Culture is everything: reflections on reducing restrictive practice at Lesney Ward

Five ward staff standing together

Restrictive practices are techniques such as physical restraint, seclusion and rapid tranquilisation used to limit a person’s liberties, movements or freedom to act independently in potentially dangerous situations.

The inappropriate or overuse of restrictive practice in mental health services has been identified as an area of concern in healthcare since at least 2015.

Beginning in 2021, the Health Innovation Network has been involved in local efforts to reduce restrictive practice based on the findings of a successful pilot led by the National Collaborating Centre for Mental Health.

We speak to HIN Patient Safety Project Manager Ayobola Chike-Michael and Ward Manager James Njoki about the programme team’s recent visit to Lesney Ward, an acute adult mental health ward which is part of Oxleas NHS Foundation Trust. Read reflections from previous visits here.


In my role of supporting mental health wards to reduce restrictive practices in south London, I recently had the privilege of visiting Lesney Ward, which is part of Oxleas NHS Foundation Trust.

Lesney is a 20-bed mixed adult mental health inpatient ward, and I was eager to explore the ward’s efforts to create a therapeutic environment with minimal use of restraints.

Upon arrival, I was delighted to find that Lesney Ward had recently undergone refurbishment. The ward now boasts a fully functioning gym, a sensory room and therapeutic garden among other enhancements.

During my visit, I met the ward manager, two other members of staff and a QI lead from the Trust. Engaging in meaningful discussions, we exchanged ideas on how to promote positive change and minimise restrictive practices within the ward.

One remarkable aspect of Lesney ward is its commitment to establishing a culture of no restraint as the default approach. As a result, the ward does not have any seclusion rooms. The primary method used to reduce the use of restrictive practice is the de-escalation method, which was commended at a CQC inspection in February 2023.

I was impressed by the variety of successful de-escalation methods employed by the ward. Apart from the verbal de-escalation methods, there were other successful change ideas the team shared with me:

  • Patient Engagement Time (PET). PET is a 7-day activity timetable with flexibilities where each staff spends 30 minutes with their assigned service user to build rapport and provide reassurance.
  • Daily community meeting. Held Monday to Friday, this meeting involves patients, staff, healthcare assistants, occupational therapists, activity coordinators and others. This could be led by patients or staff.
  • Relational security. The ward makes active use of the ‘See Think Act’ framework.
  • Simplification of language. For example using terms such as ‘physical health check’ instead of ‘vital signs’, which enhances communication between staff and service users.
  • Being proactive about giving information to service users.
  • Diverse activities. Activities on offer include arts and craft, walking group, sensory group, therapeutic garden visit, orientating to ward, gym induction and physical health competency.
  • Appropriate interventions and medications. Ensuring patients receive the right interventions and medications to prevent transfers to psychiatric intensive care units whenever possible.
  • Inclusive safety huddles. These huddles involve all stakeholders including domestic staff
  • Nutritious food. Food is sourced from reputable providers, with careful planning going into making sure that it provides the right nutrition for service users. Taster sessions were organised for both staff and service users, and a variety of fruit is available throughout the week.
  • Promoting decaffeinated beverages while maintaining flexibility
  • De-escalation for smoking demands. Employing de-escalation techniques to address service user requests to smoke, directing them to e-cigarettes.

My visit to Lesney Ward was an inspiring and enlightening experience. The recent refurbishments have enhanced the ward’s facilities and contributed to a more holistic approach to care.

The ward’s commitment to creating a therapeutic environment with minimal use of restraints is truly commendable. By prioritising patient engagement, promoting positive change, and implementing innovative strategies, they show us the possibility of creating a mental health system that values dignity, respect and recovery for all.


The culture of doing everything we can to deliver the best care at Lesney Ward is something that is quite special; it is something that predates my time here but which every staff member believes in.

We take a lot of pride in having very low levels of restraint and very rarely needing to refer our service users to Psychiatric Intensive Care Units (PICUs).

Whilst developing a culture takes years, we hope that our service users feel the benefits of our culture as soon as we start caring for them.

We are big believers in starting things off on the right foot. We make sure that all the people entering our care have their medicines reviewed as soon as possible, and we spend time with service users helping them get oriented to the ward and understanding the support we can offer them.

We hope that this helps us build bonds between service users and the staff and helps everyone to understand that we want to do everything possible to support our service users.

In the longer-term, having such a proactive culture has meant that we have been able to improve the environment we provide care within, which in turn has meant better outcomes.

Where it might have been easy for our old gym to have quietly closed when it fell into disrepair, the attitude of the team here meant that we saw it as an opportunity for improvement. Now, the gym is better than ever, and it provides a positive space for our service users.

Likewise, our garden is something that people might dismiss as being a bit of a luxury – in today’s NHS how can you justify spending time and money on greenery?

The reality is that those small things, those moments of going above and beyond the basics, can make a big difference to health outcomes and reduce the need for restrictive practice.

For example, a few weeks ago we had a new service user who was very unwell. It was very difficult for us to safely provide the care he needed as he was distressed about his new surroundings. It would have been an easy option to “escalate” this service user to PICU.

However, through going through the records of the service user, we found that they had an affinity for being outside. We tried moving some of our time with them into our garden, and we saw a huge transformation.

That sort of outcome isn’t something that comes from a moment’s work, or even a month’s work. But it shows that persistence and creating the right culture will pay off in the long term. From the first step to the last step, make sure every one has the right intention!

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Get in touch to find out more about the Mental Health Safety Improvement Programme and our work to help reduce the use of restrictive practice.

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Early Intervention Eating Disorders (FREED) National Spread Programme has been shortlisted for an HSJ Award 2023

A mental health programme which has benefitted 1000s of young people with eating disorders has been shortlisted for a prestigious national HSJ Award.

An early intervention eating disorder model which originated in south London has helped over 2,000 young people has received national recognition today (Monday, August 14).

It has been announced that the First episode Rapid Early intervention for Eating Disorders (FREED) model aimed at 16 to 25-year-olds developed by South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London (KCL) has been shortlisted for a 2023 HSJ Award.

The model provides swift access to specialised, evidence-based treatments tailored to youth, incorporating developmental considerations with a focus on early intervention. In 2020, it was selected by the Academic Health Science Network as a national programme, with the Health Innovation Network, the AHSN for south London, managing the rollout. To date, the programme has benefited 2,722 young people, leading to full early recovery in approximately 65% and halving the need for costly and disruptive in-patient treatment. The model has now been implemented in over 50 eligible mental health trusts in England, leading to estimated NHS savings of £12.1 million.

Dr Rishi Das-Gupta, the Chief Executive of the Health Innovation Network (HIN) said: "I’m pleased that the HIN has been able to support the spread of FREED. We know that eating disorders impact the lives of many young people and that intervening early is extremely helpful. This programme exemplifies how we can innovate in care delivery to reduce health inequalities and enhance access to services for our local communities - and reaching over 2,000 patients since the start of the programme is a mark of the impact of the teams delivering the service."

