Partnering with people: how experts by experience are helping to reduce restrictive practice in acute mental health settings

Group of people on an acute mental health ward

17 September marks World Patient Safety Day; the theme for 2023 is ’Engaging patients for patient safety’ in recognition of the crucial role patients, families and caregivers play in improving the safety of health and care.

As part of our celebration of World Patient Safety Day, we hear from HIN Project Manager Ayobola Chike-Michael about how her work on the Mental Health Safety Improvement Programme (MHSIP) has helped to bring together patients and professionals with the shared aim of improving outcomes.

It has been amazing to work as a patient safety project manager for the past four years. Looking back, I am grateful for the opportunity to live out my dream to make life better for both patients and staff through my skills as a project manager.

Much of this has been made possible through NHS England and NHS Improvement’s national patient safety improvement programmes, which form the largest safety initiative in the history of the NHS. These programmes have supported safety, continuous learning, and sustainable improvement across the healthcare system.  

There are five major improvement programmes focusing on medicine, mental health, deterioration, maternity and adoption/spread. Each area has key ambitions that align with NHS England’s Long Term Plan.  My reflections in this blog centre on the Mental Health Safety Improvement Programme (MHSIP); my colleague Natasha has recently written about our work on the medicines programme (MedSIP).

What is MHSIP?

The aim of the MHSIP is to improve the safety and outcomes of mental health care by reducing unwarranted variations or health inequalities across a number of specifically-targeted topics.

The MHSIP programme began initially with its focus in areas of sexual health, suicide and reducing restrictive practices. These were all significant areas of interest, however it was not feasible to drill into all three areas concurrently. Ultimately Reducing Restrictive Practices (RRP) became the main focus for Patient Safety Collaboratives (PSCs) to lead on nationally. Using quality improvement methodologies and tools, MHSIP leads worked in their local areas but also collaboratively across England, coming together regularly to share best practice and challenges.

The Health Innovation Network (HIN) where I work, is one of 15 PSCs who led on the MHSIP work in their designated local region. The HIN covered South London and it presented a valuable opportunity for me to work with mental health professionals (particularly in inpatient care) across south east and south west London.

Using the patient perspective to Reduce Restrictive Practice

Our core HIN team – made up of project managers, quality improvement experts and in-house clinicians who provide valuable support in helping us interface with clinical colleagues – was hugely bolstered by having experts by experience working in partnership with us during the programme. These experts by experience were recruited to contribute their unique perspective to the programme; working effectively with people and communities throughout our work is one of the main aims of our Involvement Strategy.

The programme exemplified the elevation of patients’ voices through the partnership with six experts by experience. The HIN primarily acted as a convening force, facilitating continuous sharing of knowledge, experiences and learning opportunities through QI collaboratives and the Patient Safety Network. These were attended by a range of healthcare professionals including mental health nurses, QI professionals, psychiatrists, ward managers, project managers, healthcare assistants, doctors, service user involvement representatives, dieticians, psychologists, and senior managers. Our work meant that each of these groups had the chance to learn from the experts by experience, who often brought new ideas or insights to the table.

Sharing spaces and sharing ideas

One of the highlights of this programme for me has been the visits to various inpatient wards. As the project manager, I was accompanied to each ward visit by an expert by experience, who brought valuable perspectives to the conversations we had with staff and service users.

This collaborative approach fostered a well-rounded understanding of the wards’ dynamics and challenges. Discussions during the visits encompassed various aspects, including the ward’s culture, compassionate leadership, staff wellbeing, potential areas for improvement, and specific techniques for reducing restrictive practice such as the utilisation of safety crosses. We also took the opportunity to address challenges unique to each ward and proposed potential solutions, tailored to their circumstances.

Participating wards successfully tested and implemented some change ideas despite often facing significant barriers,  such as staffing issues or complex caseloads. As a team, we observed and supported the implementation of several change ideas aimed at improving patient care and experiences.

Some of the change ideas included:

  • Patient involvement in planning schedules;
  • Therapeutic and sensory interventions;
  • Staff skills training and use of tools;
  • Coproduction with patients and families in decision-making processes and jointly developing care plans;
  • Visual display of routines, preferences, and staff allocation;
  • Improved indoor and outdoor spaces;
  • Reduced blanket restrictions and unnecessary rules;
  • Negotiation with patients;
  • Increased focus on patient preferences and needs;
  • Open door polices to build patient relationships.

