    5. Barriers

    Continued discrimination and phobia

    Unfortunately, some participants had experience of institutional discrimination, in which their concerns are not taken seriously or adequately resourced by decision makers, leading to a lack of trust and disengagement from the community. Digital and technology solutions can create safe and inclusive spaces by allowing individuals to access care from the comfort of their own homes, connecting them with supportive communities, and offering resources that are tailored to their unique needs.

    Concern about re-enforcing stereotypes

    Another challenge is the need to examine specific issues (such as the higher levels of mental ill health and suicide across LGBTQIA+ people) without reinforcing stereotypes.

    Digital exclusion

    There was also concern that potentially effective digital solutions may be less likely to be commissioned due to fear of excluding those without the skills or resources to access them. While digital exclusion is an important consideration, this needs to be weighed against the benefits of designing services which can make service access quick and easy for the majority. Doing this can help free up resources and staff time for more complex cases through traditional pathways.

    Data exclusion

    Current approaches to reporting and data often mean that people are either not given the opportunity to share information on their sexuality or gender or do not feel safe in doing so. This means the needs of the LGBTQIA+ community are not considered when designing or improving services.

    6. Addressing queertech challenges benefits other groups

    While the focus of the discussion was on improving services for LGBTQIA+ people, some of the issues discussed apply to other minority groups including lack of prioritisation from institutions and the need to involve end users in service design. Similarly, addressing concerns around data management can help people including refugees and those fleeing domestic violence.  


    I would like to thank everyone who came along to this event and participated in such a lively discussion. I have not been able to capture everything which was said here but this hopefully offers a taste of the challenges faced, and the enthusiasm which exists to help overcome them. There was consensus on the benefit of having a forum to share learning and an appetite to do more of this. As such we will continue to hold similar events in future and look forward to sharing our learning with you.

    Applications Open for the HIN’s First Diabetes Quality Improvement Programme

    Think-Diabetes

    The Health Innovation Network has launched a new Diabetes Quality Improvement Programme to develop clinical skills and knowledge to help improve outcomes for patients in south west London who have or are at risk of developing type 2 diabetes.

    The South West London (SWL) Diabetes Quality Improvement (QI) Programme offers GP practices help to make improvements to their diabetes care, by providing practices with practical support from a facilitator with a clinical background, to review their approach to diabetes care, and create an action plan for quality improvement.

    Did you know?

    • The average practice spends £1m on patients with diabetes every five years
    • A fifth of type 2 diabetes patients can account for almost half of all practice type 2 diabetes patient consults

    • On average only 35 per cent of diabetes patients in SWL achieve the three NICE recommended treatment targets (HbA1c, cholesterol and blood pressure)

    This will be supplemented by a series of webinars to refresh clinical knowledge around diabetes and update on local guidelines and referral pathways. The webinars will also share examples of excellent practice from south London and beyond.

    This programme builds on work that has been developed with the involvement of healthcare professionals across South West London, and tested locally at a small number of practices. Recognising the interconnected nature of cardiometabolic disease the ambition is to scale this as a multiple long term conditions approach in future years, and within the programme this year we will also provide access to learning and tools which are applicable to support all people living with cardiometabolic health conditions.

    We are in the process of applying for CPD accreditation for this programme.

    “We are delighted to be working with South West London to help them scale and spread the great work they've been doing in diabetes care through this new Quality Improvement Programme. This initiative will call on local clinical experts and facilitators to help practices improve care for the population and access the latest innovations in the area."Oliver Brady, Programme Director for Long Term Conditions and Mental Health

    Benefits to practice:

    • Efficiency – a reduction in the cost of diabetes care through improved processes
    • Refreshed clinical knowledge and improved staff experience of care
    • Support achieving financial incentives, eg QOF targets for diabetes
    • Exploration of new models of care

    Benefits to the diabetes population:

    • Patient satisfaction through streamlined processes
    • Better health and quality of life outcomes for people with diabetes and other long-term conditions
    • Increased engagement of patients with their healthcare

    Requirements

    • Applications for this programme have now closed.
    • The programme is open to all SWL GP practices. There are 40 places available which will be allocated on a first come, first served basis.
    • There is no cost but participating practices are asked to commit to:
      • attendance at learning events and webinars
      • formation and meeting of a practice ‘diabetes working group’ (DWG)
      • meeting with your improvement facilitator
      • practice senior support and sign-off

    Details

    • The programme starts on 21 June
    • The programme consists of:
      • five learning events and webinars;
      • practical support for your practice from improvement facilitators;
      • six optional clinical webinars
    Applications for this programme have now closed.

    Questions?

    Get in touch for more information about our Diabetes Team and their projects.

    Contact us

    Improving Care for Inflammatory Bowel Disease Under Challenging Circumstances

    Dr Rishi Goel writes about how a HIN innovation grant is helping to improve care for inflammatory bowel disease, and how the new service has been co-designed under challenging circumstances. Rishi is Consultant Gastroenterologist and Kingston Lead for IBD Services.

    Approximately half a million people in the UK are living with inflammatory bowel disease (IBD), with numbers rising. The chronic condition has high rates of morbidity, and can lead to poor mobility and a significant need for self-care. It can also prevent people from engaging in usual activities, as well as causing discomfort, pain, anxiety and even depression.

    IBD can behave unpredictably and patients may struggle to access care when they need it the most, such as when the disease flares up. This increases the likelihood that patients will go to emergency departments and GPs, rather than specialists, when urgent care is needed. On this basis, the case for improving care for people with IBD is clear.

    In 2021 we won a HIN innovation grant for a project to improve access to IBD care. Not only was staff time constrained by the pandemic response, but social distancing rules completely changed the way people access care. Since then, the ongoing staffing crisis and pressure on services have made it very difficult to find the time and space to push the project forward, but have made the case for improving access to care stronger than ever.

    Research findings

    • 80 per cent of patients wanted communication via digital means
    • 75 per cent wanted a mixture of face-to-face and remote consultation
    • 75 per cent wanted to be reviewed within 48 hours

    Designing a service which meets user needs

    We adopted a co-design approach to ensure that the new service met patient needs as much as we possibly could. This included a patient survey and holding a patient engagement and co-production workshop attended by 20 patients. Results of the survey showed that 80 per cent of patients wanted communication via digital means, 75 per cent wanted to be reviewed within 48 hours and 75 per cent wanted a mixture of face-to-face and remote consultation. This valuable information gave us a direction and we sought to redesign the care pathway along these lines.

    We created a digital portal using software from Zesty with the aim of putting care directly in the hands of patients. The top priority from patients was getting a quick response with advice when having a flare, and this was something we have tried to address. For the first time, the portal enables patients to log in and access help when they need it most, as well as accessing their records and results, and enabling direct messaging with healthcare professionals.

    The aims are to reduce the burden on outpatient appointments and provide a more proactive way to manage patient care, as well as educating patients on how to manage their condition themselves while still being able to access specialist help when needed. The hope is that patients no longer need to wait for conventionally-scheduled outpatient appointments which rarely coincide with disease activity or a need for care.

    The healthcare team will also be able to send prescriptions, alerts and appointment reminders, reducing the cost of missed appointments. In addition we hope it will minimise administrative burden and reduce pressure on over-stretched services.

    Looking forward

    We hope that the project will improve satisfaction with services, access and education about IBD, while reducing trips to hospitals, hospital admissions, length of stay and days off work for patients. We really appreciated the support we got from the HIN in getting to where we are now.

    While the project is ongoing, initial feedback is positive. We have been able to change and improve the patient pathway for IBD in a way which focuses on the specific needs of this condition, and did so against some extremely challenging circumstances. We are continuing the rollout of the platform, and when this has concluded we will evaluate the new service fully, with hopefully some positive results to share.

    HIN projects shortlisted as finalists for HSJ Digital Awards 2023

    We are delighted to announce that three projects involving the Health Innovation Network have been selected as finalists for the HSJ Digital Awards 2023.

    HIN programmes shortlisted for the prestigious awards include diabetes-focused projects HEAL-D and the Diabetes Prevention Decathlon, whilst DigitalHealth.London’s Digital Fellowships were also nominated.

    Award submissions were reviewed by a specialist judging panel against specific criteria that includes ambition, outcome, spread, value and involvement.

    DigitalHealth.London’s Digital Fellowship Programmes have been selected as a finalist for the Digital Literacy, Education and Upskilling Award. DigitalHealth.London is a programme delivered by Health Innovation Network in partnership with CW+, MedCity, UCLP, and other partners. DigitalHealth.London’s 12-month Digital Fellowship Programmes support NHS staff to lead transformation projects underpinned by digital innovation.

    The Digital Pioneer Fellowship has supported 97 Fellows from 45 NHS organisations across London and the south east, and national organisations including NHS England. It is estimated that over 10 million patients and 140,000 NHS and social care staff have been positively impacted by the projects of the 37 Fellows from the most recent cohort supported by Boehringer Ingelheim.

    The Horizon Fellowship, run in partnership with CW Innovation, is supporting 15 individuals within Chelsea and Westminster Hospital NHS Foundation Trust with transformation project ideas to improve patient care.

    All 112 projects undertaken by Digital Pioneer and Horizon Fellows so far have led to improved patient care and/or experience either directly or indirectly. This scaleable programme is ideal for trusts and ICSs looking to boost their digital transformation capacity and capability. The team is also keen to run more Digital Fellowship programmes. If you would like to get involved, please get in touch with Sara Nelson on sara.nelson3@nhs.net.

    The Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online programme supported by the HIN has been selected as a Finalist in the Reducing Health Inequalities Through Digital Award category. HEAL-D is a self-management education programme for adults living with Type-2 Diabetes (T2D) from African and Caribbean heritage that is delivered digitally through a video-conferencing platform. The programme was developed to address inequalities in T2D structured education attendance and outcomes among black African and Caribbean adults through improvements in access and experience. The seven-week curriculum combines lifestyle education and physical activity to support the adoption of healthy eating habits and lifestyle changes. HEAL-D was co-designed in partnership with people from the African and Caribbean community to ensure appropriate cultural tailoring and acceptability for people with diabetes and healthcare practitioners.

    The programme enables peer support, physical activity and cooking sessions to be delivered in a virtual classroom. Participants also have access to online exercise videos to encourage regular activity, videos to reinforce programme messages, and resources about diabetes and the importance of making lifestyle changes.

    HEAL-D Online demonstrates the importance of collaboration and how co-design is integral in helping people to be empowered in taking care of their health. It explores how digital tools can support the spread and adoption of innovative culturally tailored programmes. This digital solution allowed the programme to be delivered during a period when most diabetes-structured education programmes were paused, and the impact of Covid-19 was disproportionately affecting people with diabetes and from minority ethnic groups. The lessons learned from HEAL-D Online around flexible delivery will also help guide other programmes supporting the management of long term conditions.

    In the Empowering Patients Through Digital Award category, our diabetes Prevention Decathlon (PD), run in partnership with South West London ICS and Sweatcoin, has been shortlisted as a Finalist. The aim of this programme was to create choice and provide more opportunities for people to access a preventative structured education programme.

    A cross-organisational team created an exciting programme consisting of evidenced-based health and wellbeing information, a digital companion app (Sweatcoin) and in-session physical activities. Sweatcoin also offers weekly quizzes and a variety of videos including content recap and a pre-recorded at home workout programme.

    The programme has supported many of the 68,000 people in south west London who are at risk of developing Type-2 Diabetes. Delivered over a 10-week period, PD is unique compared to other prevention programmes as it allows participants to achieve rewards through physical activity attainment by using the specialist digital companion app. Through collective motivation and healthy competition, the Decathletes are able to work with their peers as part of a team, have fun and build meaningful friendships.

    Mark Edginton, Director of Operations at the HIN, said:

    “It is fantastic to see our programmes being recognised as part of the HSJ Digital Awards. All three of the projects nominated are great examples of the types of work we pride ourselves on – collaborating with our partners and local communities to ensure the real-world impact of technology and innovation on patients is maximised.”Mark Edginton, Director of Operations, HIN

    The HSJ Digital Awards Ceremony will take place on Thursday 22 June 2023 in Manchester.

    FeNO Devices Available at Discounted Cost to Practices and PCNs

    The NHS have received long-term loan offers of FeNO devices to improve access to lung function testing in primary care/the community. This initiative can support the mobilisation of quality-assured Respiratory Diagnostic Hubs (see the Respiratory Diagnostic Specification - February 2023) which aim to bring timely and accurate diagnoses, in line with the aspirations of the NHS Long-Term Plan.

    The FeNO devices are being offered by two suppliers: Circassia (NIOX VERO device) and Intermedical (Bedfont NObreath device).

    The business models for the two suppliers are quite different - a comparison of the two devices is available here. Local teams should consider which device offer is most suitable. Both offers require a three-year contract with the supplier:

    • Circassia: three-year loan agreement:
      • NIOX VERO - free of charge
      • Commitment required to buy minimum 100 test kits annually (£970 + VAT in year 1, £1060 + VAT in years 2&3)
      • No annual service required
    • Intermedical: three-year loan agreement:
      • Bedfont NO breath - £795 + VAT in year 1 (for the device and 50 mouthpieces), 695 + VAT in years two and three (device only)
      • Annual service included (normally £150 + VAT)
      • Further boxes of 50 mouthpieces (£175 + VAT) available as required, however no minimum annual order.

    View the NICE diagnostic guidance.

    Please note that both devices are also available to purchase outright. Local teams should undertake due diligence to inform which device offer should be pursued.

    If you're interested in accessing these long-term loan FeNO device offers, in south east London please speak to Cheryl Leung and in south west London, please speak to your relevant borough lead.

    Introducing Lived Experience Partners at the HIN

    In 2022, the Health Innovation Network launched an Involvement Strategy that represents a refresh in thinking and effort to co-produce health innovation. Part of this strategy was a new Lived Experience Partner role and we are delighted to have successfully appointed two partners, Faith Smith and Aurora Todisco. Faith and Aurora are working with us to advise on involvement activities within our projects, expand our community networks and support other experts by experience and service users who work with us. Their role is fundamental in supporting us to embed involvement within our organisation.

    As people with extensive experience of the health and care system and involvement activities in this space, our partners are looking forward to bringing their specialist knowledge to the table and informing the development of our co-production work. Faith has worked with local and national involvement initiatives including being on the South London and Maudsley (SLaM) involvement register which focuses on mental health. In this role she regularly provides staff training and supports recruitment processes. More recently, Faith has supported the development of the Seni Lewis Training Programme for SLaM staff to prevent and manage challenging behaviours in the mental healthcare setting.





    I'm very much a people's person, and I think a lot of what I do is because I want others to be empowered to have their voices heard.