Ulrike Schmidt, Professor of Eating Disorders at KCL and Consultant Psychiatrist at SLaM who has led development and evaluation of FREED said: “Adoption of our programme by the AHSN/HIN has turbo-charged our ability to make FREED available to young people in all parts of England. We are now working to spread and improve the evidence-base for FREED further, both nationally and internationally.”

Danielle Glennon, Head of FREED and Head of Psychology & Psychotherapy at SLaM who alongside Professor Schmidt has been part of FREED’s story since the beginning, said: “The AHSN/HIN programme meant that despite the unrivalled challenges clinicians faced through COVID, we could continue to support teams in making FREED a reality for young people in their area. The commitment, creativity, and willingness to share, as the FREED network grew, is inspirational.”

Laura Semple the Director for National Programmes at the AHSN Network said: “Over the last three years, it has been an honour to collaborate with the 15 AHSNs on the FREED Programme. Clinical colleagues have worked diligently with their AHSN partners on the ground to get new FREED services up and running across England and it is excellent to see this achievement recognised. While we know there is much more to do to improve care for young people, the national availability of FREED is vitally important progress and we look forward to seeing the FREED network continue to thrive in the future.”

More than 1,400 entries were received for this year’s HSJ Awards, with 223 projects and individuals reaching the final shortlist, making it the biggest awards programme in the award’s 43-year history. The high volume - and exceptional quality – of applications once again mirrors the impressive levels of innovation and care continually being developed within the UK’s healthcare networks.

The winners will be announced during the awards ceremony at Evolution London on November 16, 2023.

Reducing harm for people with chronic pain by reducing the prescribing of opioids 2022/23


At the Health Innovation Network (HIN) we developed a local programme across south London in response to the nationally commissioned Medicines Safety Improvement programme (MedSIP). The ambition for 2022/23 was for Patient Safety Collaboratives (PSCs) working with a minimum of 15 ICS, will collectively achieve the following outcomes among adults living with chronic (non-cancer) pain by the end of March 2023:

  • 30,000 fewer people were prescribed oral or transdermal opioids (of any dose) for more than 3 months.
  • Of the 30,000 above 4,500 patients will have been prescribed a high dose (≥120mg day oral morphine equivalent) at baseline and have now stopped opioids.
“All too often the complexity of having chronic pain and of helping people and professionals to manage pain are overlooked. High prescriptions of opioids can be a result. I’m delighted that this work has looked at how to manage pain as well as reducing harm from opioids.” Natasha Curran, Consultant in Anaesthesia and Pain Medicine at UCL Hospitals and Medical Director of the Health Innovation Network.
Our local programme covered the following:

Working with staff to drive improvement

We delivered a CPD-accredited Opioid Stewardship Quality Improvement Collaborative for clinicians across south London from October 2022 to March 2023. Please click here to find out more.

Using opioid prescribing data for system audit-feedback

We shared local opioid prescribing data packs with GP practices across south London based on the Campaign to Reduce Opioid Prescribing . Please click here to find out more.

Working in partnership with people living with chronic pain

We facilitated an experience-based co-design (EBCD) project using the Point of Care Foundation methodology. The aim of the EBCD project was to improve chronic pain management by bringing patients and staff lived and learnt experiences together to prioritise and co-design solutions as equal partners. Please click here to find out more.

Recommendations for whole systems working to improve opioid stewardship

  1. Pain clinic referrals are often seen as the next step once other options have been explored in primary care however onward referral to for example talking therapies, physiotherapy and exercise should be considered.
  2. Where possible it is important that the same clinician and prescriber who commence the opioid prescription are also responsible for ongoing monitoring and reviewing. Clinicians should have the opportunity to discuss complex cases at team meetings.
  3. Primary and secondary care clinicians should have an awareness of the breadth of services in their locality that can assist with supporting patients to adjust to the impact of living with persistent pain on their daily life e.g., social prescribing link workers.
  4. Joint consultations for complex pain management in adults across primary care networks e.g., clinic appointments with colleagues across several disciplines with specialist input from hospital pain clinics should be considered. GP appointments tend to be short, therefore making it challenging for clinicians to have sufficient time to support patients living with persistent pain as much as they would like to.
  5. Maximising digital prescribing systems e.g., creating alerts, issuing weekly prescriptions, and communicating plans to reduce high-risk opioid prescribing to other multidisciplinary team colleagues.
  6. Sharing decisions with patients about how to improve persistent pain management and agreeing on reductions when tapering opioids through regularly scheduled regular follow-ups.
  7. Introducing the idea of changes to the ways persistent pain is managed and informing patients of the risk of harm for long-term and high-dose opioid prescribing at an initial appointment and scheduling follow-ups to explore alternatives to pain medicines.

You can read more about developments with our local programme throughout 2022/23 here in our blogs:

Find out more

To find more about our local programme please contact Natasha Callender, Senior Project Manager and Medicines Workstream Lead.

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My experiences of autism and mental health care: the bad, the good and the future

Close up of young person sit on sofa hand holding mobil

There are more than 700,000 autistic people in the UK. Many autistic children and young adults experience a delayed diagnosis, which can have a significant negative impact on their mental health. 

We hear from Freddy Henderson (she/her) about her experiences being diagnosed with Autism Spectrum Disorder (ASD) and her reflections on what mental health services can do to care for autistic people in a more effective and person-centred way. 

Freddy also discusses how innovations such as Tellmi can provide valuable access to safe, anonymous peer support for autistic children and young people, who may often prefer to use digital channels. Tellmi is an innovative digital peer support app which is commissioned by the NHS and has been used by more than 80,000 young people to discuss their mental health.

Please note that this article contains some mentions of self-harm, suicide and eating disorders which some readers may find upsetting. 

I have 2 disabilities, Functional Neurological Disorder (FND) and ASD, although the latter is what I am going to be talking about today. I was diagnosed with autism six years ago, at age 17. That diagnosis came about after I was referred to the integrated neurodevelopmental team by Child & Adolescent Mental Health Services (CAMHS) as they suspected I was autistic. I had originally been referred to CAMHS when I was 15 by my school, as I was suffering a lot with my mental health and was grappling with self harm, depression and anxiety. I later developed anorexia and so was also under Child & Adolescent Eating Disorders Services (CAEDS) for about three months until I turned 18. Later at university I accessed NHS services in conjunction with the university resources to help me balance my mental health needs and medication for it.

I want to highlight that my ASD was not the direct reason I was using these services, but rather that I needed these services because the effects of my late diagnosis had become so catastrophic that it ‘broke’ my ability to cope with the world.

What I hope I can give an insight on in this blog is my own perspective what was helpful, what was not, and how I think services and treatment could be improved.

The bad

Let’s start with the worst of my experiences to get them out of the way.

My first therapist at CAMHS was terrible. They made me feel belittled and patronised, and their complete failure to understand my attempts at communicating what was going on meant that my health got actively worse.