The work has generated significant improvements across a variety of measures of patient experience and safety. It has been incredibly fulfilling to be a part of sharing practical, patient-focused ideas between services; the input of our experts by experience has been vital for understanding the human context for these interventions and gaining a well-rounded view of how they might impact patients and their families.

We are grateful to work with the six experts by experience who through their partnership with us, elevated patients’ voices. We are also grateful for the full participation and contributions of the following wards across south London – Avery ward, Aquarius ward, Jasmines ward, Lesney ward, Norman ward, and Ruby ward.

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“We want to work in partnership” – World Patient Safety Day and MedSIP

Blister packs of medicines

On World Patient Safety Day, we hear the latest from the Pan-London Medicines Safety Improvement Programme Team on their dedicated efforts to include patients in the heart of medicines safety.

Key statistics

  • Around 15.5 million people in England (34% of the population) have chronic pain (Source: Public Health England (2020). Chronic pain in adults 2017: Health Survey for England. PHE, London)
  • Between January and October 2022, an average of 21,520 fewer people per month were prescribed oral or transdermal opioids (of any dose) for more than three months, compared with the baseline period of January 2021-December 2021 (Source: AHSN Network (2023). Supporting people to manage long-term pain without opioids)

The theme of this year’s World Patient Safety Day is engaging patients for patient safety. Chronic pain affects every aspect of health and well-being beyond the physical pain; therefore, it is important to work in partnership with patients to find out how we can best support their individual needs.

The Pan-London Medicines Safety Improvement Programmes (MedSIP) team have been working across England with the other 12 Patient Safety Collaboratives (PSCs) hosted by Academic Health Science Networks (AHSNs) to improve chronic (non-cancer) pain management by reducing harm from opioids. National Institute for Health and Care Excellence (NICE) guidance states that opioids should not be used to manage chronic non-cancer pain as harm outweighs the benefit.

Each London PSC has taken a different approach to engaging patients as key partners based on local needs for patient safety and opioid stewardship.

Natasha Callender is a Senior Project Manager (Registered Pharmacist) and Medicines workstream lead from the Health Innovation Network (HIN), who led an experience-based co-design (EBCD) project, working with the HIN’s Involvement team and HIN Lived Experience Partners using the Point of Care Foundation methodology. Natasha commented on the project:

“The aim of this EBCD project was to improve chronic pain management by bringing the lived and learned experiences of staff and patients together to prioritise and co-design solutions as equal partners.

“We co-produced recommendations for peer support and group education for people living with chronic pain to share with the system. We also developed a patient film and poster to raise the awareness of how connecting with activities, groups, and services in local communities can support people to live well with chronic pain.”

You can read more about the HIN’s project in this blog and an overview of their progress and next steps with the EBCD project by clicking here.

Lucie Wellington is a Senior Innovation Advisor and Opioids Programme Manager, Imperial College Health Partners (ICHP). ICHP is supporting the North West London (NWL) Integrated Care Board in using a systemwide model to reduce harm from opioids. The programme is being delivered via two workstreams; improving opioid stewardship across the care interfaces and PCN opioid optimisation review. Both workstreams put patient and public engagement at the heart of their efforts. Speaking about their work, Lucie said:

“In line with our unwavering commitment to delivering high-quality care, our latest strategic initiative is aimed at involving patients and the public in shaping the direction of our programme. We are seeking experts by experience to contribute invaluable insights on programme strategy and patient and clinician facing resources. Collaboration with our local polypharmacy initiative further promotes shared decision-making through a behaviour change campaign, empowering patients in structured medication reviews.

“Guided by NWL co-leadership and our shared dedication to making an impact, our programme has cut high-dose opioid prescriptions by 57 patients monthly, reflecting patient centred-care.”

For more information about the ICHP programme, click here.