    - Faith Smith, Lived Experience Partner

    Faith is no stranger to the HIN, having already worked with us on our Mental Health Safety Improvement Programme, and she is delighted to be able to share her expertise at a more strategic level.

    Aurora has also previously worked with us and was part of our lived experience reference group who helped to develop our Involvement Strategy. When this new role was introduced, Aurora saw a unique opportunity to use her personal and professional experiences to help inform future engagement activities.





    In this role I'm focused on drawing upon my lived experience to deliver healthcare services from a local and neighbourhood level.

    - Aurora Todisco, Lived Experience Partner

    Aurora has extensive experience of supporting involvement work locally and nationally, and since 2021, she has shared her own lived experiences and taken part in over 350 co-production activities and engaged with over 70 national stakeholders. Her professional background, which covers finance, HR and governance development also complements the role. She currently works with Local Voice, a user-led charity that delivered the service provision for local Healthwatch organisations across north east London and supports resident voices.

    Having started their roles in February, our partners have integrated seamlessly into our organisation and are already in high demand for their expertise. Highlights so far include Faith supporting a workshop developing an e-learning for the Eating Disorders Transitions national programme and advising on focus groups for our HEAL-D programme that addresses Type-2 diabetes health inequalities.

    Aurora’s work has included taking an active role in our experience-based co-design (EBCD) project, which launched as an expansion of our work to help people manage chronic pain, for which she helped co-ordinate a patient-facing workshop in March. She has also given advice on involvement approaches for our Innovation for Healthcare Inequalities Programme (InHIP) with NHS England and has been attending the HIN Patient Experience Champions Club, a space for HIN staff to share their experiences of involvement and learn from each other.

    Both Faith and Aurora are keen to ensure their role has an impact locally at the HIN as well as on a wider scale.

    I'm keen to explore the importance of shared learning and take-up of research , recognising people's different experiences and ensuring that improvements are tailored to specific populations.

    – Faith Smith



    I'm looking forward to helping the HIN become an evidence-led organisation with strong links to the community, represented by people with lived experience.
    – Aurora Todisco

    Involvement is still a relatively new and developing area in the health innovation landscape, and we are hopeful that our approach to it will help to establish a model that can be applied in other health and care organisations. We are proud to be partnering with the people who lie at the heart of the healthcare system first, and hope that this is one way we can make our engagement more accessible, comfortable and a truly safe space for everyone involved. We are keen to be transparent and share both the challenges and successes of our approach, so please get in touch if you would like to hear more.


    I wish to be seen as a critical friend around the table where we discuss health care improvement and innovation, helping to keep track of changes and impact at governance level.
    – Aurora Todisco


    I feel very welcome at the HIN, and confident in the fact that my contributions are valued and taken seriously.

    – Faith Smith

    Find out more

    If you would like to know more, please contact Sophie Lowry, Implementation and Involvement Manager.

    Get in touch

    Meet the innovator: James Aitman

    In this edition, we catch up with James Aitman, CEO of JifJaff, an independent, intelligent automation consultancy that helps clients make the best use of their investment in automation.

    Tell us about your innovation in a sentence:

    JifJaff is a highly scalable (practice and PCN to ICS) tailored automated replication of both clinical and administrative workflows for primary care, delivered as a service.

    What was the ‘lightbulb’ moment?

    My light bulb moment was "on a basic level", having had a generic blood test that showed no issues. I rang my practice to find out my results, and in doing so, blocked other patients from calling and used an administrator's time to take a message. Then the practice had to allocate more time by booking a call to tell me there were no issues. In the call, I was also told a clinician had reviewed the results.

    I put the phone down, looked at the report and thought we could make something to read the results and make a predefined (clinically-led) decision if a follow-up is required. If not, the system could automatically generate an SMS to let me know everything is fine and I don't need to call. We can free up clinical and administrative time and support improved patient care. That was the catalyst to review multiple clinical and administrative tasks that needed to be done in primary care and automate them as much as possible. It was a busy two years of research!

    What three bits of advice would you give budding innovators?

    1. Know your market

    2. Take the time to understand the problem you are solving

    3. Be patient and do things properly

    What’s been your toughest obstacle?

    Finding the people that need our products.

    What’s been your innovator journey highlight?

    Seeing our clients’ faces when they watch their mouse move around the screen, following clinically led rules to safely do the work for the team. They see how using our tailored automation products can improve patient care, free clinical time, lower cost and enable them to spend more time focusing on patients that require support rather than admin—reviewing blood tests, coding, filing, LTC, repeat prescriptions, patient registrations and more. This helps people to understand that the products don’t have to only be used at the practice level but can also easily be scaled to PCNs, Federations and ICSs.

    Best part of your job now?

    Meeting new people and designing new automation for healthcare.

    If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

    Access to more funding!

    A typical day for you would include…

    Showing demonstrations and sitting with our innovation hub, having our products reviewed by practice owners, PCN directors, management at federations and strategic ICS leaders.

    You can find JifJaff on Twitter and LinkedIn.

    JifJaff are holding an invite-only private event in London on Thursday 27 April to build awareness around the automation work we do nationally in primary care. The event is for senior members of staff with responsibility in primary care (ideally ICS/ICB/Gov/NHS) to showcase the art of the possible with hyper automation at scale.

    Places are limited to 15 people and going quickly, so if you or any of your networks would like to attend, please register here.

    Simulation Labs: Creating a Space for Constructive Failure

    We hear from Dr James Woollard about the importance of failure in innovation, and how HIN-funded simulation labs have helped create a space for this. James is Consultant Child and Adolescent Psychiatrist, and Chief Clinical Information Officer for Oxleas NHS Foundation Trust and the National Specialty Adviser for Digital Mental Health at NHS England.

    Adopting new ways of working after many years of practice can be daunting for a healthcare professional: “What if I/we get it wrong?”. Harm to a patient or patients, a complaint, an investigation, a referral to the professional regulator and personal harm immediately come to mind. This is compounded by resource pressures, whether financial, psychological or physical, which contribute to a sense of not being able to “afford” to get it wrong.

    This is at odds with the almost universally-accepted principle that when it comes to innovation if you don’t ever get it wrong, you will never get it right. There are many accounts from successful innovators of the role of failure in their success – thinking slowly about failing quickly is their approach. Yet the NHS’s natural and understandable aversion to risk can, ironically, lead to further failure in lots of small ways and occasionally, tragically, in some very big ways.

    If we have no dedicated space for failure, then every space becomes prone to failure.Dr James Woollard

    Creating space and time for failing safely is critical to other high-performance, high-risk industries. If we have no dedicated space for failure, then every space becomes prone to failure. One way we can enable this is through simulation. Simulation spaces have been adopted in healthcare professional training, for example around high-risk situations like resuscitation. However, they have not yet been widely applied to the adoption of new digital health technologies (DHTs) in clinical practice. I recently heard an innovator aptly describe the NHS’s adoption methodology for DHTs as “spray and pray”.

    With this in mind, Dr Victoria Betton, Dr Asanga Fernando and I applied for funding from the HIN to run a pilot of simulation labs to help mental health professionals to become more comfortable talking about digital health technologies with patients and carers.

    The project brought together simulation experts, clinicians, technology owners and digital clinical leadership to produce a range of insights for different users. Clinicians found it helpful to play with and experience different approaches for talking about technology with patients. Furthermore, they also understood how to make the best use of technology as part of that process. Tablet computers, for example, are better for shared exploration of an app than the tiny screen of a smartphone, particularly with concerns about social distancing.

    Clinicians wanted app owners to produce more standardised information about digital health technologies that could be used to support this process. They also wanted simulation or trial modes that would allow the clinician to explore an app without having to pretend to be a young person. The digital health technology developer involved in the lab has taken this learning on board and is working on supporting clinicians to have good conversation about their products. For the simulation team, we had further insight in how to organise and run simulation experiences around clinical scenarios involving DHTs.

    As a digital clinical leader, concerned with clinical safety, usability, and evidence for effectiveness, I am keen to continue to develop and use simulation-based approaches at all stages of the innovation lifecycle. By doing this we can ensure we have DHTs that work for patients and clinicians, are safe and deliver good value. As a child psychiatrist, I see we have much to relearn about playfulness as a serious endeavour for learning. I hope we have the courage to “pause and play” through simulation rather than “spray and pray” when it comes to innovation and digital health technology adoption.

    Find Our More

    Find out more about the simulation lab pilot in the full evaluation report.

    Read the Simulation Lab Report

    Accelerating the remote monitoring market through partnership

    The Health Innovation Network and NHS England (London Region) recently held a series of procurement roundtables focused on remote monitoring. In this blog HIN Chief Executive Rishi Das-Gupta and NHS England Regional Director of Digital Transformation Luke Readman discuss how developmental partnerships offer the chance to accelerate the development of this emerging technology.

    “Trust is hard won and easily lost. Any effective partnership needs to have a high level of trust, this means that partners must be willing to work together to solve problems collaboratively, agreeing to work in the best interests of the partnership goals.”

    Healthy relationships need clear boundaries and shared goals; during the pandemic we had to procure remote monitoring solutions at pace, leaving precious little time to build trust and align visions. In London, some remote monitoring suppliers overpromised and underdelivered on the quality and time taken to build and deliver solutions; whilst service expectations were not always realistic which also contributed to the breakdown of some relationships.

    The Health Innovation Network and NHS England (London Region) recently held a series of procurement roundtables, bringing together experts from across industry alongside commissioner and provider organisations to explore a better way forward.

    Given our collaborative approach, it seems fitting that the “red thread” running through these lively discussions was the importance of developmental partnerships and contractually enabled collaboration to achieve our collective goals.

    Some of the tactics discussed in the roundtable report include:

    Early market engagement: Co-defining problems with industry to lay the ground for partnership working through dialogue.

    Developmental contracting: Building the intention to develop a solution into contracting processes.

    Meeting future needs: Creating work packages which account for areas of uncertainty or with the flexibility to respond to “unknown unknowns”.

    Testing via pilots and evaluation: Testing work packages through contracts which build lower-risk pilots into delivery before committing to larger costs.

    Harnessing innovation: Contracting with multiple suppliers to harness innovation in all patient cohorts across a geography, including making use of Dynamic Purchasing Systems to allow new suppliers to join and local systems to articulate their own bespoke needs.

    We are delighted to share the initial outputs of our roundtable events.

    Further guidance and recommendations looking at how to procure and contract for partnerships can be found in our full report released in April 2023.

    Applications open for HIN and My Home Life’s Care Home Pioneer Programme 2023 Cohort 5

    The Health Innovation Network (HIN) and My Home Life England are delighted to announce the fifth South London Care Home Pioneer Programme – a leadership support and professional development programme delivered free of charge to Care Home Managers, Deputies and Senior Nurses to advance their skills, facilitate personal growth and enable them to effectively manage the complex everyday issues that impact on the quality of their service.

    The programme is now open for applications from care home managers, deputies, and senior nurses, working in the following settings: older person’s residential homes, older person’s nursing homes, learning disability and mental health care settings, and supported living settings, in south London.

    Did you know?

    • Since 2017, 84 managers from 77 care homes in South London have participated in the programme.
    • The Pioneer programme has had representatives from all the South London boroughs.

    The Pioneers programme is a collaboration between My Home Life England and the Health Innovation Network, which has delivered leadership development to 84 care home managers across South London, over 4 cohorts since 2017.

    The Care Home Pioneer Programme uses Action Learning techniques, involving experiential learning through a continuous process of action, learning and reflection, supported by colleagues, with an intention of improving practice. The Pioneers will work alongside mentors from the HIN to deliver a real-world service improvement project in their care home. Previous Pioneer projects have led to significant improvements in local priority areas such as falls reduction or oral health.

    The free programme is jointly funded by care home commissioners and the NHS and will consist of a combination of four face-to-face workshops and nine monthly action learning sets, both virtual and in-person. At the end of the programme, there will be a celebration day to celebrate all that has been achieved.

    If you are interested and want to know more about the programme, click the link here to read the flyer and apply.

    This infographic highlights key feedback from Pioneers who took part in the programme in 2022.


    Table Reads; 2022 Pioneer Programme post-programme survey  Cohort 4’s Pioneer Care Home Leader’s completed surveys following their Celebration Event. This infographic details high level overview of their feedback. *,	92% of respondents stated that… Their sense of achievement had improved 	92% of respondents stated that… Their understanding of how to improve the culture of care had improved, 92% of respondents stated that… Their quality of management and leadership had improved,	92% of respondents stated that… Their confidence as professionals had improved,	92% of respondents state that… The quality of their engagement with staff had improved, My Home Life England and HIN logos,	*Based on 12 respondents

    Pioneer, Cohort 4, Care Home Pioneers, said: “The Health Innovation Network and the support from My Home Life England team has boosted my confidence, skills, and knowledge in working jointly with the multidisciplinary team. The forum that was held has empowered me to exercise the duty of care and leadership while supporting a positive professional working relationship. I aim to maintain the good practice and to continue to grow and develop together with my team..”

    Andrea Carter, Programme Director, Healthy Ageing Team, Health Innovation Network, said: “The resilience and kindness of this particular group shone through and will stay with me for a long time, even after 27 years working in health and social care.”

    You can find some great examples of Pioneer projects that have been carried out by clicking on the following here or alternatively watching the video below.

    Further information

    Find out more about the programme and how to apply.

    Download

    We're here to help

    Get in touch for more information about Cohort 5 of the Care Home Pioneers programme.

    Get in touch

    Nipping it in the bud: helping the NHS treat eating disorders as early as possible

    To mark Eating Disorders Awareness Week, National Programme Manager Jill Owens reflects on the challenges of eating disorders, why it is crucial to treat them as early as possible and how early intervention services like First Episode Rapid Early Intervention for Eating Disorders (FREED) can help.

    Eating disorders are on the rise, with referrals already increasing before the Covid-19 pandemic and particularly pronounced growth afterwards. Hospital admissions for eating disorders have increased by 84 per cent in the last five years, with children and young people especially affected with a rise of 90 per cent. They can affect anyone regardless of gender, ethnicity, age or body size. Tragically, eating disorders have the highest mortality of all mental health disorders.

    I have personally seen how these disorders can fool people into thinking that it is a protective factor – providing either control or comfort. It can also be very secretive and isolate a person from those who want to help them. Recognising difficulties with eating and taking those first steps to find help takes courage and strength, but it is worth it because healthy eating habits help us live full and happy lives.

    The phrase ‘prevention is better than cure’ - attributed to the 15th Century Dutch philosopher Erasmus - seems so logical that it’s hard to imagine a time when this sentiment wasn’t commonly used.

    However, eating disorders are one group of illnesses where the causes and triggers can be so diverse that universally effective prevention is hard to find. If we can’t yet prevent people from developing eating disorders, what can we do?

    We know that eating disorders cause changes in the way a person thinks and feels, which become harder to reverse over time.