I was very quiet and reserved in sessions and had flashes of anger when my therapist tried to make suggestions; I felt attacked and as though they were accusing me of not trying hard enough. I never shouted or expressed that anger outwardly, but it meant I was defensive and ardently against sharing information that I deemed to be too personal.

At the start of one session my therapist walked in and put a colouring book and pencils on the table and told me to colour. After a few minutes, I asked if we were going to talk. They replied with “well if you’re not willing to talk to me, why should I talk to you?”.

A couple of days later I was held overnight in hospital after a bad self-harm incident, which led to meeting my next therapist.

The next therapist made me feel much better. They were kind and patient with me and gave me practical help with how to formulate sentences expressing my thoughts and feelings. They would ask direct questions rather than open-ended ones, something that helped immensely.

We’ll come back to them later, but first let’s quickly talk about another bad experience.

It is now widely recognised that eating disorders are rife within the autistic community (especially young people) and I was no exception. What started as a desire to get “in shape” quickly morphed into a monster beyond my control.

I won’t describe any of my thoughts, actions or physical consequences as eating disorders are notoriously competitive and I don’t want to trigger other people who might be vulnerable themselves. The only part relevant to this story is that I was very unwell.

I was only in CAEDS treatment for about three months just before I turned 18, and so was transferred to the adult services where I promptly discharged myself after the therapist there criticised me for not making eye-contact with them.

Any readers with a vague understanding of autism may see the issue here. Eye contact is often difficult for autistic people and I don’t look at people’s eyes at any time, let alone when I’m feeling vulnerable. By this time, I had my diagnosis and the sheer disregard for my condition and the traits it presents as meant I rejected all additional treatment for my anorexia.

I am very pleased to say that I no longer have anorexia as I put in a lot of hard work and, with the help of some borrowed ideas from the fat acceptance movement, managed to overhaul the disease that controlled me for 3 years.

The (mostly) good

Now, onto the good experiences!

My second primary therapist was the person who helped me get an autism diagnosis, which turned out to be one of the biggest turning points in my mental health journey.

Up until that point I genuinely believed that I was fundamentally flawed as a human being and there was something intrinsically wrong with me. I considered myself nothing short of a complete waste of space and that my life would forever be spent in pursuit of a goal I would never achieve.

Getting my diagnosis put a stop to most of these thoughts, although it remains difficult to completely dismiss ideas you have held for the majority of your life.

It helped me come to terms with my differences and understand that I was not ineffectual as a human being, but rather I just operate a bit differently.

I was able to recognise my strengths for what they were, rather than consider them some minor penance for my otherwise catastrophic flaws. The diagnosis helped me to separate my brain from my mental health disorders. It helped me understand why I thought the way I thought and act the way I act.

It also helped explain why so much of the therapy I had had had been ineffective. Of course the CBT for panic attacks hadn’t worked; I wasn’t having panic attacks, I was having meltdowns.

Another type of support that helped hugely was when I met other autistic people.

At my university there was an autism support group. Granted, it was run by non-autistic staff members and in my third year it took such a drastic turn for the worse that I left after arguments with said staff, but still. I met a couple of good friends there who I miss dearly as we are no longer in the same city.

Meeting other people like me was amazing. We were able to connect on a level I hadn’t experienced before as we had an innate understanding of each other. That is not to say that my friendships with autistic people are inherently better than those with non-autistic people – they are just different.

Of course, autistic people are not a monolith and so there were some people there who I really disliked. Regardless of the ups and downs – being able to talk about our shared experiences was such a relief.

During my second year at university, the pandemic hit.

Covid-19 impacted every aspect of our lives, including the support services I was in. I got removed from the NHS community mental health service and the university wellbeing service as they wanted to free up capacity for people struggling to adjust to life in such a different world. The irony was not lost on me.

The ASD group was also moved online and let me tell you, trying to do a jigsaw puzzle over zoom presents some complications. I think it’s fair to say that aided in the breakdown of the group dynamic and made it quite difficult for the members who weren’t very confident to get to know the group.

We ended up doing activities such as a name-this-vegetable quiz, organised by one of the staff members. This quiz was later referenced when the whole group was arguing with the mentors that they were treating us like children.

The difference between in person support and digital support was stark. No one was ready for the pandemic and as everyone struggled to adjust, those accessing support services just plain struggled.

However, there was a definite silver lining to the switch to digital content and support: my university was online, which turned out to be an absolute godsend. By my second year I was still struggling with my mental health and processing a suicide attempt a year earlier. I had also started to develop what I now know is FND, although it would take roughly 4 years to get diagnosed.

In short, I was both physically and mentally really ill. Being able to do classes online was bizarre at first, but not having to expend energy getting to and from class and dealing with the sensory nightmare of being in public was amazing.

Lots of the pressure I had felt, both economically struggling at work and socially struggling on nights out, had been lifted. People found ways to socialise online, and jobs offered flexible working where possible. It hugely helped me.

The future

That is why going forward I am such a proponent of a hybrid approach to pretty much anything that can be hybridised. Whether it’s flexible office hours or the option of having therapy online, giving people the option to choose what suits them best hugely helped me and so many of my autistic and otherwise neurodivergent friends.

I still like going out with my friends, and having workplace banter is fun, but having seen the real benefits that digital services offer makes me very reluctant to go back to how things were.

And this is a key concept that I want to convey: when the world changed it was because it had to, but the effect was more surprising than anyone anticipated. All manner of people benefitted in unforeseen ways and thus having an open, flexible approach to resources and services is, in my humble opinion, the way forward.

Peer support does not have to be in person. Digital channels can be just as useful as in-person, and possibly more so when you consider factors such as geographical isolation, physical disability or time restrictions. Apps like Tellmi allow users to connect with others like them. Just as meeting my autistic friends was hugely helpful, having access to other people who may be experiencing similar issues is hugely helpful.

I’ve had the chance recently to speak with and work alongside the creators of the Tellmi app, and it seems clear that a lot of the reason why their service works for autistic people is because they put an emphasis on listening to and learning from autistic people to make their app better. Having people involved in the day-to-day running and development of the app who are neurodiverse is undoubtedly a good thing.

Consulting, engaging and co-producing with diverse groups of people will help build better solutions that work for all people. Just as neurodiverse people should be consulted about improving services for neurodiverse people, changes which have the potential to affect any group should be decided with the involvement of people who are representative of that population.

An underlying cause of the lack of effectiveness for many of the treatments I experienced was that they did not account for my autism. Autism is a fundamental part of me – and something I am very proud of – yet I was being funnelled through services not designed for people like me. As such, is it not surprising that they did not help me, and in some cases caused me harm?

Any support for autistic people needs the input of autistic people. And any services that might support autistic people also need the input of autistic people. You can have the best intentions in the world and be the brightest person alive, but if you haven’t lived as an autistic person, you will never build services which truly support autistic people alone.

Almost all the solutions I have found that have got me to where I am now have been of my own creation.

And where I am now is pretty darn great. I am happy, I am optimistic, and I am enjoying my life – which is much more than I could say when I was 15.