Jess Catone is an Implementation Manager leading the Medicines Safety Improvement Programme at UCLPartners . UCLPartners has formed a core working group and an Opioids Network with representation from patients, Primary Care Networks (PCNs), community pharmacy, secondary care and mental health trusts across North Central and North East London. The aim of the Opioids Network is to provide a platform for patients, healthcare professionals, and voluntary/charity sectors to engage, share learning and develop better ways to manage chronic non-cancer pain. Jess briefly summarised some of the key elements of the UCLPartners programmes:

“We have produced an implementation guide for group education sessions, which was co-developed with patients and clinicians and includes a suite of material to support the work. These sessions, called ‘Feeling ALIVE: I cAn LIVE well with pain’, provide patients with information on ways to better manage their persistent pain and incorporate a follow-up consultation with a healthcare professional. The sessions also give patients an opportunity to meet and converse with other people who are experiencing similar issues with managing persistent pain.”

For more information on the work underway at UCLPartners, click here.

We are delighted to work with NHS England Patient Safety Team, PSCs across England and Pan-London system partners to improve the lived experiences of patients living with chronic pain. Let's continue work together to empower patients, enabling them to play a vital role in enhancing safety and minimising opioid-related harm within chronic pain management.

 

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Health Innovation Network joins international consortium harnessing AI and augmented reality for clinical rehabilitation

The Health Innovation Network (HIN) has today (July 26 2023) announced it will join the international TeleRehaB Decision Support System (DSS) project.

TeleRehaB DSS is a partnership developing AI-based telerehabilitation solutions for people experiencing balance problems after a stroke, delivered via augmented reality (AR). The technology can also be used with people experiencing Mild Cognitive Impairment (MCI) or long Covid-19.

Balance problems causing falls are one of the most common complications after strokes, with up to 73% of people who have had a stroke experiencing a significant fall within one year. Falls related to balance issues are often also associated with other conditions causing changes in cognitive ability such as MCI. These falls can cause physical injury (especially in older people) and may lead to the loss of self-confidence and depression.

Balance physiotherapy is a key intervention for falls prevention, but access to specialist falls prevention services is limited in many countries due to lack of appropriately trained clinicians and the complexity of effectively diagnosing and treating the underlying causes of the condition.

The TeleRehaB DSS project uses AI technology to make balance physiotherapy more available to non-specialist practitioners, through the introduction of guided diagnostic tools and personalised intervention-selection aids. These interventions are then delivered in the patient’s own home, with an AR “physiotherapist” guiding the patient through a tailored rehabilitation programme.

Supported by Innovate UK funding, the HIN’s primary role will be to provide expert guidance on facilitating the spread and adoption of new technologies and ways of working associated with the project. The HIN will also help TeleRehaB DSS engage with healthcare professionals and patients across the UK and further afield to localise its work.

The HIN joins a prestigious group of academic institutions, NGOs and research and development centres working on the project, with representation spanning Europe and Asia. Current members include:

  • University College London
  • Chulalongkorn University (Thailand)
  • National University of Athens (Greece)
  • Universitae Klinikum Freiburg (Germany)

Anna King, Commercial Director at the HIN said: “We are delighted to be joining the TeleRehaB DSS consortium and working on such an exciting use of a virtual reality solution in rehabilitation, to target a major health challenge where technology has a significant potential to improve care.

“I look forward to bringing our deep expertise in the spread and adoption of innovations in healthcare to bear on this international project; together we have a chance to explore how this emerging area of technology can best meet the needs of patients and clinicians.”

UK participants in Horizon Europe Project TeleRehabilitation of Balance clinical and economic Decision Support System are supported by UKRI grant number 10070260.

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Remote monitoring: embracing cultural change and developmental partnerships to enable patient choice

The Health Innovation Network and NHS England (London Region) recently held a series of procurement roundtables focused on remote monitoring. In this blog Dr Sanjay Gautama, Clinical Informatics Lead for the London region and consultant anaesthetist, discusses why it is crucial for suppliers and services to change their ways of working if they want to deliver change for patients.

At the heart of the promise of remote monitoring is the ability for patients to exercise greater choice as to where they receive safe and high-quality care. Remote monitoring is already starting to deliver on that promise, and enable people to be cared for in their own homes – a giant leap forward for digital technology in healthcare.

Whilst the early signs are that many patients are adapting well to this brave new world, commissioning, designing, and implementing these new technologies has been challenging for many of the professionals involved.