    Fortunately what we do have is the ability to tackle them as early as possible with the right tools, support and awareness. There is growing evidence that the earlier we act to provide help to people with eating disorders, the better their chances of recovering quickly and living their lives to their full potential.

    We know that eating disorders cause changes in the way a person thinks and feels, which become harder to reverse over time. While recovery is possible and well worth aspiring to at any stage, a “golden window” for starting treatment of about three years from the onset of the disease seems to deliver the best long-term results. To get treatment as early as possible, people need to be able to spot the signs in themselves or others and know where to go for help.

    At the HIN we have been proud to lead the spread and adoption programme for early intervention in eating disorders since 2020, a programme which has been coordinated by the AHSN Network. As National Programme Manager I have been thrilled to work with people who see the importance of early intervention, and to be part of a programme which has benefited so many people.

    The model for the programme is First Episode Rapid Early Intervention for Eating Disorders (FREED). FREED supports early interventions for people aged 16-25, the most likely age to develop an eating disorder and a unique time of life where considerable changes take place. FREED uses innovative methods to address the challenges of emerging adulthood and the early stages of eating disorder development, reducing the duration of untreated illness.

    FREED was developed by a team at South London and Maudsley NHS Foundation Trust (SLaM) and Kings College London (KCL) with support from the Health Foundation. The FREED team have been working hard to develop research and evidence to demonstrated the effectiveness of this approach, including studies that show:

    • 32 per cent reduction in wait time from referral to assessment in FREED patients;
    • 59 per cent of FREED patients with anorexia nervosa reached a healthy weight by 12 months, compared to 17 per cent of non-FREED patients;
    • duration of untreated eating disorder reduced from 19 to 13 months.

    At the Health Innovation Network we are delighted that FREED services are now either active or developing across England. All 15 Academic Health Science Networks (AHSNs) have provided time and expertise to support local services in understanding the evidence behind FREED and work towards adoption. The programme is drawing to a close in March 2023, leaving a legacy of increased awareness of the benefits of early intervention, numerous resources to help eating disorder services set up early intervention services, and well over 2,000 young people having received treatment.

    The work will continue to move forward with support from NHSE and leadership from the team at SLaM/KCL, as well as the many specialist FREED Champions and services throughout England.

    If you are concerned about yourself or someone else, please contact your GP. You can also find more information through an eating disorders awareness and support charity, such as BEAT Eating Disorders.

    Find Out More about FREED

    FREED Website

    Healum Personalised Care – Free Licenses Available for GPs

    Funding has recently been made available by the Small Business Research Initiative (SBRI) for Healum licenses for up to 30 GP practices in south London for one year.

    Healum software is interoperable with EMIS and is designed to help patients to make healthy choices which minimise their risk of cardiovascular disease, and reduce pressure on workforces. It empowers staff and patients to work together by providing educational content, self-management tools and patient care plans.

    The care plans are linked to the GP health record and combine clinical and non-clinical recommendations as part of a shared decision-making process that involves staff from across each practice, including GPs, nurses, pharmacists, healthcare assistants, health and wellbeing coaches and social prescribing link workers.

    There are no additional or hidden costs for practices using the system. They are fully covered by the project funding. Practices using Healum will help to shape its development and content, to help it meet the needs of GPs and patients.

    Oliver Brady, HIN Programme Director for Long-term Conditions, said:

    “I am delighted to work with Healum again, this time to support the adoption and spread of their innovative system tailored to the needs of people at risk of CVD and the Healthcare Professionals responsible for their care.” 

    You can find out more about what Healum software can do for your practice on the Healum website. To register your interest please contact Alice Holden at Healum. The HIN are supporting this project as part of the SBRI grant so you can also get in touch with Kristina.

    Please share with any practices who may be interested.

    The Language of Involvement

    Group discussion with woman speaking on microphone

    Involving the public is crucial to ensuring health and care services are designed as effectively as possible. However, it can be difficult to get the language of involvement right. Alice Beaumont, in the HIN's Insights team, shares what we’ve learnt about using appropriate language around involvement and how this can help improve engagement.

    As our principal tool for expression and communication, language can be a vehicle for positive change. However there is a considerable amount of pressure when it comes to choosing how best to convey meaning. This is particularly true in the context of patient and public involvement (PPI) where a range of words and phrases are used synonymously, and the terminology used is not standardised. This can be confusing and has arguably slowed the adoption of involvement in improving healthcare services. At the HIN, we are keen to use terms that people understand and prefer, and this is a challenge that we have grappled with when developing our Involvement Strategy.

    Several of the terms used to define this area of work – particularly engagement, participation, and involvement – are used interchangeably, and other terms like co-production and co-design can add further complexity. In our strategy we use the word involvement as an overarching term to describe activities that actively engage people in AHSN programmes, seeking their feedback and using their insights to inform design and delivery. We see involvement as a way of working where service providers, commissioners and users work together to reach a collective outcome.

    There is a considerable amount of pressure when it comes to choosing how best to convey meaning. This is particularly true in the context of patient and public involvement.

    Within involvement, the idea of patient engagement features heavily. This phrase is generally used to describe the notion of producing more responsive and transparent healthcare systems. In the context of PPI however, the word engagement can be misleading. Unlike in involvement (where it is implied that inclusion is necessary), engagement can indicate that there is little to no expectation of reciprocal action from the participants within activities. The term engagement can also generate confusion between involvement and person-centred care (PCC, also known as care planning), which refers to working in partnership to focus care on the needs of individuals.

    Another word that is frequently used in the context of PPI is participation, which is usually applied specifically to involvement within health research. Additionally, co-production and co-design refer to a PPI process which emphasises the sharing of power and responsibility. While these terms may describe distinct approaches to involvement, they all share the philosophy of valuing partnership and collaboration.

    The challenges of language are not limited to defining the theory of involvement; we also need to be careful when describing the people that we involve. The terms patients and public are often used mutually with words including citizen, consumer, layperson, expert by experience or service user. Choosing between these can spark debate, for example the term consumer is often rejected as it can imply an element of choice, which does not come with an illness.

    Some people we involve dislike being referred to as experts by experience, as they may not see themselves as experts and feel pressured by this description. Similarly, patient is generally accepted in certain contexts, such as when discussing physical conditions. However within the sectors of mental health and intellectual disability, the term service users is more often used, and, where meaning will not be lost, we should simply say people.

    Within the HIN’s Involvement Strategy, we want to involve people with lived experience, which is a widely accepted and inclusive term. On its own, it is unclear what lived experience refers to, but within the context of healthcare, we define it as personal knowledge about healthcare systems gained directly and first-hand, rather than through representations constructed by other people.

    When delving into discussions about what we should and shouldn’t say, it is easy to become confused, or even overwhelmed. It is therefore important to remember that the way we approach involvement, and how we communicate with people and communities, should be primarily judged by the outcomes we achieve, rather than the words we choose to describe it. There is not one right answer when it comes to the language of involvement; all we can do is use tact and sensitivity. If we start by asking people what language they would prefer, and adapt according to the context and individuals, then there really isn’t too much to be afraid of.  

    Find out More

    Find out more about our involvement work in our involvement strategy.

    Read the HIN Involvement Strategy

    Is diversity in the workplace a good thing? (yes, but….)

    HIN CEO Rishi Das-Gupta writes about the importance of diversity in the workplace and the challenges it can present.

    The NHS recently dropped its diversity targets (they are not part of planning guidance for 2023-24) and some MPs and media are waging war to remove the posts which were added to make the workplace fairer and more diverse. While this is understandable in the current cost-constrained environment, diversity within the NHS is essential for providing high-quality, patient-centred care.

    A diverse workforce brings a wide range of perspectives, ideas, and skills that can lead to better outcomes for patients and their families. However, it is important to acknowledge that there can also be challenges associated with having a more diverse workforce. One such challenge is that there are usually more opinions to take into account (which is the point!) and so it can take longer to reach decisions - at a time of crisis this can be frustrating. However, I think that now is a time of change. Including diverse perspectives is essential and we all must get more comfortable fostering disagreement within our teams.

    I temporarily left the NHS to get experience in other industries before returning, so often feel I should speak up when I have a different view. I’ve always been surprised by how uncomfortable this feels in the NHS and call on all our leaders to understand and foster constructive conflict to get to better answers for our patients and staff.

    It is possible to argue that the NHS has one of the most diverse workforces in the world. In London, where I work, providers have people with backgrounds from almost every country in the world and speaking scores of languages. In addition, across the service as a whole we have near equal gender balance (NHSemployers). We bring individual perspectives based on professional background, patient interactions, and personal circumstances. Despite this, some groups are still systematically over/under represented in senior decision making. As the makeup of decision-making groups changes, the conversations can be less comfortable.

    Most NHS discussions start with common values and so if you disagree, you might not be ‘NHS’ enough. I temporarily left the NHS to get experience in other industries before returning, so often feel I should speak up when I have a different view. I’ve always been surprised by how uncomfortable this feels in the NHS and call on all our leaders to understand and foster constructive conflict to get to better answers for our patients and staff.

    When a group of individuals with different backgrounds, experiences and perspectives come together, it can often lead to a wider range of opinions and ideas being put forth. This can be a positive thing as it leads to more thorough discussions and considerations of different options. However, it can also lead to a longer decision-making process as the group works to come to a consensus. Without good discussion facilitation or chairing, this conflict can feel uncomfortable.

    Benjamin Laker and Vijay Pereira explored the reasons for team conflicts in an article in Harvard Business Review published on 31 May 2022 (that was not focused on diversity). However, they highlighted four common causes of conflict from a study of 1,000 managers across 76 companies – and I think that each of these can be exacerbated by diversity in backgrounds, professional experience and communication preferences:

      • Communication difference - 39%
      • Unclear expectations - 22%
      • Unreasonable time constraints - 16 %
      • Opaque performance standards - 14%

      These are all factors which are at play in our discussions in healthcare – and the risk of each of these factors coming into play increases as the diversity of the team increases and as we work across organisations as part of ICS working. It’s even more important as we work under time pressure and there is a need for swift and efficient decision-making.

      It is important to remember that this added time and effort is necessary to make well-informed and inclusive decisions that take into account the needs of all patients and staff. Which brings us to what we can do about it… In my opinion we should:

      • Spend time to outline what our values are (or have them pinned to the wall) and highlight whether a conflict is a result of us having different values or applying our values differently.
      • Spend time being clear about what problems we are trying to solve – my experience is that we always want to solve the problem without clarifying exactly what we understand by it. In a diverse group the chances of having different interpretations of the issues is high. Personally, I value using a problem statement worksheet to tease out the issues.
      • Recognise communication differences – in organisations I’ve worked with this has been done using Myers-Briggs or the Insights Discovery tool. These can be the start of a discussion but other factors are important too.
      • Spend time agreeing actions – and make these clear. Laker and Pereira suggest being clear about what is satisfactory delivery and what is good/above the required level which sounds like a great way to go… but I must admit I’m not always good at doing this!
      • Negotiate the time constraints if you feel this is what is causing frustration – I find the best questions to ask as a manager are “Is that a realistic timeline?” and “What will need to be delayed to get this done on time?”
      • Getting performance standards right in the NHS is harder… In general I think we are nicer than in other industries where I’ve worked. I think it’s important to highlight when performance is below the expected level and have seen this done sensitively with questions to understand why this was. Often, I’ve found it’s because the required outcome was unclear for instance, I might have a different understanding of what a “high-level financial model” is to a management accountant. Less frequently, the person didn’t have the skills and support needed, or there were personal issues that prevented delivery – it’s rare that people’s heart wasn’t in the right place (which I think of as a values issue).
      A diverse workforce brings a wide range of perspectives, ideas, and skills that can lead to better outcomes for patients and their families. However, it is important to acknowledge that there can also be challenges

      In conclusion, diversity within the NHS is a vital aspect of providing high-quality, patient-centred care. However, it is important to be aware that there can be challenges associated with having a more diverse workforce which include the potential for increased conflict within teams, taking longer to reach decisions and that discussions feel less comfortable.

      I think it is important to acknowledge these challenges and that it is crucial to remember that the added time and effort is necessary to make well-informed and inclusive decisions that take into account the needs of all patients and staff. As this is a change and doesn’t come naturally to all of us, supporting our teams and particularly facilitators and managers to foster good conversations is really important.

      So, the gauntlet is laid down! We need to create a culture of open communication and respectful dialogue (and implement effective conflict resolution techniques when things get heated). Together we can work through these challenges and ultimately create a more productive and successful work environment for the NHS.

      Understanding the Importance of Evaluation in Innovation

      Chandra Banerjee recently joined the HIN for an eight-week placement as part of the NHS Graduate Management Training Scheme. Here he writes about what he learnt from working on evaluation and shares advice for other graduates.

      Before joining the HIN, I had worked at a tech start-up, where I briefly came across Academic Health Science Networks (AHSNs). After joining the graduate scheme, I again briefly interacted with an AHSN during my operational placement working on technology implementation. As part of the scheme, I would be doing an eight-week placement at an organisation of my choosing, and due to my interest in innovation and transformation my Director of Strategy suggested the HIN. He put me in touch with Rishi, the HIN’s Chief Executive, to find out more.

      Rishi painted a comprehensive picture of the role AHSNs play in fast-tracking the adoption of new technology, ways of working, and evaluation of programmes. I could see how valuable it was and wanted to be a part of it. From my experiences in implementing electronic patient record (EPR) systems, I knew the importance of robust evaluation of implementation processes and outcome KPIs in sharing good practice, disseminating new technology across the system and demonstrating value for money. Luckily, there was an opportunity to work on evaluation at the HIN.

      I joined the DigitalHealth.London Team at the HIN in November 2022, working on evaluating the Evidence Generation Bootcamp. The bootcamp is designed to help digital health companies get the evidence they need to demonstrate their products are suited to the NHS. The Insight and Evaluation team and other academic collaborators provided guidance how to develop an evaluation proposal and study design through a hands-on approach. I was encouraged to interact with the companies, design the study tools, collect data, analyse it in line with the protocols and formulate my first evaluation piece.

      I’m hugely passionate about the potential for evaluation to drive improvement, and this role allowed me to see first-hand how AHSNs like the HIN can help new products go from development through to implementation. I got a lot of support from colleagues to develop my skills and learned a huge amount which I’m looking forward to applying in my innovation journey within the NHS.

      The AHSNs play a hugely important role but are often overlooked. I would thoroughly recommend a placement at an AHSN for anyone else on the management training scheme. They can help broaden your understanding of bringing products and services into the system, and evaluation is a skill which is relevant for almost any role. AHSNs are also uniquely placed to give you an understanding of the whole spectrum of the health and care system. They offer a chance to work on a wide range of clinical themes at the cutting edge of developments which offer the opportunity to massively improve outcomes for patients.