You might look at me, in my wheelchair with my headphones on and sunglasses blocking out external stimuli and think my existence is something which requires improvement. But I am at my best. Imposing one’s own ideas of how someone else should live is an issue for the ages, and that is precisely why it is imperative that we remove assumption and prejudice from the equation when we are trying to make services better for people.

I mostly don’t read work on autism by non-autistic authors. It is often derogatory, wrong or just plain offensive and I have no time for it.

My autism is a condition of which I take pride in and use to my advantage. I don’t have to be a genius like Einstein or a world changing advocate like Greta Thunberg in order to deserve the right to live as my authentic self.

I have no interest in support that hasn’t been developed by someone like me because it will be inherently steeped in presumptions and expectations that I don’t ascribe to. I will only ever be happy when I accept that I am not fundamentally flawed because of my condition and work alongside it to shape my life in the best way for me.

Interested in how digital technology can be used for mental health?

Speak to our expert team about how digital technology can be used to help mental health and wellbeing.

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“We are ‘done unto’ by health” – how do we help care home providers get an equal voice in integrated care?

Here the Health Innovation Network’s Clinical Director Carrie Chill reflects on the learnings from a recent event focusing on how to ensure social care can have a louder voice in integrated care systems, and how those in the health system can support them.

Have we unlocked the full potential of integration?

I joined colleagues recently at a London-wide event to explore the potential of increased involvement from care providers at a more strategic level in the health and care system.

The Health Innovation Network supported a number of organisations at the event, which was hosted at City University London. These included My Home Life England, a charity working to improve the quality of life for those living, visiting, and working in all care settings, and Care Providers’ Voice, an organisation aiming to create strong networks of providers and maximise the benefits of collaboration across local geographies.

Attendees included care professionals in leadership roles from London nursing homes, residential homes and domiciliary care providers. They were joined by system leaders from local authorities and at a London level to explore how care providers can contribute to strategic development of Integrated Care Systems and Integrated Care Partnerships.

One of the early themes which emerged from the discussion was that care colleagues felt they needed a better understanding of the way health and care systems operate at a strategic level. They also felt they needed confidence, support, and resource to become more involved. There was a feeling among care providers of sometimes being required to undertake training or activity which had been done before or was of little value to the care setting. I felt many of these feelings were summed up by the comment that “we are ‘done unto’ by health”, with very little power to influence such situations.

We heard from Mike Armstrong and Tay Nagendran from Care Providers’ Voice on what has worked well in north east London. They explained how they have supported providers with recruitment and training and how “having a seat at the table” has helped local authorities deliver services more effectively.

I was struck by the consensus that the involvement of care providers would be both valuable and welcomed, but also by the hurdles to be jumped before it could become a reality. Care providers felt mentoring and ongoing support would be beneficial and there was much debate about exactly where and how their involvement would be most impactful.

It is so positive that My Home Life and Care Providers’ Voice have raised the profile of this important issue in London, and continue to do so. I feel we at the HIN are well placed to support these discussions through our networks including our Care Home Leads Forum, our Pioneer Alumni, through strengthening partnerships, and by exploring the potential of a London Care Network.

I believe we are just starting on the road to full integration. Great work has been done to configure the system, but we now need to work from the bottom up, to engage and include not just health, but also care and the voluntary sector.

It may not be quick, it may not be easy, but it will certainly be worthwhile.

The HIN and MHL are in the fifth year of working together to deliver the South London Care Home Pioneer programme to develop the leadership skills of senior care home staff.

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To learn more about this programme, contact us via the email below.

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Accelerating FemTech: How can FemTech help reduce inequalities in maternity care?

The final webinar in the Accelerating FemTech: Inspire series was hosted by West of England Academic Health Science Network (AHSN) and was on the topic of inequalities in maternal and neonatal care.

Anna King, Commercial Director at the Health Innovation Network, began the webinar by introducing the Accelerating FemTech initiative and the Accelerate programme which is currently open for applications.

Alex Leach, Director for Innovation and Growth (acting), provided a short introduction to West of England AHSN and the work the organisation has being doing across Bristol, Gloucestershire and Wiltshire, leading the way on multiple maternity and neonatal care programmes.

The first presentation was delivered by Ann Remmers, Maternity and Neonatal Clinical Lead for West of England AHSN, on the topic of health inequalities and the impact they have on outcomes and experiences in maternity care. Ann provided insight into what is meant by inequalities in health and what these mean in maternity care, sighting shocking statistics such as the MBRACE-UK Report finding that black women were 3.7 times more likely to die than white women during maternity care. Ann concluded by emphasising the power of collaboration when looking at innovation in this space.

Sonah Paton, Founder and Director of Black Mothers Matter, spoke next about the lived experiences of black mothers, the evidence available and the context which led to the founding of Black Mothers Matter, encouraging innovators to remember the real people behind the statistics. She provided an overview of the support which the organisation provides including an online resource library and shop, antenatal support boxes and taught sessions in a community group including with pelvic health specialists and baby yoga instructors. Sonah also discussed the Black Maternity Matters initiative, co-produced with multiple partners including West of England AHSN, and currently being piloted in Bristol Trusts, involving training and QI projects.

Finally, the Founder & CEO at Anya, Dr Chen Mao Davies, gave an inspiring presentation on the multi-award winning FemTech start-up which is leveraging AI, 3D technology and access to world-class specialists to support parents with breastfeeding. This was born out of Chen’s personal experiences of breastfeeding and aims to help the 90% of mothers who are reported to give up breastfeeding before they wanted to. She shared the company’s co-production approach and patient involvement strategy, and the resultant improvements that they were able to make to the Anya product as a result.

If you found these clips interesting, you can now 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.

Relicensing of AHSNs confirmed

Today the Government has confirmed that that Academic Health Science Networks (AHSNs) are being relicensed for a further five year period as part of a broader commitment to science, research and innovation.

Set up in 2013 by NHS England to act as innovation arms of the NHS, AHSNs work locally and nationally to support the spread of all types of innovation within the NHS, from new technologies to ways of working and service improvements. Under the Department of Health and Social Care and the Department of Science, Innovation and Technologies’ joint commission - the Office for Life Sciences (OLS) - AHSNs also provide bespoke support to innovators to accelerate promising innovations from development to adoption, and boost economic growth.

The Health Innovation Network (HIN) is the AHSN for south London. In the last year we have supported over 70,000 patients to benefit from new treatment and diagnostics in south London. In addition, we have supported national programmes such as FREED which had resulted in all 54 mental health Trusts adopting this innovative programme, developed in south London, to support people with eating disorders.

Dr Rishi Das-Gupta, HIN Chief Executive and Hitesh Thakrar, HIN Chair said: “Today’s announcement is very welcome and re-iterates the importance of AHSNs as part of the research, innovation and health and care infrastructure.