A particular impediment to progress thus far has been navigating existing procurement processes; a topic some of my colleagues discussed last month.

I am pleased that we are now in a position to share the in-depth outputs of recent collaborative work, bringing together perspectives from industry, commissioning, procurement and implementation teams to suggest a new way forward, focusing on developmental partnerships.

Getting the way we work together right has huge implications, not just for the initial procurement of digital infrastructure, but also the ongoing flow of data between different systems and ability to maintain interoperability as our requirements and ecosystems inevitably evolve over time.

Ultimately, it is the collegial and collaborative relationships between suppliers and services which will be vital if we want to see the pace of improvement to patient outcomes keep up with the potential speed of technological advancement in remote monitoring.

Technology should make doing the right thing for the patient the easiest option for the clinician – and developmental partnerships seem the way to achieve this.

Our report covers practical insights into key elements of establishing successful developmental partnerships, such as choosing who to involve, and advice on how to nurture these partnerships over time through effective engagement and contracting.

We hope that you will find it useful.

Read the full report

View our full roundtable report containing expert insights into how developmental partnerships may help to improve the commissioning, design and implementation of remote monitoring solutions.

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New NHS Innovation Service streamlines national support for innovators

Doctor using tablet device

HIN Chief Executive Rishi Das-Gupta has hailed this week’s launch of the NHS Innovation Service as an important step forward in delivering life-changing innovation more quickly.

Coordinated by the NHS Accelerated Access Collaborative (AAC), the service has been developed to support the UK’s Life Sciences Vision and accelerate the uptake of promising and impactful innovations into the NHS.

The NHS Innovation Service provides access to guidance and coordinated support from AHSNs and other organisations who have experience, knowledge, and expertise in developing and supporting the spread and adoption of healthcare innovations.

Innovators working with the service will be provided tailored guidance to help them complete processes which will help “unlock” adoption and spread within the NHS, including:

  • Regulations and service standards relevant to innovations
  • Demonstrating evidence of efficacy
  • NHS procurement and reimbursement processes

The service enables innovators to access support from expert organisations through a single coordinated platform. Organisations currently part of the NHS Innovation Service include:

  • The AHSN Network
  • Department for International Trade (DIT)
  • Medicines and Healthcare Products Regulatory Agency (MHRA)
  • National Institute for Health and Care Excellence (NICE)

Innovators create an account and complete an innovation record, which contains detailed information about their innovation. This enables an expert team to determine the requirements for the innovation to be adopted and put the innovator in touch with the right organisation at the right time. At each stage, organisations offering support have access to the innovation record, which will accelerate the process and avoid duplication – saving innovators having to reintroduce their concept and progress to each organisation.

The NHS Innovation Service is currently in public beta – a public testing phase. Users will be able to provide feedback on the service based on their experiences, creating opportunities for it to improve with further testing. The service replaces the HealthTech Connect platform.

Dr Rishi Das-Gupta, HIN Chief Executive said: “The NHS Innovation Service will further bolster the expert support already available to south London innovators through our own Innovation team and the DigitalHealth.London programme.

“I am particularly pleased that this new service will allow streamlined engagement with national bodies such as MHRA and NICE, who can often be crucial players in facilitating the spread and adoption of the most promising innovations. Reducing the complexity of interfacing with these bodies will undoubtedly mean patients benefit from innovations sooner.

“This work is another powerful demonstration of our sector’s commitment to collaboration as a driver of world-class health innovation in the UK.”

Inclusive innovation: 5 things you can do to make healthtech better for the LGBTQI+ community

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Post Title

To celebrate Pride Month 2022, we’ve teamed up with DigitalHealth.London NHS Navigator Brett Hatfield to look at some practical steps anyone working in health and care can take to make health tech more accessible and inclusive to the LGBTQI+ community.

The LGBTQI+ community is affected by disproportionately worse health outcomes and experiences of care. Health technology and innovation can play an important role in tackling these long-standing inequalities, with progress already being made through movements such as Queertech – but it is important we keep up this momentum.

Whether you are a clinician or commissioner, member of the LGBTQI+ community yourself or aspiring ally, any person working in the health and care system can contribute to making health and care technology better for people who identify as lesbian, gay, bisexual, transgender, queer or intersex.