      Find Out More

      Find out more about the Graduate Management Training Scheme.

      Find Out More

      Working Together to Prevent Cardiovascular Disease

      Supporting the NHS workforce to develop skills and drive improvement is one of the HIN’s top priorities. As part of this we set up the Cardiovascular Disease (CVD) Prevention Fellowship and now we’re sharing guidance to help other organisations looking to run similar programmes. Sophie Mizen, Project Manager for the Fellowship Programme, writes about what we learnt from running the programme and how you help spread the word.

      We set up the Cardiovascular Disease (CVD) Prevention Fellowship to address an area which is a top priority for the NHS. There are six million people in the UK with CVD and taking action to prevent it is the best way of reducing harm and saving lives. With a total cost to the NHS of £16bn per year, it’s also a more efficient way to tackle the problem than treating CVD at a later stage.

      CVD Fellowship Stats

      • 85 participants from all 12 south London boroughs
      • 19 projects in hypertension impacting 21 GP surgeries
      • 14 projects in lipids impacting 22 GP surgeries
      • Three projects in familiar hypercholesterolaemia impacting seven GP surgeries
      • Four projects in atrial fibrillation impacting eight GP surgeries
      • 98 per cent of participants feel more confident in delivering care to patients at risk of CVD
      • 96 per cent are more confident in supporting their colleagues with CVD care
      • 95 per cent think patients at risk of CVD have benefited as a result

      The Fellowship is one of a number of collaborative learning opportunities provided by the HIN to develop skills in the workforce and support the delivery of improvement projects aligned to health and care priorities. This supports our objectives of developing the skills needed to power health and care systems of the future, as well as making an immediate positive impact in areas of need.

      The CVD Prevention Fellowship ran between April and November 2022, and included clinical webinars from specialists in the field, and collaborative quality improvement (QI) sessions where fellows could gain new skills, share learning and work on their own QI projects. The Fellowship was open to all health care professionals in primary care in south London.

      Running the programme presented some challenges – not least because the number of participants was higher than we expected with over 100 initially expressing interest! We also know that clinicians tend to have very limited time, and while the Fellowship was free to join, we were not able to fund back-fill for time taken out of work. As such we had to keep the time commitment to a minimum, and were flexible in our approach to collecting progress updates.

      We also adapted our approach to communication channels as we went. Our used of continuous feedback helped us listen to Fellows' needs and adapt the programme accordingly. As such, we switched our focus from quality improvement theory to practical troubleshooting when we realised this would be more beneficial to the Fellows and a more productive use of their time. We also incorporated some additional sessions such as a webinar on behaviour change in CVD and a drop-in clinic with a specialist going through lipids case studies.

      The response to the fellowship was overwhelming, with over 80 fellows being upskilled in various areas of CVD and quality improvement. The fellows were required to deliver an improvement project in their practice/primary care network, to apply their new skills and knowledge. As part of the programme 40 quality improvement projects collectively impacting a total of 63 GP practices, representing all 12 boroughs in south London.

      Patients positively responded to the work and we received some great feedback on the impact the quality improvement projects had on an individual level:

      Thanks for giving me the information about statins. I did not realise that statins had anything to do with protecting the heart. I just thought it was to reduce cholesterol which I have been trying to do by good diet and exercise. Although sometimes I like to enjoy myself a little and eat the unhealthy stuff, I take my atorvastatin daily and I have not felt any side effects. Looking forward to the next blood test.

      You can find out more about the patient experience in our case study pack which includes information on all the projects.

      Throughout the programme feedback was received on the beneficial impact of education and training. A final feedback survey revealed that 98 per cent of fellows felt more confident delivering care to people at risk of CVD, and 96 per cent said they are supporting colleagues more with CVD prevention. Most importantly, 95% per cent said their at-risk patients have benefited from what they learnt. We also received great feedback from participants – you can find out more in the video below.

      We learnt a lot from running the programme and wanted to share this to make it easier for anyone else thinking of running a similar programme. That’s why we’ve put together a guide outlining our approach, learnings and what we would do differently next time. Please share with any individuals or organisations who might be interested.

      Find out More

      Find out more about the Fellowship and access the resources mentioned in this blog.

      Find out more about the CVD Prevention Fellowship.

      New Funding to Help Prevent Cardiovascular Disease

      Doctor uses stethoscope to monitor heart of patient.

      The Small Business Research Initiative (SBRI) has awarded a total of £3.3 million funding to support initiatives designed to tackle cardiovascular disease (CVD) in England. A portion of the national funding will be used to scale up initiatives in two projects to prevent CVD in south London: Healum patient management software and the CVD Prevention Decathlon.

      CVD is the area where most lives can be saved by the NHS over the next decade. There are 7.6 million people living with CVD in the UK, and it is a leading cause of premature disability, mortality, and health inequalities, responsible for one in four deaths each year. The UK Health Security Agency estimates that the annual healthcare cost of CVD in England is around £7.4 billion, with an annual cost to the wider economy of £15.8 billion.

      SBRI Healthcare, an Accelerated Access Collaborative (AAC) initiative in partnership with the AHSN Network, has awarded a total of £3.3 million to eight late-stage innovations that help detect, prevent and manage CVD.

      Healum is a patient management system that connects to patient-facing digital services. It is designed to improve health outcomes and access to care for patients with long-term conditions, supporting them to make the best choices to live healthier, happier lives. The HIN will be supporting the adoption of Healum in primary care across south London.

      The CVD Prevention Decathlon provides structured education for those at risk of CVD in order to minimise the risk of developing it. It uses structured learning and physical activity delivered by Xyla; gamification via the Sweatcoin app; and personalised behaviour change videos created by Citizen Communications. Funding has been allocated to support rollout in South West London ICS and evaluate the return on investment from using it. This builds on the successful Diabetes Prevention Decathlon – winner of a 2019 HIN innovation grant – which saw 92 per cent completion rates and an average 45 per cent increase in activity levels among participants.

      Ambra Caruso, Senior Programme Manager at the HIN, said: “We are delighted that new funding has been allocated to help tackle CVD in south London. We are looking forward to continuing and expanding our support for Healum and Decathlon to minimise the risk posed by CVD for as many people as possible”.

      Chris Gumble, Project Manager for Long Term Conditions and Prevention at the South West London Health and Care Partnership, said: “We are immensely proud to have the ability to deliver the CVD Prevention Decathlon to our local population, and want to thank SBRI Healthcare for awarding us the funding to do so. Having seen the success of the Diabetes Prevention Decathlon over the last few years, we have an amazing new opportunity to expand the offer to those at risk of CVD. In collaboration with the Health Innovation network, the Prevention Decathlon has grown into something special: 700 people this year will have the opportunity to attend the programme over the coming year”

      SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative – a partnership between patient groups, government bodies, industry and the NHS hosted by NHS England – and is delivered in partnership with the AHSN Network.

      Matt Whitty, CEO of the AAC, said: “The SBRI Healthcare awards help the NHS to develop new technologies and solutions to address some of the biggest healthcare challenges facing society. We have selected these innovations because they have the potential to make a big difference to patients. By supporting the most promising innovations the NHS will continue to evolve, helping meet more patients’ needs and encouraging more innovators to come forward with ideas that make a difference.”

      Find out more about the new funding announcement from SBRI.

      Recommendations for improving perinatal health inequalities: A Darzi journey

      Women and birthing people from Black, Asian, or mixed ethnic backgrounds are significantly more likely to experience poor outcomes during their maternity journey.

      Between September 2021 and October 2022, Darzi Fellow Rosie Murphy undertook work in Croydon to explore these inequalities and what might be done to improve local services.

      This is the second in a series of blogs reflecting on the learnings and experiences from her Fellowship. Read Rosie's first blog focusing on partnering with minoritised women and birthing people and third blog focusing on the challenges of tackling structural issues during fixed-term projects.

      Croydon is an ethnically and socially diverse London borough. Approximately 52 per cent of Croydon residents are from minority ethnic backgrounds and this is representative of the maternity population. As such, it felt a particularly appropriate location to spend time understanding why significant perinatal health inequalities related to ethnicity still exist.

      Over the course of my time as a Darzi Fellow, I spoke with maternity service-users, staff and other stakeholders from across Croydon about the underlying causes of these health inequalities; you can read about some of methods used to involve people and communities in the project here.

      This blog details five recommendations which I hope will support ongoing work in Croydon, but which may also be relevant to other maternity services or health and care services looking to tackle health inequalities.

      1. Acknowledge the role of systemic racism in upholding perinatal inequity and make organisational commitments towards becoming anti-racist

      This subject was raised during one of the earliest conversations I had with a voluntary sector colleague. At the time, she was also working on a project with a neighbouring mental health trust who had made an organisation-wide commitment to become anti-racist. She felt strongly that this was the minimum standard to build trust and engage with the NHS on projects such as this. During my fellowship there has been a catalogue of publications supporting this recommendation including the Black Maternity Experiences survey, the Birth rights Inquiry into Racial Injustice, the Race and Health Observatory (RHO) report on Ethnic Inequalities in Healthcare and the recent Invisible report from the Muslim Women’s Network.

      Of course, it is vital that an organisational commitment to strive towards anti-racism is backed up with a suitable action plan that identifies how this will be achieved - without which, it can serve as a fig leaf to hide inaction.  

      2. Work collaboratively to find solutions and invest in social capital

      Both health and health inequalities are created in the community. The solution to tackling perinatal health inequalities is unlikely to lie within the four walls of a hospital, even if that is where the inequality is being played out. It is therefore crucial that the NHS knows how to work collaboratively with its communities to co-design strategies to tackle perinatal inequalities.

      One of the messages that came across strongly from the conversations at the Whose Shoes event was the need for stronger networks to support birthing people and their families; an investment in local “social capital” for pregnancy and early years.

      The HEARD campaign is currently working on developing a local maternity programme to meet this need. Ideas included developing maternity peer support, training hairdressers to have conversations about the importance of early referral to maternity services to increase community knowledge levels and a Maternity Champions programme.

      3. Invest in effective data capture at a local level

      Capturing accurate data around ethnicity in the NHS can be problematic and unreliable. Although there is enough data at a national level to identify the scale of the issue, we don’t consistently have effective data capture at a smaller scale to evaluate of the impact of local initiatives. Without baseline data, assessing the impact of any programmes is difficult because realistic targets cannot be set and funding for projects is jeopardised.

      However, some localities have developed effective workarounds. For example, in maternity care, when the childbearing parent is booked in at hospital, a family origin questionnaire is completed to facilitate screening for sickle cell disease or thalassaemia. This could be used to also aid a conversation around the importance of accurate ethnicity data for population health monitoring and as such, upskilling midwives to carry this out could be effective.

      Finally, it is important that data capture also considers inequality through an intersectional lens. There is a clear need to improve data capture around other protected characteristics and exclusion health factors in conjunction with ethnicity such as sexuality, religion and deprivation decile or housing insecurity.

      4. Listen, hear and take action

      The theme of not listening to women has been written large throughout the course of my Darzi Fellowship. Accounts of women not having their concerns listened to, or not taken seriously are an omnipresent feature of sequential maternity reports. When women express choices that go against guidelines or medical advice they are often not supported adequately. Action must be taken to better equip maternity staff to have conversations around informed decision making and personalised care.

      Even in circumstances where maternity staff are supportive of women’s bodily autonomy, processes to support fully personalised informed decision-making during labour are not well established. Widespread uptake of new approaches, such as the iDecide tool, are likely to improve the safety, personalisation and experience of labour care.

      5. Invest in staff

      There remains a widespread misunderstanding about what racism is and how it plays out in health settings, so enabling staff to identify this and supporting them to examine their own bias is so important. Locally delivered cultural awareness training would further support increased safety of personalised maternity care.

      A second training recommendation would be to support maternity staff to develop an enhanced understanding and awareness of the role of maternity services in addressing social determinants of health. In maternity services, the perception persists that health interventions such as smoking cessation, weight management and glycaemic control are only required for the duration of the pregnancy. A more long-term view is required to maximise the long term health impact and mitigate against the disparate incidence of chronic disease. Consideration should be given from a commissioning perspective to other opportunities for staff to deliver public health interventions during pregnancy aligned with the prevention agenda. For example, this could be through improving family health and mental health literacy among specific populations.

      For any of these recommendations to be implemented, there is also a requirement to invest in a full-time member of staff with a responsibility focused on health inequalities related to ethnicity. Their role would include engaging with the local community and developing the social capital initiatives, embedding cultural shifts, and ensuring that choice and personalisation are protected in maternity care. They would also be there to deliver training as appropriate, set up mechanisms for routine collections of maternity experience feedback and oversee the implementation of new and improved data capture as described earlier in this blog.

      With enormous thanks to Ranee Thakar, Gina Short, Olamide Odusanwo, Manjit Roseghini, Donnarie Goldson, Mobola Jaiyesimi, Antoinette Johnson, Leila Howe, Gemma Dakin, Alison White, Jay Patel, Ima Miah, Felisha Dussard, Andrew Brown, Tai Lamard, Gill Phillips, Paul Macey and all the birthing families of Croydon who were so generous in sharing their experiences with me.

      Find out more about the maternity and neonatal work happening in South West London ICS.

      Find out more

      Read more about health inequalities in England in the Marmot Review. Originally published in 2010, many of its findings and suggestions are now more relevant than ever for healthcare professionals to understand.

      Read the Marmot Review

      Partnering with minoritised women and birthing people to improve maternal and perinatal outcomes: a Darzi journey

      Women and birthing people from black, Asian, or mixed ethnic backgrounds are significantly more likely to experience poor outcomes during their maternity journey. Between September 2021 and October 2022, Darzi Fellow Rosie Murphy undertook work in Croydon to explore these inequalities and what could be done to improve local services. This is the first in a series of blogs reflecting on the learnings and experiences from her Fellowship. Read Rosie's second blog focusing on key recommendations from the project and third blog focusing on the challenges of tackling structural issues during fixed-term projects.

      Evidence points to a shocking disparity in maternal and perinatal death, preterm birth and fetal growth restriction, between people from black, Asian and mixed ethnic backgrounds and their white counterparts. This has a significant impact on health and economic outcomes, and while the causality is not fully understood there has previously never been a policy ambition designed to address this.

      However, following the health inequalities highlighted by the Covid-19 pandemic and the impact of the Black Lives Matter movement, this is starting to change. In September 2021, NHS England requested each local maternity and neonatal system develop a strategy to address this by September 2022.

      The Context in Croydon

      In Croydon, work to improve outcomes for women from minoritised ethnic backgrounds was underway before this. The maternity unit delivers 3,200 babies per year and approximately 52 per cent of Croydon residents are from minoritised ethnic backgrounds, which is representative of the maternity population.