“It also builds on statements by NHSE over the last year and the Hewitt Review last month which highlighted AHSNs as an essential function. It provides a renewed mandate to continue our AHSN work across south London, which forms a core part of the support we provide to the local health system as part of our work to support the spread and adoption of innovation across London and nationally and to innovators locally, nationally and internationally.”

Professor Gary Ford, Chair of the AHSN Network said: “It is a testament to the collective impact of the AHSNs over the past 10 years that our commissioners have issued a further licence. We welcome the opportunity and challenge this provides for our teams to identify, develop and spread innovations that meet the priorities of the NHS over the next five years.

“The challenges facing the NHS will only be met by widespread adoption of innovation in digital and diagnostic technology and in data to transform clinical pathways and empower patients.”

The new license will come into effect from 1 October 2023 with the option of a review after two years.  As part of the new licence, AHSNs will be renamed health innovation networks. Each organisation will continue to support local innovation and transformation, working with their local integrated care boards (ICBs) while continuing to come together as a national network to spread promising solutions at scale.

The real impact remote monitoring has on care home residents and those who care for them

Project Manager at the Health Innovation Network Andrew Scott-Lee reflects on the learnings from an evaluation of more than 170 London care homes using remote monitoring.

The use of Remote Monitoring (RM) technology to monitor physical health conditions outside of hospital has increased rapidly in recent years, and in particular since the Covid pandemic. This growth in use has also been seen in care homes where the technology has been introduced to enable monitoring of residents’ health at home and to improve the chances of identifying deterioration quicker.

Our evaluation of the implementation of remote monitoring in 173 care homes across four London Integrated Care Systems in 2021 found that 73% of homes continued to use the equipment months after implementation. Many care home staff reported benefits to them, residents, and the wider healthcare system.

The report highlights the confidence that RM instils in care home staff, who are often not trained to the same level of nurses or doctors. Utilising the physical health monitoring kit, baseline health data is collected, and guidance is available so that appropriate action can be taken when readings change. Training in use of the technology empowers staff to interpret observation readings and communicate effectively, confidently and in a clinically appropriate way with GPs, urgent care, and ambulance services.

I was able to explore in detail the approach that South West London (SWL) Integrated Care System took to implement RM in care homes, by undertaking a series of interviews with staff who led the digital transformation, and care home managers. The experience of these staff is described in this report.

You can see from the report that SWL’s Integrated Care System has made impressive progress in implementing digital transformation in care homes. My conversations with staff also highlighted the challenges faced by the care home sector in general in making the transition to digital ways of working.

Prior to the pandemic, many care homes predominantly used paper-based approaches for tracking and monitoring resident care, so the transition to digital monitoring requires - for some - a change in mindset. Care homes continue to experience high staff turnover rates, making it difficult to embed change. The amount of training and on-going support for digital transition may vary across different geographies, which impacts a home’s ability to sustain a digital transition once they have begun the journey.

Despite challenges, the commitment of care home staff to do what is best for their residents dominates. Although RM remains in its early stages of adoption in care homes overall, care home staff and GPs recognise its value.

Further evaluation may demonstrate that more consistent early identification of deterioration could result in fewer 999 calls and ambulance conveyances from care homes, and shorter, more appropriate hospital attendances and admissions.

Technological advances offer the potential for health and care services to work even better together to ensure that care home residents receive the right care, in the right place and at the right time, and services are used as efficiently as possible.

This can only be good news for care home residents, and the people who support them.

Download the report

Find out more about the impact of remote monitoring in care homes in our full evaluation report.

Download here

Using Virtual Reality to Help People with Acute Mental Health Conditions

Aileen Jackson, Head of Mental Health at the HIN, writes about the promising results from a pilot of virtual reality (VR) relaxation technology on mental health wards.

A scuba diving experience with wild dolphins. A sunny meadow in the Alps. A coral reef. A sunny mountain meadow with animals. A guided mindfulness meditation on the beach. A session of Tibetan sound bowls. These are some of the images and sounds that have helped to reduce stress for people with acute mental health issues.

Learning about how a cutting-edge virtual reality (VR) relaxation innovation has supported people with acute mental health conditions has been truly inspirational and uplifting. After being made available on an acute in-patient mental health ward, the VR headset was, perhaps unsurprisingly, well received by service users and staff. So why is this intervention not routinely offered on all mental health wards?


The project was made possible through a Health Innovation Network innovation grant back in 2019. It was developed by virtual reality pioneer Dr Simon Riches, Highly Specialist Clinical Psychologist, in partnership with Kings College London and VRelax.

The pilot involved 42 service users at South London and Maudsley NHS Foundation Trust, of which 28 were inpatients and 14 were attending outpatients. The most common diagnoses for those who participated were schizophrenia, schizotypal and delusional disorders. All service users had one session of virtual reality relaxation.

How did VR help?

Positive outcomes were reported by all 42 participants, including significant reductions in stress, anxiety, and sadness, and significant increases in relaxation, happiness, and connection to nature.

A particularly interesting learning for me was how the virtual reality experience translated into the real world. Just one session resulted in participants being more open to trying new things and getting out into real world nature. There are also really promising indications that providing a calming VR experience can lead to a reduction in violence and aggression on the wards.

As with all new innovations there are some lessons to learn. Some practical issues were encountered around navigating the VR devices both for clinicians and service users, and some clinicians reported disconnect with participants as they were unable to see and experience the VR at the same time. However, in general clinicians were enthusiastic about the benefits of the intervention.

The main conclusion is that virtual reality relaxation can be a powerful tool in the context of often-stressful psychiatric wards, enabling service users to have a virtual break to visit beaches or mountains. This is especially pertinent to service users in south London and in any populated urban area, who don’t have ready access to peaceful, natural environments.

Given these promising results, I would encourage mental health wards to consider how they can offer this low-cost and potentially highly beneficial option to service uses.

Read the Full Evaluation Report

Find out more about the impact of virtual reality relaxtion for acute mental health conditions in the evaluation report.

Read the evaluation report

Delivering holistic care for physical health conditions through digital talking therapies

Could digital talking therapies tools help to provide more well-rounded care to people with physical health conditions? Health Innovation Network project manager Gemma Dakin discusses the potential benefits of these digital tools and work being done to increase their usage.

The links between physical and mental health are well-established. About one in three people with a long-term physical health condition also has a mental health problem (most often depression or anxiety), and people with mental health conditions may also have a long term physical health condition such as diabetes or cardiovascular disease.

Despite this, approaches to treatment often remain segregated. Looking specifically at treatments primarily for physical health conditions, access to high-quality mental health support or “joined-up” physical and mental health interventions is limited.

However, in recent years, innovations have started to emerge which provide tailored support to help people manage the mental health implications of physical health conditions. Many of these innovations are based around providing digital access to talking therapies (sometimes known as Improving Access to Psychological Therapies or IAPT).

Talking therapies use techniques such as guided self-help or cognitive behavioural therapy (CBT) to help people self-manage their symptoms and find improve their wellbeing. They are most suited to treating mental health problems of relatively low severity; there is a growing nationally-recognised evidence base suggesting they can improve the quality of life for people with physical health conditions ranging from diabetes to lower back pain.