In this blog we’ll be looking at 5 steps anyone can take to get started with LGBTQI+ inclusive innovation – if you’ve got additional ideas or resources we’d love to hear from you.


1. Learn about the health experiences of LGBTQI+ people

People from the LGBTQI+ community have faced – and continue to face – specific barriers and challenges when it comes to health. In recent years, progress has been made on understanding some of these challenges and starting to address some of the underlying issues that have resulted in health inequalities.

• Read Stonewall’s “LGBT in Britain Health Report” (PDF)

On the other side of the therapeutic relationship, many LGBTQI+ NHS staff also sadly continue to experience discrimination, with one recent survey revealing that more than a quarter of lesbian, gay or bisexual staff had received bullying or poor treatment from their colleagues.

• Read The King’s Fund blog “Supporting LGBTQ+ NHS Staff

2. Join a community

The LGBTQI+ community has a long tradition of connections spanning geographies, languages and backgrounds. Many thousands of communities and forums now exist in helping to bring together people who identify as LGBTQI+ (and allies) with specific interests. Many of these intersect with the worlds of health and technology, making them the perfect place for incubating ideas, discussing challenges, or simply listening and learning more about the experiences of LGBTQI+ people.

We’ve listed a handful of relevant communities below, but many more can be found by searching the web:

Intertech
Lesbians who Tech
Guy’s and St Thomas’ LGBT+ Network
Pride in STEM
LGBT+ Future NHS workspace


3. Be data-savvy

A particularly relevant inclusive innovation topic for people working in the design and deployment of NHS technology services is the importance of getting monitoring and data collection right.

Monitoring refers to the collection of consistent data about service users to help identify population health risks, inequalities, or opportunities for service improvement. In many instances, having information about characteristics such as sex, gender or sexual orientation provides vital insight that makes a real difference to service users.

Whilst monitoring (or data collection for other purposes, such as for clinical risk management) is important, the way that this monitoring is conducted is also important to consider for inclusive services. For example, if required, methods for collecting data around sex and gender should be designed inclusively to avoid excluding people who identify as trans or non-binary.

• Read “If we’re not counted, we don’t count” (PDF), a guide from the LGBT Foundation about monitoring best practice
• Read NHS Digital guidance on monitoring
• Read “Let’s talk about sex*”, a blog from former NHS Digital service designer Emma Parnell about how her personal connection to the trans community helped to shape a more inclusive Covid-19 vaccination booking service


4. Get inspired

The future looks bright for innovations that may tackle health inequalities within the LGBTQI+ community, or improve health outcomes for people who identify as gay, lesbian, bisexual, transgender, queer or intersex. We’ve picked a few innovations that are already making waves:

LVNDR, who are pioneering a new approach to inclusive and personalised healthcare that integrates with existing services
Love Positive, who are exploring new approaches to more inclusive and body positive relationship and sex education programmes
Plume, who are improving access to gender-affirming therapies and supporting trans people in the US
Helsa Helps, who deliver Empathy VR (virtual reality) training combined with psychological mechanisms to immerse users in stories depicting stigma and discrimination towards minority people, experienced through the eyes of the stigmatised, addressing homophobia, transphobia, racism, and sexism
Kalda, who offer a smartphone app for LGBTIQ+ mental wellbeing. They provide users with access to on-demand LGBTQIA+ courses and mindfulness sessions addressing some of the stressors that come with being LGBTQIA+

Note: these apps and services may have not been formally evaluated or assessed by the Health Innovation Network and their inclusion in this article should not be considered an endorsement for use.

Don’t forget that if you’re an innovator looking for support, you can get in touch with us!


5. Challenge yourself

Helping your workplace become as inclusive as possible could start with something as simple as changing your language slightly, or thinking about using your pronouns to introduce yourself. Whether you identify as LGBTQI+ yourself or you want to become an ally, what could you do to help LGBTQI+ colleagues thrive?

• Read “Challenging the default“, an NHS Employers blog from Dr Michael Brady
• Read “Why pronouns matter“, an NHS Confed blog from Dr Jamie Willo
• Read “7 ways you can be an LGBTQ ally at work“, an article from Stonewall