      In Spring 2021, a passionate and dedicated midwife, Olamide Odusanwo, was determined to do what she could to tackle the issue of perinatal inequality. With colleagues Gina Short, Helen Chambers and Ranee Thakar, she set up the HEARD (Health Equity And Racial Disparity) campaign.

      They carried out surveys with women (and birthing partners) and staff to better understand the local context. This led to changes including increased appointment length and frequency for people from minoritised ethnic backgrounds, and the creation of a dedicated service for people who felt their concerns were not being heard during their maternity journey. They also helped identify the scale of work needed to tackle the issue and the clear need for a dedicated midwife to work on the project.

      This is where I came in – a midwife by background, with a passionate interest in health inequalities – I came to Croydon as part of the Darzi fellowship leadership programme. The Darzi fellowship includes a PGCert Leadership in Healthcare and a change project in the hosting trust. We are expected to explore the challenge in depth to develop long term, sustainable solutions.

      Tackling a ‘wicked’ problem through involving people and communities

      To scope the project we interviewed a number of stakeholders including women and birthing partners from minoritised ethnic backgrounds, as well as voluntary sector staff involved in related health equity projects. The most common themes were access, barriers and listening to women and birthing people.

      We looked for data which could help illustrate these three themes. However, data on ethnicity is poorly recorded which made it difficult to establish a baseline. While work is ongoing at a national level to address this (NHSEI 2021), it was a significant limitation to the project. We also struggled to find data to illustrate the themes of listening to service users and barriers. However, the theme of not listening to women and birthing people was identified in the preliminary Ockenden report where recommendations were made about the need to improve this.

      Due to its complexity the issue was quickly identified as a ‘wicked’ problem. Wicked problems need to be addressed using a collective approach. This is because no individual perspective is enough and so solutions must be built on collective knowledge. Accordingly, there was a clear need to develop a ‘collective’ to undertake the work by creating a network.

      We hosted a Whose Shoes event to engage interested citizens and wider health and voluntary sector staff, to establish a network and start discussing solutions. Whose Shoes is an award-winning board game with a multi-perspective approach to transforming health and social care services by putting the person in the centre. It is renowned for its co-production ethos and has a strong track record in maternity care.

      It was crucial for us to reach groups beyond those normally reached by our engagement work. As part of this we had to overcome mistrust of institutions, which we started to address by holding the event at a trusted voluntary sector partner organisation - Croydon BME Forum - instead of on hospital premises. We sent invitations via social media from this organisation, the Asian Resource centre Croydon, Happy Baby Community and Big Local Broad Green.

      The event was well attended and resulted in us expanding the membership of the HEARD campaign to include local experts by experience (women and birthing partners) and wider health and voluntary sector members. This was key for co-design of the next steps. The picture board below recaps the informal discussions that were had during the Whose Shoes event, highlighting the topics that members felt were important to address.

      Mindmap. Title: More Voices, maternity experiences. Sections include communication, personalised, feedback, cultural competency and community.

      As is often the case with fixed-term projects, it feels like we are really starting to gather momentum, just as my year is coming to an end. Nevertheless, the brilliant work of the HEARD campaign will continue after the completion of my Darzi fellowship and as I leave, I am acutely aware of the power of people. This project started with one idea from one midwife, who shared her idea with others, who in turn shared it with more people who then all came to coalesce around the same cause - to drive the change they wanted to see in their community.

      With enormous thanks to Ranee Thakar, Gina Short, Olamide Odusanwo, Manjit Roseghini, Donnarie Goldson, Mobola Jaiyesimi, Antoinette Johnson, Leila Howe, Gemma Dakin, Alison White, Jay Patel, Ima Miah, Felisha Dussard, Andrew Brown, Tai Lamard, Gill Phillips, Paul Macey and all the birthing families of Croydon who were so generous in sharing their experiences with me.

      Find out more about the maternity and neonatal work happening in South West London ICS.

      Find out more

      Find out more about what Academic Health Science Networks (AHSNs) are doing to tackle inequalities in maternity care.

      Find out more

      Reflecting on the challenges of trying to change structural issues over a 12-month project: A Darzi journey

      Women and birthing people from Black, Asian, or mixed ethnic backgrounds are significantly more likely to experience poor outcomes during their maternity journey.

      Between September 2021 and October 2022, Darzi Fellow Rosie Murphy undertook work in Croydon to explore these inequalities and what might be done to improve local services.

      This is the third in a series of blogs reflecting on the learnings and experiences from her Fellowship. Read her first blog focusing on partnering with minoritised women and birthing people and her second blog outlining recommendations from the project.

      During my Fellowship, the lack of trust in institutions among minoritised ethnic communities, particularly for the NHS and maternity services within that, was profound. Mistrust of the NHS from communities who have traditionally been underserved or let down is nothing new; challenges with the rollout of the Covid-19 vaccination programme are proof of this. 

      What became clearer during my Fellowship was that short-term engagement projects – those designed to tick NHS boxes rather than really listen and work together – often did more to damage these relationships with communities. Every individual, in every voluntary sector organisation that I spoke to, raised the issue of sustainability and warned me that engagement would be challenging. Engagement is built on relationships, and relationships take time to build. This means that outputs or changes don’t come quickly, but when they do, they are likely to deliver more long-term benefits.

      "Engagement is built on relationships, and relationships take time to build."

      The lack of time to properly sustain and embed the new relationship presented a real barrier throughout the Fellowship. Whilst I recognise the merit of the Darzi approach to scoping and appreciate how this helped to generate a more comprehensive understanding of perinatal equity, this type of project requires significant structural and institutional change. It needs long-term investment and is not suitable for a 12-month fixed term contract. The consequences of the short-term project directly impact the proposed solution - engagement.

      The lack of long-term investment appeared to feed a sense of imperiousness about the way in which the NHS approaches engagement. The subject matter, location and timing is often based around the preferences of the system rather than the needs and wishes of the individual, with remuneration that is often inconsistent and bureaucratic. This in turn reinforces cautiousness or reluctance from people to participate. 

      Those who do choose to engage do so hoping it will make a difference and be a valuable use of their time and efforts. In turn, we must show them the impact of their contributions such as with visual minuting or other ways to convey that their voices have been heard, even if the changes are yet to be made or seen. The process of demonstrating that the people have spoken and supporting realistic management of expectations about the pace at which change is made in the NHS is not often factored into engagement work or shared with our stakeholders.

      I would argue that it is critical to sustain continued engagement with our stakeholders as time goes on. Where project participants have been invested in over a longer timescale, it is more likely that the tangible impact will be seen and felt by the communities involved and affected. As such, more trust and willingness to engage is built with the organisation. This positive impact creates a virtuous circle where engagement will feel more worthwhile and less risky to citizens.

      I hope that with the appointment of a new Darzi fellow with a focus on improving perinatal equity across South West London, those who did place their trust in my Darzi Fellowship project will still see the impact of their contributions. Along with the perinatal equity and equality strategies that the Local Maternity and Neonatal Systems are being supported by NHS England to achieve, I hope that the recommendations I have made will be taken into account. However, we must be aware that the more work like this is commissioned as short term projects producing unsustainable outputs, the more bridges will be burned and the harder and less effective engagement will become.

      "It is critical to sustain continued engagement with our stakeholders as time goes on. Where project participants have been invested in over a longer timescale, it is more likely that the tangible impact will be seen and felt by the communities involved and affected."

      With that in mind, I wanted to finish my series of blogs with an example which I feel captures the essence of what proper investment in lived experience can achieve for all involved:

      During my fellowship I worked alongside a woman who had experienced quite severe post-natal mental illness. During her recovery she was invited to join a patient participation group – a paid opportunity to talk with other women affected by post-natal mental illness about her experiences and recovery, as a part of their treatment.

      As well as helping the women she spoke to, she found the experience cathartic and felt it improved her own ongoing recovery from serious illness.

      Eventually, an opportunity presented itself to join a co-production forum at the same Trust. From a starting point of the uncertainty of recovery, the woman in question has now undergone a complete career change, giving up her old job to commit to improving NHS services as a lived experience lead. Her work has also helped her thrive as a mother, hopefully reducing her own risk of future illness, and improving her children’s wellbeing, all whilst making services better for others!

      It’s important to note here the impact of the participation being paid. Paid lived experience contributions help to foster a sense of value of the ‘work’ the lived experience expert is contributing and maintains their dignity, as well as reducing any sense of tokenism or box-ticking on the part of the NHS. In this case, it also enabled participation over a longer period of time which is likely to have not only benefitted the trust, but also facilitated the development of the necessary skill set to support the woman to move into a paid role within the NHS.

      We sometimes talk about an asymmetry between the respect we give to patients and healthcare professionals when they try to influence services; a healthcare professional “reports”, but a patient “complains”. The Patient Experience Library’s Inadmissible Evidence report discusses such issues at length. But, as the example of the lived experience lead shows, engaging with patients can bear fruit – as long as we have the bravery, determination and vision to approach it in the right way.

      With enormous thanks to Ranee Thakar, Gina Short, Olamide Odusanwo, Manjit Roseghini, Donnarie Goldson, Mobola Jaiyesimi, Antoinette Johnson, Leila Howe, Gemma Dakin, Alison White, Jay Patel, Ima Miah, Felisha Dussard, Andrew Brown, Tai Lamard, Gill Phillips, Paul Macey and all the birthing families of Croydon who were so generous in sharing their experiences with me.

      Find out more about the maternity and neonatal work happening in South West London ICS.

      Want to involve patients in your project?

      Read the HIN Involvement Strategy 2021 and learn about how we are striving to involve people and communities in making health and care better.

      Read our strategy

      How Government Investment Can Support Life-Changing Medical Breakthroughs

      Following last week’s announcement by the Office of Life Sciences of a new approach to tackling health challenges, Lesley Soden, Innovation Programme Director at the HIN, writes about the important role government has to play in ensuring medical breakthroughs can benefit patients in the UK.

      The UK government announced last week that over £113 million will be available to fund research into four healthcare missions: cancer, obesity, mental health and addiction. This will help unlock the next generation of medicines and diagnostics to save lives, transform patient care and ensure UK patients are the first to benefit from medical breakthroughs.

      At the Health Innovation Network, we support many companies every year that have innovative digital and technology healthcare solutions at different stages of development. In the UK start-ups often create the most game-changing technology, however they lack evidence to demonstrate clinical efficacy and cost savings for the NHS. Government funding is crucial to pay for the research needed to demonstrate impact and support quicker adoption within clinical pathways.

      There are promising innovations whose clinical trials show excellent results supporting cancer diagnosis and can help our stretched clinical workforce to diagnose cancers earlier. These include:

      • Caddie

        An AI system developed by Odin Vision to support earlier and easier detection of colorectal cancer and characterise polyps (abnormal tissue growth in the bowl) by helping doctors to identify polyps more easily during colonoscopy procedures. Find out more about Caddie.

      • MIA

        A deep learning solution developed by Kheiron Medical to improve breast cancer screening that support radiologists to make the decision to recall or not recall. Find out more about MIA.

      • DERM

        A Class IIa medical device created by Skin Analytics using AI to help clinicians classify suspected skin cancer referrals, helping to safely discharge benign lesions without relying on dermatologists’ review. Find out more about Derm

      Funding will support the development of technologies that enable earlier, more effective cancer diagnosis helping to achieve the ambition that by 2028 three-quarters of cancers will be diagnosed at stages 1 or 2. Another step forward is the £40.2 million for research into mental health to develop and introduce digital technologies to support patients.

      The mental health in the UK has been impacted by the pandemic and the NHS is experiencing the greatest demand ever upon its services. But there are promising evidence-based innovations that can help people to manage better at home and prevent mental health crisis including:

      • Limbic

        An AI chatbot to support NHS’s talking therapies services (IAPT) to screen new referrals, collect patient information and create service efficiencies to reduce costs by saving hours of clinician’s time in triaging the referrals. Find out more about Limbic.

      • Wysa

        Helps users to get access to early mental health support by using clinically underpinned tools and strategies using AI to ensure users are provided with tailored modules and activities for their current mental health needs whilst waiting for assessment and treatment. Find out more about Wysa.

      • Lumi Nova

        Developed by BFB Labs has used gamification to support 7-12 year olds to self-manage their worries using cognitive behavioural therapy (CBT). Recommended by NICE, this game can help to treat children with anxiety. Find out more about Lumi Nova.

      Generally, both the NHS and private investors are fairly risk-adverse when it’s comes to the most cutting-edge innovation and in particular those that disrupt existing clinical pathways requiring complex transformation. Being able to pump-prime these innovations helps to demonstrate the impact upon patient care, accelerating adoption and provides assurance to NHS providers and commissioners of their safety and effectiveness.

      If this funding is going to be truly transformational and build on the vaccine taskforce model, we need to make sure that the research can be used for both clinical trials but also for testing in real clinical settings. If we can roll out vaccines at rapid speed but in a safe and inclusive way, then we should be able to apply this motivation for digital and technology solutions.

      We look forward to hearing more about these funding competitions and how they can accelerate life-changing innovations for patients, boost NHS efficiency and keep the UK a global life sciences hothouse.

      Learn More

      Find out more about the government’s new strategy from the Office of Life Sciences.

      Read the government's new strategy

      SBRI Healthcare awards over £180,000 to HIN-backed innovations for autistic people and people with learning disability

      SBRI Healthcare has awarded over £180,000 to two HIN-supported projects that help narrow inequalities for autistic people and people with learning disability in south London.

      The projects include an annual health check and health planning tool to improve access to services; and a software tool to help people with a learning disability or autism to capture their needs and tailor support accordingly.

      SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative – a partnership between patient groups, government bodies, industry and the NHS hosted by NHS England – and is delivered in partnership with the Academic Health Science Networks (AHSNs).

      It is estimated that about 1.5 million people have a learning disability in the UK, and about 800,000 people are autistic. Many people have both a learning disability and are autistic. There has been a rise in referrals for autism assessment, with systems under pressure to meet demand. Significant health inequalities can impact access to the right support for autistic people and people with a learning disability.

      The Successful HIN-backed Projects

      Maldaba

      Improving annual health checks and design EMIS interoperability

      Awarded £96,396 

      This project will open up a digital communication pathway between primary care and service users so that annual health check (AHC) and health action planning (HAP) processes will be more inclusive and provide better access to health and care services, including health promotion.

      RIX Software

      RIX Multi Me Toolkit – for person-centred integrated health and care for people with learning disabilities and autism

      Awarded £83,277

      The RIX Multi Me Toolkit enables people with a learning disability and autistic people to capture their needs and share how best to provide them with support and healthcare, using simple multimedia apps and a secure online support network. This project will refine these tools in partnership with service-users and providers.