Improving access to talking therapies in south London

Through the Health Innovation Network’s activities in mental health, the work of DigitalHealth.London and the work of our colleagues at King’s Health Partners (KHP), we have a well-developed network of promising innovators providing solutions to support mental wellbeing for people with physical health conditions.

In late 2022, the HIN co-hosted a webinar with the Healthy London Partnership showcasing some of these solutions to an audience of NHS commissioners, clinicians and other interested parties.

Presenting at the webinar were:

  • Limbic: a chatbot-based solution designed to speed up the patient journey between assessment and treatment and offering tailored psychoeducation and CBT.
  • Silvercloud: a system providing digital access to therapy and therapeutic tools, currently being used across four long-term condition areas.
  • Minddistrict: a versatile online mental health platform providing access to services such as Acceptance and Commitment Therapy (ACT), CBT and psychoeducation.
  • Mahana: a specialist digital treatment for people living with Irritable Bowel Syndrome (IBS).

Each of these innovations presented evidence for the potential benefits of their solution to support people with physical health conditions – not only through improving outcomes for patients directly, but also through reduced administrative burden on services. You can find the slides presented at the event here.

With 1.9 million people with depression or anxiety disorders expected to be using talking therapies services by 2024, digital services will have an increasing role to play in managing demand and enabling convenient access to effective care. New innovations embracing person-centred co-design will help to provide more different ways for patients to access tailored support. Waiting lists for many forms of treatment will continue to be a challenge across the mental and physical health sectors; evidence-based digital solutions which help people manage and improve their mental health and wellbeing will undoubtedly grow to be an important element of providing truly integrated care.

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Interested in using digital talking therapies to support patients? Get in touch with the team to find out how we can help

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Partnering with People at the HIN: HEAL-D

In the UK, Type 2 diabetes affects African and Caribbean communities at a higher rate than white European communities. To address this disparity, a type 2 diabetes self-management, and education programme called Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) was developed.

We hear HIN Involvement and Implementation Manager Sophie Lowry and Project Manager Sally Irwin talk about how HEAL-D was formed, pivoting to virtual delivery and the potential of a national scale-up.

The project has recently become the subject of a protocol paper in BMJ Open, which can be found here.

African & Caribbean communities in the UK are disproportionately affected by diabetes, with evidence that African & Caribbean communities are three times more likely to be affected than white Europeans. Additionally, there’s poorer control at diagnosis, where onset is 10 years younger. To help tackle this inequity, Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a type 2 diabetes self-management and education programme for people of African and Caribbean heritage, was launched in south London.

Initially, this course was designed using co-production methodology by Kings College London (using National Institute for Health and Care Research) funding. As well as working with people with lived experience of type 2 diabetes, the project engaged community leaders and healthcare professionals. Often, the process involved building trust with community “gatekeepers” such as faith leaders, and then engaging with individuals once credibility within the community had been established.

Through this engagement work, the project team identified barriers and facilitators to motivate lifestyle behaviour change, improve healthcare access, foster engagement amongst local communities, and identify appropriate cultural adaptations.

At present, we at the HIN are supporting HEAL-D through the National Insights Prioritisation Programme (NIPP). This is an initiative by the Accelerated Access Collaborative (AAC) and the National Institute for Health and Care Research (NIHR) to accelerate the evaluation and the implementation of innovation that supports post-pandemic ways of working, builds service resilience, and delivers benefits to patients. Through this programme, we‘re evaluating the delivery of HEAL-D online (led by Sophie) while preparing for national scale-up (led by Sally).

When planning our NIPP project, we were keen to continue with the co-production ethos and ensure that people with lived experience of type 2 diabetes helped to shape the project. To do this, we wanted to collaborate with people throughout, not just gather views as part of the qualitative evaluation.

This all sounded great in theory, but then we had to do it!

We believe that our lived experience collaborators should be fairly compensated for their time, given their contribution as equal partners to our projects. Therefore, we first prioritised building involvement in the project budget when sending our NIPP proposal. Once approved, recruiting people became easier as the developer of HEAL-D, Dr. Louise Goff, had the details of several enthusiastic people who had previously offered to support any further HEAL-D projects. After getting permission for their details to be passed on, we contacted everyone individually to explain more about the project and what we were asking them to do. We then had an introductory session where everyone got to know each other and shared their experiences of HEAL-D.

The group have supported us/the project offline by doing various tasks.  These included:

  • Reviewing existing learning resources
  • Suggesting questions to be used in the post-course questionnaire
  • Conducting interviews as part of the evaluation
  • Reviewing evaluation materials such as information sheets and consent forms

Additionally, the group has stayed connected via a WhatsApp group, which has enabled us to get quick input into the project through questions such as, "Would you prefer HEAL-D to be known as a ‘programme’ or a ‘course’?" Likewise, the group has served as a place for people to share advice, tips, and information on local diabetes initiatives.

As the project develops, we will ask for people's input in further activities, including the analysis of data collected for the evaluation and reviewing an updated HEAL-D website.

We are also involving people in other ways including conducting interviews with HEAL-D service users to gather their experience of HEAL-D online and seeking input from people who are not aware of or engaged with HEAL-D about their attitudes towards remote delivery and digital exclusion.

To recruit people for these activities, we reached out through creating a poster and then sharing it with local community organisations to share through their social media, newsletters, and other communication channels. We have also attended community events, to speak with people, get their input and invite them to join us.

Through building strong relationships with our group and reaching out to broader audiences to hear a range of voices, we have received valuable input and made sure that HEAL-D continues to be focused on the needs of those that use the service. We are pleased that we have been able to continue the HEAL-D involvement ethos and look forward to seeing the outputs that would not have been possible without involving people with lived experience.

If you would like to read more, check out this blog by Lorraine, a member of the group who recently shared her experience of the HEAL-D course to help spread the message about HEAL-D, or check out our webpage about the NIPP project:

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

Read the Health Innovation Network Involvement Strategy 2022-25

Learn about how we are involving people and communities to change health and care for the better.

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“Let’s embrace the complexity and apply what we know”

Head Shot of Amanda Begley

Digital health adoption is the focus of a newly published set of journal papers, jointly curated by the HIN’s executive director of digital transformation Amanda Begley. Here she reflects on the role of complexity and evidence on digital health adoption and the practical steps available.

With thanks to Frontiers, my co-editors Yiannis KyratsisHarry Scarbrough and Jean-Louis Denis and our 74 authors, we have just completed the editorial for our Research Topic Digital Health Adoption: Looking Beyond the Role of Technology | Frontiers Research Topic (

With 50,000 views already and the research topic being in the top three in the journal section, digital health adoption is clearly a hot topic. So, I thought it important to let you know about the open-access articles available to read.

Do read our short editorial – it provides brief summaries of all the articles and has embedded links to help you navigate to which of the 10 in the research topic are of most relevance to your work and thinking.

The editorial also describes four key non-technology related aspects of digital health adoption (co-creation, stakeholder management, ethical and social factors and the need for transparency), and five key levers to adoption:

  1. Understanding and responding to the needs and preferences of diverse individuals and communities
  2. Early and active stakeholder engagement in both design and technology use
  3. Building the capability and confidence of all actors to acknowledge and raise quality, privacy, security and safety concerns
  4. Adopting a holistic, rather than a piecemeal approach to build a supportive ecosystem
  5. Considering seriously the wider ethical implications.

I don’t want to repeat the content of the editorial here, so am instead sharing a couple of reflections:

  • Let’s embrace the complexity: We are increasingly realising the breadth of considerations and capabilities required to implement digital health technologies ethically, equitably, efficaciously, and economically. Although this may feel at times overwhelming, one of the many things I love about the health and care system is that it’s complex, requires careful thought and partnerships – change can be unpredictable, hard won, and takes time. With the growing research and practical insights accumulating, we are now better informed about how to enable technology adoption. Also, national policy work continues, like NHS England and National Institute for Health and Care Excellence’s (NICE) current work on a policy framework for defining the assurance pathway for digital health technologies and NICE’s Early Value Assessment
  • Let’s apply what we know. As an assistant and trainee clinical psychologist and when completing my PhD, reviewing the evidence-base was second nature to me. However, as I moved into commissioning and operational management, I got so busy fire-fighting that I forgot to draw on the evidence (like implementation-, complexity- and behavioural sciences) to inform my efforts to implement innovation and transform care. It’s only been in the last 15 years that I’ve drawn on the rigorously captured findings of the authors included in this series and utilised the vast knowledge that sits in our open access journals like Frontiers, BMJ Open and Implementation Science to name but a few. I know how hard it is to make time for this but doing so gives greater rigour to our efforts.

So digital transformation is not easy, quick or straightforward – but perhaps I’d be bored if it were… 

However, if we continue listening to our users and staff, openly sharing and actively learning from others, and working with colleagues across care settings and sectors then anything’s possible – including digital health adoption at scale for our patients, populations and staff.

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Speak to our team to understand how the HIN could support your organisation with digital transformation projects

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Making mental health a priority starts with our workforce

Andy Scott-Lee recently joined our Mental Health team, having spent most of his career with front-line mental health roles. We speak to him about his reflections on his first few months at the Health Innovation Network and what his experiences have made him think about how we could protect and improve the mental health of our nation.

Every week, so it seems, a new worry is added to the list of issues affecting society. Between the housing crisis, the climate crisis, and the cost-of-living crisis, there seem to be more factors than ever making life difficult for ordinary people.

In a world where everyone is affected by these issues differently, where do we start when it comes to finding common ground for improving our nation’s mental health and wellbeing?

In my opinion, it all begins with looking out for the people looking after our mental health.

Most clinical teams working in mental health are under significant pressure at the moment. I think awareness of those stresses probably peaked during Covid-19, where we saw a significant increase in mental health issues experienced by NHS staff, but it’s so important that we don’t slip into thinking those operational pressures have gone away.

People working in the NHS need to feel they are valued and that they and their services are supported by their organisation to do the job they were trained to do. I've worked on the front lines of mental health, and so often have found that the times where I delivered the best care were when I felt my health and wellbeing were being prioritised.

To be authentic and consistent in my care for others, I needed to first feel good about myself.

Making time to change our culture

Improving the way we look after our workforce is a responsibility for everyone working in mental health. 

Many mental health professionals already take a mindful approach to their own wellbeing, and I feel this is something we should continue to encourage. Certainly, the mantra of "be gentle on yourself" was something that I repeated to myself when treating many of my patients with trauma, and there is a wealth of insight and guidance on effective self-compassion dating back as far as Buddha. But self-help is only a part of the solution. 

One of the biggest things I’ve noticed since joining the HIN is that wellbeing isn’t just listed as an “organisational priority” – it is something that everyone actually invests time and effort into. 

Finding everyone represented in health and wellbeing conversations has been a relieving and refreshing experience. At all levels, it is acknowledged that the time and effort that goes into improving our wellbeing is reflected in the quality of the work that we do. Dedicated wellbeing champions lead the way, and it is great to see staff from all backgrounds and seniorities consistently taking advantage of activities designed to improve our physical and mental health. 

Of course, the HIN does have significant organisational differences to a Trust providing clinical care. But I think the essence of what we have here – senior leadership buy-in, dedicated champions and advocacy across the organisation for wellbeing as a priority – could be applied anywhere. 

Practical action, not policies 

Health and wellbeing isn’t a new topic within the NHS; NHS England’s People Plan from 2020 is full of sound thinking on the issue. 

But despite “islands of improvement” we haven’t made enough progress as a system, and perhaps we’ve fallen into the trap of talking too much and acting too little. 

So my challenge to people working in mental health is this – what can you do to improve the wellbeing of our workforce, and in turn improve the care that we provide? 

Can you find a way to reduce the workload of someone so that their “wellbeing champion” objective becomes part of their core responsibilities rather than an add-on to do in their personal time? 

Can you be the senior leader who always makes time to attend a wellbeing walk or other activity? 

Can you be the person who takes the initiative to learn from what’s working elsewhere? 

I believe you can. 

Evaluating remote consultations in mental health: creating a positive legacy from the pandemic

Covid-19 catalysed huge changes for mental health services, with many appointments switched from face-to-face to video or telephone consultations almost overnight. More than two years on from the start of the pandemic Dr Stuart Adams (Consultant Psychiatrist and Chief Clinical Information Officer at South West London & St. George’s Mental Health NHS Trust) discusses the lasting legacy of these changes – and how a new evaluation tool will be a vital enabler for further improvements to the service user experience.

The pandemic has been exceptionally difficult for everyone involved in mental health – service users, clinicians and managers have all had to deal with situations that I think most of us hoped we would never experience.

Whilst nobody will look back on the past two years fondly, I think it is important that we do what we can to ensure that we learn from such testing times, and maintain momentum on some of the accelerated transformation work enforced by the pandemic. One of the areas where I think we have a real opportunity to create a positive legacy is the use of remote consultations in mental health.

Starting in 2021, we partnered with the Health Innovation Network, experts by experience, and other local stakeholders on a large-scale evaluation of the rapid adoption of remote consultation technologies. Over the course of that evaluation we spoke to thousands of mental health service users and staff about what the switch from face-to-face to telephone or video consultations had meant for them.

Whilst the evaluation identified some complex challenges around the adoption of remote consultations by mental health services – not least ensuring digitally excluded people were not “left behind” – there were also many positive themes in our final report.

People we spoke to in our evaluation often talked about the convenience of remote consultations, saving time and money on travel to appointments. Writing at a time of an emerging cost of living crisis and a renewed focus on making the NHS as environmentally sustainable as possible, the convenience factor seems more relevant than ever.