      Background

      ‘Competition 20 – Autism and Learning Disabilities’ was launched in May 2022, as a Phase 1 development funding competition, funded by the Accelerated Access Collaborative, in partnership with the Academic Health Science Networks (AHSNs) and Autistica. It specifically sought innovations to help with early identification and diagnosis and equal access to effective support and care.

      Alongside progress being made by the NHS Long Term Plan, NHS England’s Transforming Care Programme, and the Core20PLUS5 initiative, the new funding aims to accelerate change and use the best of cross-sector collaboration and technical expertise.

      The competition was open to single companies or organisations from the private, public, and third sectors, including large corporates, small and medium enterprises, charities, universities and NHS providers.

      The projects will run for up to six months, with the aim to demonstrate whether the innovations are technically feasible. Innovations that can prove their impact and potential will be able to seek further funding for prototype development and evaluation, with the aim for successful technologies to be adopted for use by the NHS.  

      Matt Whitty, Director of Innovation, Research and Life Sciences at NHS England and CEO of the Accelerated Access Collaborative, said:

      “Earlier this year our learning disability and autism demand signalling report identified the most important research questions and innovation challenges that need addressing to help deliver for those impacted and we’re delighted to build on that work by investing in the fantastic innovations we are announcing today.

      “We have selected these innovations because they have the potential to make a big difference to tackling health inequalities in autism and learning disabilities – and by supporting the most promising innovations the NHS will continue to evolve, helping meet more patients needs and encouraging more innovators to come forward with ideas that make a difference.”

      Dr Lorcan Kenny, National Research Lead for Autism, NHS England, said:

      “NHS England remains committed to improving healthcare for autistic people and people with a learning disability, who can face significant health inequalities. Innovative technology along with good quality research about its effectiveness will be key in achieving some of the goals set out in the NHS Long Term Plan, such as reducing diagnosis waiting lists, delivering efficient services and improving coordination and quality of care.”

      Dr Amanda Roestorf, Head of Research at Autistica, said:

      “Autistica is delighted to be partnering with NHS England and Small Business Research Initiative Healthcare (SBRIH) to solve unmet needs of autistic people and people with learning disabilities. The SBRIH funding pathway will support the research initiatives to bring new technologies to the NHS as a crucial step to enabling autistic and other neurodivergent people to live happier, healthier, longer lives. These projects demonstrate that rapid innovation based on high-quality evidence and collaboration between industry, health and care services, and academic experts, is both possible and necessary to create practical solutions to improve the lives and outcomes of autistic people.”

      Find out more

      You can find out more about the other projects awarded by SBRI across England.

      Find out more about the winning projects

      Medication Without Harm: Improving care for people living with chronic pain

      Unsafe medication practices and medication errors are a leading cause of avoidable harm in healthcare systems around the world. That’s why Medication Without Harm is the theme of the World Health Organisation’s third Global Patient Safety Challenge. The HIN’s Ayo Chike-Michael writes about the part we are playing to address this.

      The Impact of Opioid Over-prescribing

      People living with chronic pain understandably want to limit its impact on their daily lives. I can relate to this, having had three caesarean operations in the past 19 years. For weeks after the surgery, I didn’t need anyone to remind me to take my pain-relieving medicines! In my experience the pain resolved in a few weeks. However there are many people who live with chronic pain (defined as pain lasting longer than 12 weeks), estimated to be between one and six per cent of the population in England (NICE 2021).

      Where self-care pain-management approaches are not sufficient, most people typically depend on their doctor or increasingly their pharmacist to prescribe the right medication. Opioids (such as codeine, morphine, fentanyl and buprenorphine) are commonly prescribed and offer great benefits to many people living with pain. In the UK, most opioids require a prescription and are only meant to be used on a short-term basis.

      What clinicians think good looks like may be different from what the patient thinks. The work is easier when both discuss and agree together on way forward - Lelly Oboh, Consultant Pharmacist for Care of Older People and SEL ICS Pharmacist Over-prescribing Lead

      It is estimated over half a million people in England are prescribed opioid pain relief for longer than three months. When the source of long-term pain does not have a cause that can be treated, opioids can do more harm than good, especially in high doses. This leads to tolerance, which means higher quantities are needed for the same effect. This can cause overdependence, side-effects and worsened physical and mental health. In England, it is predicted that without action about 6,000 people a year could be hospitalised as a result of taking opioids for extended periods. (AHSN Network, 2021).
      This is why prescribers should review progress with patients to reduce or stop opioid use as appropriate and offer patients alternatives Initiating and prescribing opioids safely is one of the many ‘wicked’ problems in healthcare. The prescriber needs to decide the right dosage, monitor progress and support the patient with information; while the patient needs to be well informed from the beginning, involved in decision making and feedback.

      To help address the problem, NHS England commissioned 15 regionally based Patient Safety Collaboratives (PSCs) to address this issue through the Medicines Safety Improvement Programme (MedSIP). The programme aims to reduce high dose prescribing (>120mg oral morphine equivalent) for non-cancer pain by 50 per cent by March 2024. All PSCs aim to support clinicians in their region to prevent initiation of opioid use where possible, deprescribe when necessary, offer targeted support to patients prescribed opioids for chronic pain and aim to offer nonpharmacological alternatives.

      “It's about working differently, not working harder” – Cleo Butterworth, Associate Clinical Director- Patient Safety, Health Innovation Network

      Opioid Stewardship

      At the Health Innovation Network we’ve developed a CPD-accredited quality improvement collaborative programme that brings together clinicians from across south London to develop their skills for safer use of opioids. Masterclasses are delivered by clinical experts and people with lived experience, focusing on the complexity of pain management and how to support patients. The programme has thirty-five participants who are mainly GPs and pharmacists. It will conclude in March 2023 when participants will test their improvement ideas through a pilot, and ultimately implement them across a wider population.

      The opioids stewardship programme is championing empowerment of everyone involved with prescribing opioids – Sarah Dennison, Controlled Drugs Accountable Officer for NHS England – London

      As one of the organisers, the masterclasses have helped me to better understand the nuances interwoven into the work of the prescribers, and frustration of people living with chronic pain. It’s important to hear the patient’s side and listen, question and collaborate with them.

      Natasha Callender, the programme lead, has shared her reflections from the four sessions delivered so far below: 

      • Clinicians should not initiate discussions with patients about complex pain with a primary focus on deprescribing opioids. Instead patients should be primed with information about the best ways to manage complex pain, harms from long-term high dose opioids and supported through regular follow-ups so they can be involved in decisions.
      • Persistent pain is complex and has strong links to mood, emotional wellbeing, mental health, childhood experiences, patient expectations and fears, and previous experience of pain.
      • Pain is not one single concept – it is important to understand the different type of sensations and the impact these have on patients’ lives.
      • It is important to navigate the nuances of addiction and dependence through discussion with patients and raise awareness of non-pharmacological alternatives.

      This project is featured in our Annual Report 2022/23.

      Find out more

      To find out more about the Opioid Stewardship Programme contact Natasha Callender.

      Get in touch

      Transforming Type 1 Diabetes Care in South East London

      This World Diabetes Day we are very excited to share with you all the transformational work occurring in type 1 diabetes outpatient care in south east London.

      The Impact of Type 1 Diabetes

      Type 1 diabetes is a potentially devastating diagnosis for individuals and families, putting enormous demands on people to manage their diabetes every single day. More than eight per cent of people in the UK with diabetes have type 1 diabetes, and new diagnosis rates are increasing by four per cent each year. Recent advances in technology and understanding of type 1 diabetes have been huge, and the avoidance of diabetes complications is now possible for everyone.

      Diabetes complications can be severe, and avoiding these is linked to good glucose management. The NHS supports this through structured education sessions, clinic-based support from diabetes specialists and access to technology such as insulin pumps and glucose monitors. All people with type 1 diabetes should be receiving care from specialist services in order to support them to achieve and maintain safe glucose levels.

      Unfortunately, there are still variations in access to, and outcomes of, diabetes care. Recent analysis in Hackney and Brent suggests that around 30 per cent of people who are diagnosed with type 1 diabetes are not under the care of a specialist diabetes team. Nationally we measure whether people with diabetes meet three key treatment targets (HbA1c, cholesterol and blood pressure) as an indicator to how well we are managing diabetes at a population level. The recent National Diabetes Audit shows that only 24.4 per cent of Londoners living with type 1 diabetes have achieved all three treatment targets. This is even lower among people of ethnic minority groups and those living in more deprived areas.

      Type 1 diabetes outpatient transformation aims:

      • Engage and connect with people with type 1 diabetes in the community, and particularly those not currently under the care of specialist diabetes teams;
      • Improve equitable implementation of, and access to, technology;
      • Drive improvement in provision of, and access to self-management support, including structured education and peer support;
      • Build capacity and type 1 diabetes competency within the workforce across all specialist and non-specialist care sectors;
      • Improve data monitoring, reporting and transparency on health outcomes to measure experience of care.

      What We’re Doing

      To address these variations NHS London Diabetes Clinical Network have created the Type 1 Diabetes Outpatient Transformation Framework. The framework challenges providers and commissioners of diabetes care to question how we can make changes which reduce inequalities in diabetes care access and outcomes. Its ambition is to ensure 100 per cent of people living with type 1 diabetes have access to structured education, self-management support, specialist diabetes care and technology in a way that meets their needs and expectations, irrespective of location, ethnicity, and deprivation.

      We have convened a network of outpatient and community providers on behalf of south east London ICB in order to respond to and implement the framework. Collaboration and transformation is at the core of this network. It has strong representation from all outpatient provider sites in south east London, as well as community providers and mental health trusts. The network provides a space for providers and commissioners to work together on transforming and adapting local type 1 diabetes care to the needs of south east Londoners.

      Provider-commissioner collaboration and co-production will continue to be at the heart of what we do at the network. Healthcare transformation and improvement is inherently a WICKED problem. It is through the network’s diversity of thought and experience that we can hope to address this problem, and to unpick the challenges people with type 1 diabetes face daily when trying to manage their health. We are in the beginning stages of an exciting journey in south east London; a journey that we are embarking on as a team.

      I have really enjoyed working with south east London colleagues in setting up the network. It has given us the chance to understand the challenges and aspirations of providers and commissioners, and unite in our efforts to improve T1 diabetes care. – Dr Sophie Harris, Chair of South East London Type 1 Outpatient Transformation Network

      Find out more

      To find out more about what we’re doing to support people living with type 1 diabetes, contact HIN Project Manager Kate Rawlings.

      Get in touch

      Good Boost: Using AI to help people with musculoskeletal conditions

      Two women exercising in a swimming pool.

      Participants

      • Four fifths of participants had incomes in the lowest forty per cent;
      • Eighty-four per cent were Black or Asian;
      • Almost half were living with another long-term health condition;
      • Fifty-five per cent of participants reported they were inactive before they started.

      A project funded by a Health Innovation Network innovation grant has used artificial intelligence to improve the lives of Londoners with musculoskeletal (MSK) conditions.

      The year-long Good Boost Project was led by King’s College Hospital rehabilitation clinicians, physiotherapists and hospital volunteers. It was launched in Southwark in April 2021, and also piloted at Kingston Hospital.

      The project supported patients living with long-term MSK conditions (conditions affecting the joints, bones and muscles), those recovering from joint replacement surgery, as well as older patients, giving them the opportunity to keep active.

      Patients were offered a personalised water-based exercise programme, developed using artificial intelligence. This was tailored to their health condition, fitness level and confidence in the water.

      After just five months:

      • Two-thirds of participants reported an improvement in their health
      • Almost a quarter reported improvements in their functional capacity
      • More than a fifth reported a reduction in pain levels

      Nicky Wilson, Consultant Physiotherapist at King’s College Hospital NHS Foundation Trust, explained: “This project began in the second Covid-19 national lockdown to make sure that people with MSK conditions could continue to keep active and well.

      “Delivering the Good Boost Project in the heart of the community is increasing opportunities for people with MSK conditions to access rehabilitation, widen their social support networks, and embed regular ongoing physical activity into their lives, which will improve and maintain their health. It’s hugely exciting and humbling to see the impact the programme is having.”

      Dorothy Oxley, 74, from East Dulwich, was invited to take part in the project after undergoing knee surgery in October 2021. She said: “My operation on my knee had left me with mobility problems, and I was determined to get my independence back. So when my physiotherapist mentioned the Good Boost Project, I was delighted to take part.

      “I’m glad I signed up, because it really did help me build my confidence and become more mobile. Being in the water meant I wasn’t worried about losing my balance and falling, and everyone in the group supported each other. It truly was a boost.”

      Find out more

      Find out more about Good Boost in the full evaluation report.

      Read the full evaluation

      Primary Care Automation Grant Winners Announced

      The winners of the London Digital First Primary Care Automation Grants have been announced today by the Health Innovation Network, working in partnership with NHS England. Grants of up to £65k will be awarded to projects across London to pilot automation solutions in primary care.

      Automation refers to the design and implementation of technologies to provide services with minimal human involvement. Automating high-volume, repetitive, rule-based tasks can improve productivity, efficiency, reliability, compliance, speed and accuracy, colleague morale, and integration between people and process. This can help free up clinical and administrative staff so they can focus on securing the best possible outcomes for patients.

      Over £600,000 has been allocated across eleven innovative primary care projects in London. Grant applications were assessed upon the scope, scale, impact, sustainability, and opportunities for spread and adoption of their projects. Pilots will be monitored against agreed metrics over the next 12 months, before being evaluated.

      “Primary care faces an ever increasing workload. It is exciting to see these automation pilots provide hope for a range of solutions to tackle this workload with improved outcomes for both staff and patients. It might not be long before we look back and wonder how did we ever manage without some of these automation solutions” - Dr Shanker Vijay London Region GP Clinical Lead Digital First Programme, NHS England 

      The grants programme provides a unique opportunity for us to pilot a variety of innovative automation solutions that can transform the way practices manage their workload. We hope that through this work patient care and staff morale will be improved by automated processes freeing up both clinical and administrative staff from some of the most time consuming and repetitive tasks they currently undertake." - Matt Nye, Director, London Digital First Programme

      The grant winners are:

      Dr Lucy Goodeve-Docker, Lambeth Digital Lead, Lambeth Healthcare Federation South East London

      Lambeth Healthcare Federation are using Healthtech-1 automation technology to establish full automation of online registration into the clinical system (EMIS). Automating online patient registrations will allow patients to register within minutes, remove user data errors, reduce administrative data input time, allow accurate demographic collection, and ensure households are appropriately aligned to support safeguarding principles. Health-tech 1 is currently on the DigitalHealth.London Accelerator programme.

      Image

      Lucy McLaughlin, Cancer Recovery Program Lead for North Central London (NCL), North Central London ICB - Performance & Transformation Directorate

      NCL plan to improve patient appointment non-attendance for cervical screening in Islington by using a SPRYTs AI powered virtual receptionist named Asa, which interacts with patients via WhatsApp and email. Asa incorporates behavioural science approaches and linguistics to change behaviours. This allows Asa to adjust language and other messaging content and design for specific population segments, to optimise attendance at screening appointments.

      Image

      Dr Nisha Patel, GP Partner and Trainer, Nightingale Practice in City and Hackney and City and Hackney GP Confederation Clinical Lead

      The Nightingale Practice is working with Edenbridge (APEX), to automate workforce rota management, predict patient demand and workforce requirements, highlighting surplus and deficit staffing levels. By applying “rules” around capacity requirements and leave-booking, the administrative burden on practice staff will be reduced and access for patients to GP appointments improved.

      Image

      Dr Sian Knight, Executive Partner, Modality Medical Services, Lewisham, SEL

      Modality Medical Services are working with their in-house Robotic Process Automation Team to automate pathology results filing, specifically the automation of bowel cancer screening results. A bot will file 'normal' bowel cancer results, automatically send an SMS to patients with normal BCS results (with guidance of when to contact the GP) and communicate with patients that have been identified as not having participated in the BCS.

      Image

      Dr Raza Toosy, lead GP, Sutton IT Solutions, and Jagdish Kumar, Head of New Business for Sutton PCNs

      The Park Road Medical Centre are working with PatientChase to improve long term condition management and risk stratification in Sutton, Wallington, Cheam, and Carshalton. The automation of self-booking coupled with enhanced risk stratification will allow our centralised call and recall team to focus their efforts on patients with the highest clinical need to access various pro-active health services. A Customer Relationship Management system will be used to record insights through engagement with groups with health inequalities to better understand how best to reach and engage with them.

      ImageImage

      Dr Robbie Howell, Clinical IT Lead; and Anastasia Remos, Asthma WAF Project Lead for N1 PCN & Islington GP Federation, NCL

      North 1 PCN & Islington GP Federation will be using GP Automate’s Robotic Process Automation functionality to automate processes for clinical and admin staff through 5 automated products: Lab Reports, New Patient Registration, Accurx Asthma Floreys, Accurx BP Floreys and Accurx Diabetes pre-appointment questionnaires. Through automating these manual and time-consuming tasks they intend to improve patient outcomes, workforce satisfaction and sustainability of general practice.

      ImageImage

      Dr Joanna Yong, GP Partner at St Andrews Medical Practice, Barnet PCN 2, NCL

      Barnet PCN 2 is using Blue Prism’s (BP) cloud-based intelligent software to automate the clinical document workflow process. A bot will determine:

      • no action;
      • coding only,
      • identify specific documents which are coded and go to an allocated team member for a decision, and;
      • further action for low risk pathways such as smear results, appointment letters and follow-ups eg breast screening mammogram results and long term conditions. 

      This bid complements existing locally run GP Assistant Programme and complements a second PCN2 cancer based clinical pathway automation. 

      Image

      Dr Kiran Nakrani, NCL GP Website Clinical Lead, Barnet PCN 2, NCL

      This automation project builds on the EMIS e-safety netting template which is already used across London and aims to track the outcome of important cancer documents via the Health information Exchange (HIE) Cerner portal for patients referred via the two week target pathway. A bot will mimic current process of:

      • identifying the clinical letter;
      • filtering it into the correct process for DNA vs Clinician Workflow;
      • identifying the outcome of the target referral as either DNA or patient contact made by secondary care;
      • advising the referring clinician on next steps.
      Image

      Dr Rob Seal, GP at Lavender Hill Group Practice and joint Clinical Director at Battersea PCN; and Dr Soleman Begg, GP at St John’s Hill Surgery, Wandsworth PCN and Battersea PCN, SWL

      Wandsworth PCN and Battersea PCN are working with JiffJaff and Automation Anywhere to automate high volume and repetitive tasks that can be clinically significant. These include:

      • clinical safety validation process for laboratory tests;
      • patient compliance with antipsychotic mediation;
      • division of clinical administrative workload;
      • reducing workload for pharmacy technicians.

      Time saved from automating these processes will allow clinical staff members to spend more time on patient care and administrative staff to focus more on patients who require personalised engagement.

      ImageImage

      Dr Manotheethan Jegasothy, GP in Kingston and Richmond; and Dr Soleman Begg, GP at St John’s Hill Surgery, Chessington and Surbiton PCN

      Chessington and Surbiton PCNs are working with JiffJaff and Automation Anywhere to automate the filing of ‘normal’ pathology results. Improved automated processes will ensure results are processed quicker and will benefit patients with real-time reporting of their results. Time saved through this automated process will result in clinicians and administrative staff having more time available for the practice and patients.

      ImageImage

      Dr Jwala Gupta, Clinical Director, Havering North PCN; Dr Gurmeet Singh, Clinical Director, Havering North PCN; Dr Pratheep Sunthara-Moorthy, Co-Founder of Care IQ

      Havering North Network will be using the CareIQ proprietary automation engine to provide automated recall of patients with hypertension, diabetes and atrial fibrillation.

      A central team will oversee the recall using staggered invites and providing a uniform process across the PCN. This will include CareIQ questionnaires, telephone, video, and face to face consultations.

      ImageImageImage
      In October 2022, 14 automations were launched across 11 pilots. The resulting pilot summary report was published in April 2023, and provides a wealth of recommendations, resources and learnings, assisting with future automation journeys. The full report can be read here.

      Download the report

      Read the full report to learn more about the benefits and obstacles of implementing these technologies in primary care settings.

      Download the report

      Four Lessons from our Anti-Racism Project

      Our anti-racism project is co-led by Catherine Dale, Programme Director of Patient Safety and Pearl Brathwaite, Project Manager in our Accelerated Access Collaborative team. We hear from Pearl and our CEO Rishi Das-Gupta on what they have learnt from the project since its inception in December 2021.

      1. Sometimes you don’t know you have a problem until you talk about it.

      The HIN is a great place to work, and we employ people who commit to our values and want to improve care and health for all. We have an agreeable environment, but recognise that our teams don't yet reflect the diversity our local south London community.

      What we’ve realised is that sometimes you don’t know you have a problem until you talk about it. We started a conversation following George Floyd’s murder in 2020, speaking to staff to understand the impact of race and racism on people working in the HIN and the communities we work with and serve.

      We realised that our individual experiences of life, work and community have been and continue to be impacted by race, and that we wouldn’t have spoken about it without this opportunity.

      2. It starts with conversations in a safe space.

      Our underlying approach has been to create a psychologically safe space which embodies the HIN values of being brave, open, together, kind, and different. We listened to perspectives from across the organisation. We discussed case studies, stories, and relevant news to highlight the issues and understand how our perspectives differ as a result of our experiences.

      To aid internal discussion, we used a liberating structure framework to encourage the various themes to ask three questions: What? So What? Now What?. This structure is designed to help facilitate the gathering of facts ("what?"), make sense of those facts ("so what?"), and understand what we can do next ("now what?").

      This worked well for us because our teams tend to want to fix problems. Teams identified a challenge in moving to action and the "now what?" too quickly, because of the vast amounts to explore in the "what (is the issue)"’ and the "so what (why is it important)?".

      Practically it takes time to have these conversations and we had to set aside time to do this. This meant that we were making an active choice to engage in this work and appointed a trusted external facilitator to guide some of these organisation-wide conversations.

      The series of conversations were:

      • How we talk about our ambitions in becoming an anti-racist organisation;
      • How we talk about the impact of racism on individuals and the community that we serve;
      • How we seek to influence others, in our everyday lives and outside of the HIN.

      3. Expect the conversation to be difficult at first, but easier over time

      This topic brings people's experience to the fore. It helps to be clear that this can be an emotive and deeply personal subject… so it will probably make people uncomfortable. It challenged our unconscious bias and beckoned us to become vulnerable and open to change.

      There still exists a general worry around terminology, fear of getting it wrong and a fear of destabilising something that is working. Language is important and can trigger emotional responses, so it was important to recognise that we might make missteps and invite people to talk about the impact of language use on them. When it came to language, we wanted to agree a common terminology that we use to talk about this. Black and Asian Ethnic Minority, Minority Ethnic, BAME and Global Majority are some of the terms we have collectively chosen and discussed. We are still learning. 

      We have heard from a colleague, who took a secondment before the anti-racism programme launched, about the impact she noticed on returning to the organisation. She observes that the values of the organisation are the same, but we now have deeper and more confident conversations about race, racism and health inequality.

      4. Recognising progress keeps everyone going

      On this journey we need to stay motivated. We did this by sharing progress with our colleagues and keeping up to date with our commitments, vision, and ambitions for the organisation. We asked ourselves:

      • Is this sort of change measurable? Changes are incremental, and we are committed to seeing constant change in our meetings, projects and interactions, as opposed to one standalone project.
      • What metrics should we set and why? Measuring change is important to keep enthusiasm for the programme and to justify ongoing focus, commitment, and budget. Our evaluation team is helping to capture change via quantitative and qualitative means.
      • What about the change that can’t be measured? When we hear conversations have gone well, we reflect and highlight good practice. A recent example, as shared by Rishi, is a training opportunity that was shared with leadership only. However, as the leadership team is not very diverse we decided to share the training more broadly to give the opportunity to a wider group of applicants. This is not a conversation or decision that would have taken place without our anti-racism work.

      Change is incremental and we need to take stock from time to time. Though we have highlighted the impact of talking and having conversations, we recognise it doesn’t end here. After listening to views from across the organisation we have been able to identify action that is needed to make incremental change. We will move safely towards this.

      We hope to share more with you as the work progresses.

      Rishi and Pearl

      Access Denied: Addressing Inequalities in Digital Healthcare Tools

      Clinician using technology

      James Friend, Director of Digital Strategy at NHS England London region, writes about how the Access Denied report is shedding light on digital inequalities and what you can do to help.

      The NHS has the potential to transform services for patients, from assessment to treatment, through digital technology. But it is crucial that this is done in a way which reduces rather than increases inequalities.

      The Covid-19 pandemic led to a rapid increase in the use of digital technology in healthcare, whether this is the use of the NHS app for vaccine passports, the proliferation of online doctors’ consultations or the development of new tools for remote monitoring or self-management of conditions. This has many benefits. It can make services more flexible by enabling out-of-hours access, and digital services can be an improvement for people who are visually impaired or who have limited English skills.

      But while for many people accessing services digitally is now the norm, this is not yet universal, and there is evidence of a link between digital exclusion and social disadvantage. People with protected characteristics under the Equality Act 2010 (age, disability, race) are less likely to have access to the internet, and the skills to use it (NHS Digital, 2019); and the impact of this has not yet been fully understood.

      The role of digital is currently being considered by the newly-formed Integrated Care Boards, and this presents a unique opportunity to make sure that people without digital access are not left behind. That’s why the Health Innovation Network, the Academic Health Science Network for south London, hosted an important roundtable with experts on this topic which I chaired. The Access Denied report takes the key points from this discussion and explores the impact of digital inequalities in healthcare, making a series of recommendations for those seeking to adopt new technologies:

      • Work with digital innovations that meet the highest standards for accessibility and usability.

      • Test digital products and services thoroughly with a cross section of patients, providers and commissioners.

      • Use data to optimise delivery to improve outcomes and minimise exclusion over time.

      • Understand how people may need specific channels of delivery at different times or for different services.

      • Ensure you capture data so you can measure and compare outcomes and experience by channel.

      • Don’t plan care pathways for the majority – ensure it is optimised for those from minority backgrounds too.

      • Consider the support needed to move people to digital pathways.

      • Ensure equality impact assessments for transforming care pathways pay attention to digital exclusion as a potential risk of inequality.

      We are also calling on designers, developers and the NHS to work together in two ways:

      • We need to develop frameworks, similar to those seen for information governance and clinical safety, which would set out guidance for mitigating against health inequalities that could become adopted and embedded by design.

      • Ethical considerations must be built into the clinical safety case of the tool and data used to inform or train algorithms must be thoroughly examined for bias.

      You can find out more about digital inequalities, their impact and what you can do about them in the Access Denied report.

      Find Out More

      Find out more about digital health inequalities and how to avoid them.

      Read the Access Denied Report

      How the Low Carb Program is Helping People with Type 2 Diabetes

      Person using phone app in kitchen surrounded by healthy vegetables.

      Post Title

      We hear from Arjun Panesar, Founding CEO and Head of AI at DDM Health, developers of the Low Carb Program which provides type 2 diabetes structured education across South London, with a particular focus on supporting ethnic minority communities.

      As of May 2023...

      • Current average HbA1c reduction is 7.0mmol/mol
      • 6.2 per cent average weight loss at 12 months
      • Additional patient and public involvement to explore attitudes to digital tools for type 2 diabetes support

      South east London ICB commissioned the Low Carb Program in June 2021 to provide structured education for patients with type 2 diabetes in south east and south west London.

      Alongside type 2 diabetes structured education, health coaching and behavioral change support aligned to NICE guidelines, users can choose to follow a low carbohydrate, Mediterranean or balanced diet approach tailored to their health goals, needs and preferences. The platform provides live weekly cook-alongs, exercise classes, meetups, a moderated community, and AI-tailored recipe suggestions based on allergies, dietary requirements and cultural preferences.

      “I found the weekly group sessions very useful. When you are trying to lose weight and feel like you are not making progress on certain weeks, you get encouragement from the health coaches and fellow members.” – Karthik S

      By providing users with a personalised program to meet their needs, we make it so much easier for people to integrate healthy lifestyle choices in their lives and stick to a program of self-management. This helps to support long-term maintenance of a healthy weight and ongoing behaviour change.

      The platform, delivered in nine languages, has proven to be very popular. Real-world data collected after 12 months demonstrates that 83 per cent of patients activated their referral, with 73 per cent of participants completing the intervention. Over 60 per cent of participants are from ethnic minority backgrounds and list English as a second language, with almost half digitally excluded. The project also supports the ICB’s broader Primary Care Green Plan to use local languages to convey important health messaging and understand the cultural needs of the communities affected.

      “I went for a blood test the other day and my HbA1c has gone down from 7.2 per cent to 6.5 per cent. I’ve also gone from 107kg to 91kg in 5 months” – Maxine K

      We started with a series of digital patient workshops with prospective service users and existing patient champions from within the identified boroughs to understand local needs. South east London alone has an estimated 1.9 million residents and is an area of mixed deprivation. Over and above the language needs, we identified a requirement to support digital and digitally excluded users. The platform was integrated within the existing digital booking platform used in the borough and directed eligible patients with type 2 diabetes to the Low Carb Program.

      “I have successfully maintained my blood glucose level and weight loss (17kg) over more than 12 months now.” – Albertos F

      The project, supported by the Health Innovation Network, hasn’t just shown popularity but impact too. Self-reported measurements showed a -6.9mmol/mol HbA1c reduction and 6.2 per cent weight loss at 12 months. A five per cent weight loss reduction can reduce a person’s risk of heart disease, musculoskeletal problems, stroke, type 2 diabetes related complications and some even cancers, such as breast cancer, by 12 per cent.[1]

      Notably, the service supports democratising access to digital tools for hard-to-reach communities. The project has led to the Low Carb Program’s outcomes being showcased to NHS England, which we are incredibly grateful for.

      “It’s made such a big difference to my confidence. I love the new Mary!” – Mary R

      Find Out More

      Find out more about the Low Carb Program and how it’s helping address health inequalities.

      Find Out More About the Low Carb Program

      Meet the innovator: Louisa Stacey

      Woman in front of wall

      Post Title

      Woman in front of wall

      In this edition, we catch up with Louisa Stacey, Head of Strategy and Operations at Ufonia, an automated telephone-based system that allows routine clinical conversations to provide a standardised, high quality and efficient experience for patients.

      Tell us about your innovation in a sentence: Dora is an automated telephone based system that can have routine clinical conversations with patients to provide a standardised, high quality and efficient patient experience.

      What was the ‘lightbulb’ moment?

      Being approached by Nick (CEO and Founder of Ufonia) to come and work for Ufonia. This gave me the confidence to believe that I could use all of the skills, abilities, and experience I had gained throughout my academic and NHS career, to make a bigger difference to more patients, clinicians, and the wider NHS.

      What three bits of advice would you give budding innovators?

      1. Be brave and bold - believe in your vision and have the conviction to see it through; there will always be very difficult days
      2. Work collaboratively - there are so many talented people willing and able to assist you in achieving your vision
      3. Be empathetic - to develop a true and meaningful understanding of how your innovation will be used to make a difference

      What’s been your toughest obstacle?

      My toughest obstacle has been and still is…trying to reconcile striving to do the best with a ‘just do it’ mentality to ensure we are delivering value to patients, Trusts, and commissioners as readily as possible.

      What’s been your innovator journey highlight?

      The buzz I get when I work directly with clinical teams to understand their processes and constraints, followed by the collective realisation of the potential impact that Dora can bring in releasing clinicians’ valuable time to deliver services to the many thousands of patients on their waiting lists.

      Best part of your job now?

      Genuinely, the team I work with and the impact that this has on the pace, scale, and quality of work delivered. Everyone is phenomenally talented and driven to achieve the same goals which is fundamental in any team to support happiness, retention, and delivery. Check out the team here: https://www.linkedin.com/company/ufonia/mycompany/

      If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

      Reduce the duplication of effort and variety of systems and processes in place at each individual Trust to support the adoption of technology e.g. all Trusts accepting a set of nationally recognised assurance documents supporting information governance and security measures (DPIA, DTAC) without having a Trust-specific template.

      A typical day for you would include…

      My day is very varied and can start with meeting busy clinicians at 8am before their clinics begin or logging on early to check emails and slack messages to understand the priorities for the day. Then I will meet the Ufonia team for our virtual daily standup at 9am and find out what work everyone has on as well as a fun fact (e.g. What are you most looking forward to about Autumn?). Whilst we are recruiting more team members into operations, a lot of my day involves meeting with NHS staff to support the implementation of Dora to their services, and with commissioners to demonstrate return on investment. I particularly enjoy helping members of the Ufonia team to find and solve problems which drive improvements in our ways of working. When I have a quiet moment, the creativity flows and I can think of bigger picture strategic work which is a huge motivator for me.

      You can find Ufonia on Twitter and LinkedIn.

      ‘That’s how we’ve always done it’ – why AHSNs hold a powerful role for staff and patients

      As part of the NHS Graduate Management Training Scheme, Ellie Boden spent eight weeks working at the Health Innovation Network. Here she describes what that taught about the role of AHSNs.

      At one point or another, I think all of us have heard the phrase ‘that’s how we’ve always done it’, which can be annoying at best and dangerous at worst. Enabling change in the NHS can be a difficult and lengthy process and the formation of the AHSNs were set up with the aim of tackling this challenge.

      This means the HIN is in a position to look at a service with a fresh perspective and question why it’s always been done a certain way. By sitting separately to hospitals and community trusts, the HIN can help partner organisations to take a step back from the fire fighting and develop a headspace in which opportunities for change can be considered.

      This may appear indulgent, but it is vital in the process of innovation and improvement, allowing care providers to think differently and collaborate. And by driving the spread and adoption of innovation, the HIN can improve health outcomes for patients and drive economic growth. Whether this be technology or service redesign, I saw changes move quickly due to the vast network of stakeholders with which the HIN has formed relationships.

      It’s important to recognise that lots of our colleagues in transformation teams closer to the frontline also want to implement change. Yet, they may struggle to do so due to multiple barriers, which is why the work that AHSNs do is so important. HIN colleagues are the enablers and facilitators of change – they may not implement the change on the ground, but they support those on the frontline to do so. Since working at the HIN, I have seen first-hand the strong relationships that each team has with key stakeholders. That these relationships help the HIN to influence organisational change is one of its biggest strengths.

      Although the HIN consistently demonstrates its ability to facilitate change, it can still come up against challenges as an AHSN. It can be difficult to determine the impact of an AHSN – wicked problems make it harder to measure tangible benefits of changes. Furthermore, the complex steps between engaging with teams to introducing a transformation that leads to service improvement, can make the impact unclear. In addition, it can be tricky to convince a team to introduce new innovations, even more so during the pandemic.

      Yet AHSNs are the solution – crisis creates innovation at a time when the NHS needs it even more and these changes, particularly regarding digital technology, will be a necessity for the healthcare system moving forwards.

      With the HIN being such a unique organisation, working with them may be a good choice for organisations needing additional support. The breadth of skill and expertise that exists, along with strong relationships throughout the system and an ability to be flexible, creates an organisation that would make an excellent partner.

      As a Graduate Management Trainee, working at the HIN provided me with insight into an area of the NHS I had no former knowledge of. The opportunity to be challenged and yet supported made the HIN a fantastic placement experience and I would highly recommend it to graduate trainees seeking similar opportunities.

      Interim Director of Digital Transformation appointed to HIN executive team

      From July the Health Innovation Network will welcome Amanda Begley as the new Director of Digital Transformation on secondment from Guy’s and St Thomas’ NHS Foundation Trust (GSTT) for 12 months.

      Amanda is currently Director of the Centre for Innovation, Transformation and Improvement (CITI) at GSTT and brings a wealth of experience in areas that are particularly relevant including leveraging the value of health data by co-developing the Health Data Research UK Hub for Cancer (DATA-CAN) and her work at NHS London and UCLPartners on innovation, as well as her operational roles including working at Kingston Hospital.

      Dr Rishi Das-Gupta, Chief Executive at the HIN said: “We recognise that there is an increasing need to support digital transformation over south London and are well placed to support on this given our strong links with digital innovators through the DigitalHealth.London programme. Amanda will help us clarify this so we can fulfil our aim to make our region the leader for adopting digital innovations.” 

      Dr Amanda Begley, Director of Digital Transformation said: “I am really excited  to join the team and work with colleagues across south London to plan how digital transformation can benefit , patients, staff and partners as we all recover from the after-effects of the pandemic.”

      Adapting Diabetes Care to the Challenges of Covid-19

      You & Type 2

      As part of Type 2 Diabetes Prevention Week we hear from the HIN's Kate Rawlings on the You & Type 2 programme, and how it was adapted to the challenges of Covid-19.

      Post Title

      Since early 2020 organisations across the world have been asking “How do we adapt and respond to Covid-19?”, and nowhere was this more true than in our own halls at the HIN (or virtual halls, as they soon became).

      Since 2018 the HIN has worked with NHS South West London Clinical Commissioning Group to develop a personalised care and support planning pathway known as “You & Type 2” for people living with type 2 diabetes. Like with other healthcare services, its delivery was significantly challenged by the emergence of Covid-19. However, with this challenge also came opportunity, and the HIN launched two new branches of You & Type 2 to support people living with diabetes in light of Covid-19: @ Home and Risk Stratification.

      @ Home

      As the pandemic gained momentum, more and more pressure was being placed on primary care practices, who were forced to prioritise emergency care and reduce face-to-face contact. This often meant a halting routine checks, including annual diabetes care reviews.

      You & Type 2 was temporarily paused, however, with the help of remote technology providers Thriva and Healthy.io, a remote monitoring pathway was developed. The @ Home pathway allowed people with diabetes to receive a free home blood testing kit, urine kit and blood pressure machine in the post. Following the tests, a care planning phone call allowed for seven of the eight key care processes to be completed remotely.

      Risk Stratification

      Identifying and prioritising high-risk populations was an important part of the Covid-19 pandemic response. It quickly became apparent that people with diabetes were at higher risk of severe illness should they contract COVID-19, but also at risk of their diabetes worsening with the halting of routine care.

      Building on existing frameworks produced by the London Clinical Networks and UCL Partners, and with the support of clinical experts, the HIN developed a risk stratification framework. This framework consolidated general and disease specific criteria to focus on people at high risk, but not currently under secondary care. It could be loaded straight into EMIS and created a list for GP practices of people with diabetes at high risk for follow up. This allowed practices to focus their limited resources appropriately.

      Image

      Evaluation

      Initial feedback on the pathways is positive. Over 100 people have used the @ Home pathway, and users have praised it for its convenience. Four practices across South West London have been trained to use the risk stratification tool. Full evaluations are being completed and will be released in the coming months.

      Although borne out of the restrictions placed on routine care by COVID-19, these pathways show how the NHS can innovate and adapt in long term disease management to make services more convenient to their population, and how to prioritise interventions for those most in need.

      22 million steps taken to prevent type 2 diabetes

      To celebrate type 2 diabetes prevention week Chris Gumble, Project Manager for long term conditions at the South West London Health and Care Partnership, has written about the outstanding results seen by the Decathlon programme, which won a HIN Innovation Grant in 2019.

      Post Title

      “The programme offers everyone the opportunity to learn and to grow and to thrive”

      The health and wellbeing of our local populations has been tested beyond limits over the last few years. Healthcare services have had to adapt and programmes like the Prevention Decathlon have evolved to meet this new “normal”. But, one thing has not changed: the drive and determination of the team working to improve the Prevention Decathlon.

      I wanted to reflect on the last 18 months and share the  incredible journey we have been on that may just change the life of those who attend the programme for good.

      ✓ 0% completion rate

      Collaborating with Sweatcoin and Harlequins foundation, new cohorts of Decathletes (what we call our attendees) have undertaken the Prevention Decathlon over the last year, all recruited from community places of worship, and who were recruited in partnership with the Wandsworth Community Empowerment Network (WCEN).

      Using the Sweatcoin bespoke app, we are able to track the steps taken by our Decathletes throughout the programme. In total our 59 Decathletes have walked an amazing 22 million steps over the ten-week programme period, which is an average of 45% increase in physical activity levels. Completion rates are at an all-time high of 92% (comparable programme average around 56% in SWL) with individual achievements by Decathletes showing an increase of activity levels by 336%, weight loss of up to 10kg as well as one "MVP" losing 16.4% of their total body weight.

      ⇧ 0% increase in physical activity levels

      These incredible numbers are real people’s achievements and ones that have undoubtably changed their lives for the better. In March, Decathletes were celebrated and awarded for their achievements.

      This was all achieved by adapting the programme to meet the needs of the current climate. Throughout Covid-19, the Prevention Decathlon became a digitised offer (virtual delivery) as face to face groups were restricted. At the same time the curriculum was expanded to be more culturally inclusive with the support of the members from the WCEN.

      Award nominations aplenty were achieved by the Prevention Decathlon programme over the last year with us being nominated for the London Sport Award 2021 for “Health and Wellbeing Programme of the Year” as well as a nomination for the best not-for-profit partnership at the HSJ Partnerships award 2022 in collaboration with Harlequins Foundation.

      “It’s not just healthy eating. We talk about wellbeing, physical activity, stress and sleep, and it’s tailored to different types of diet.”Nicola Clarke - Diabetes Specialist Dietician and Decathlon Facilitator

      Looking to the future, a new partnership with the public health teams across Richmond and Wandsworth will see the Prevention Decathlon be accessible to another 800 Decathletes over the coming year!

      The Pentathlon, a 5-week version of the programme has also been created in collaboration with the WCEN that does not focus on a specific long-term condition, but on general health and wellbeing. The programme has been created in collaboration with the WCEN and is delivered by local people to their respective communities across SWL.

      On the horizon is a really exciting version of the Prevention Decathlon that will be aimed at those at risk of developing cardiovascular disease, thus opening the door to thousands more people to take control of their health and wellbeing and living longer, happier lives!

      Watch this space for other updates soon as the Prevention Decathlon wants to break boundaries via a Heptathlon programme, a health and wellbeing programme for those with learning disabilities. Working with the learning Disability team in Kingston, the programme will start its development in June 2022.

      Improving Outcomes for Patients in Community Care: Innovation at Bromley Healthcare

      When it comes to innovation, have you properly considered the role of community services? With changes to integrated care happening from July, community care is finally starting to get the recognition it deserves. We spoke to one of our partners, Dr Cath Jenson, Medical Director at Bromley Healthcare, about the difference they are making.

      Too often overlooked, community care is now being recognised as the glue between primary and secondary care, helping provider collaboratives within the new integrated care systems to succeed.

      As medical director at community provider Bromley Healthcare, I’m proud of the role we play in testing innovative solutions for integrated care and using data to drive improvement. For example, did you know we are the accelerator site for two hour response in south east London? Or that we are driving new standards for outcomes in meeting the needs of frail and complex patients outside hospital, integrating with the ‘One Bromley’ proactive care pathway and our own therapy and rehabilitation services (including bedded unit)?

      Many don’t know we have specialist nurses across numerous fields – our children’s ‘hospital at home’ being another example of our innovations (shortlisted for a 2021 RCN Nursing Award in the Child Health category) aimed at keeping patients at home safely with a growing range of complex medical needs previously requiring admission. Or that we are the prime contractor for out-of-hospital diabetes care in Bromley and have recently recruited the first population health apprentice in London to develop population health initiatives for One Bromley (including Primary Care Networks).

      And then there’s the services we provide outside Bromley, including special care dentistry across south east  London and health visiting in Bexley and Greenwich. In total we have over 35 services and 1,200 staff making the difference to patients in their own homes and communities.

      There is a wealth of experiences and ways to make a real difference to patients in community care and to further enhance this we are now recruiting to newly established Clinical Director positions, to cement and develop our clinical leadership. Further information:

      Find out more

      To find out more please email Dr Cath Jenson.

      Get in touch