Managing the transition from transformation to business-as-usual

Two years on from the start of the pandemic, it has been positive to see that people are continuing to make the most of remote consultations as an option for accessing care. About 12% of all our consultations at South West London and St George’s are now conducted remotely, with much higher take-up in some services such as CAMHS.

So – with a robust evaluation in the books and uptake seemingly in a steady state, is this “mission accomplished” for remote consultations?

Not from where I’m standing, if we want to really make the most of the potential of these innovations.

We’ve come a long way in terms of technology from those first days of the pandemic, from shaky connections and clunky interfaces, through to more dependable solutions with functionality that helps rather than hinders the therapeutic alliance. But – anybody who has been a part of a remote consultation knows there’s still room for technological improvement.

We’re also still understanding the answers to some big questions around implementation – for example the benefits and drawbacks of phone versus video-based remote consultations.

And finally, as with any service, we must commit to interrogating our delivery of remote consultations to ensure we are providing service users with the best (and most effective) choices and services. This brave new world contains many exciting opportunities for Quality Improvement, and we have only just scratched the surface of what might be possible.

Meaningful evaluation underpins progress in all of those areas, which is why I am pleased that our partnership has produced a new appointment survey, designed to help Trusts understand service user experiences of remote consultations on an ongoing basis.

The free tool can be easily adopted by any NHS service and delivered through a variety of platforms. Along with other project resources from the partnership, we hope it will be useful for clinicians and managers hoping to further develop remote consultations as an option for their service users.

Here’s to continuing to drive progress that benefits services users, clinicians and systems – with robust evaluation illuminating the road ahead for all of us.

Opioid Stewardship QI Collaborative

In response to the nationally commissioned Medicines Safety Improvement Programme (MedSIP), the Health Innovation Network has developed a local programme aiming to reduce opioid-related harm to patients experiencing chronic pain (non-cancer related).

This work is one of at least 15 Patient Safety Coalitions collaboratives (PCS) established at ICS level across the country. By March 2024, the aim is to have 30,000 fewer people prescribed oral or transdermal opioids (of any dose) for more than 3 months preventing ~484 deaths.

The Health Innovation Network (HIN) delivered a CPD accredited Opioid Stewardship Quality Improvement Collaborative for clinicians across south London from October 2022 to March 2023.


If you would like to see examples of how participants improved chronic pain management by reducing harm from opioids, please click here.

The collaborative combined masterclasses from local and clinical specialists with QI workshops. Participants were supported to develop an improvement project linked to one of the focus areas in their own practice. You can read more about the QI collaborative in our blog here. Below you can see a summary of the key learning from the masterclasses and QI workshops.

This masterclass was co-delivered with Dr Cathy Standard, Consultant in Complex Pain and Pain Transformation Programme Clinical Lead for NHS Gloucestershire ICB who provided an overview of complex pain management and Clare Howard, Wessex AHSN. Clinical Lead for the Wessex Medicine Optimisation Programme who provided an overview of the NHS BSA Opioid Prescribing Comparators dashboard.

Key learning

  • Persistent pain is complex and has strong links with mood, emotional well-being, mental health, adverse childhood experiences, patient expectations, fears, and previous experience of pain.
  • There is not a strong association between the perception of persistent pain and the extent of tissue injury at the pain site.
  • Clinicians must work as a team to support the management of complex cases, acknowledge the complexity of persistent pain and assess appropriately with consideration of patients’ preferences and recognise high dose opioid prescribing is a sensitive marker of complexity.

Evidence-based audit and feedback

In response to the nationally commissioned Medicines Safety Improvement Programme (MedSIP), the Health Innovation Network has developed a local programme aiming to reduce opioid-related harm to patients experiencing chronic pain (non-cancer related).

This work is one of at least 15 Patient Safety Coalitions collaboratives (PCS) established at ICS level across the country. By March 2024, the aim is to have 30,000 fewer people prescribed oral or transdermal opioids (of any dose) for more than 3 months preventing ~484 deaths.

To support practices, they were provided with a resource pack signposting resources to support staff in general practice to review patients prescribed high-risk opioids (e.g. patients on opioids for more than 12 weeks for chronic pain and those prescribed high doses). The approach was modelled on a successful campaign undertaken by the West Yorkshire Research and Development team and their support enabled the production of opioid prescribing reports

Monthly reports were cascaded through medicines optimisation leads to general practices between November 2022 to March 2023. The reports were based on NHS BSA Opioid Prescribing Comparators dashboard, to help practices understand their own opioid prescribing trends and to increase awareness of the dashboard. The objective was to encourage a reduction in inappropriate prescribing of high-risk opioid prescribing in chronic pain.

The graph below highlights the impact of both the QI collaborative and evidence-based audit and feedback across general practices in south London.

Experience-based co-design

In response to the nationally commissioned Medicines Safety Improvement Programme (MedSIP), the Health Innovation Network has developed a local programme aiming to reduce opioid-related harm to patients experiencing chronic pain (non-cancer related).

This work is one of at least 15 Patient Safety Coalitions collaboratives (PCS) established at ICS level across the country. By March 2024, the aim is to have 30,000 fewer people prescribed oral or transdermal opioids (of any dose) for more than 3 months preventing ~484 deaths.

It is widely known that living with chronic pain can impact all areas of life, and at times can be stressful and challenging. Living with chronic pain can leave people feeling alone, isolated, and not being aware of how to access support that does not come in the form of pain medicines e.g., opioids. To ensure patients were involved in our programme of work, the HIN Involvement and Patient Safety and Experience teams facilitated an experience-based co-design (EBCD) project using the Point of Care Foundation methodology. The project aimed to improve the experience of people living with chronic pain by leveraging existing service improvement in south London.

Our chronic pain experience-based co-design project provided a great space for service users to share their personal experiences across the integrated care pathway. By taking part in the project, I felt that patients were listened to and empowered to speak up to ensure services providing care and support to people living with chronic (persistent) pain were improved based on their needs and preferences.Aurora Todisco, Lived Experience Partner, Health Innovation Network

The stages of our chronic pain experience-based co-design project

The project used all the standard elements of EBCD: filmed interviews with people living with chronic pain, staff interviews and feedback events. The catalyst film summarised patients collective experience providing insights into getting a diagnosis, the role of medicines, the role of alternatives to medicines, relationships with health and care professionals, follow-up with health and care professionals, self-management and adjusting to living with chronic pain.

In this project, the approach moved away from traditional EBCD in two important ways.  We did not observe any chronic pain consultations as they vary significantly, and we had a large co-design group that we split into two to explore a range of options during the co-design meetings. The co-design groups focused on deciding and refining co-design group outputs.

Who was involved?

The majority of project participants were from south East London and included the following:

Our implementation considerations

  1. Treat people living with chronic pain as a whole person. Appreciate that everyone will be at a different stage of living with chronic pain and are still processing and adapting to living with chronic pain.
  2. Build relationships with staff members delivering services to support chronic pain in your integrated care systems.
  3. Ensure participants are aware of what the project can deliver in the time allocated from the outset and they have collective ownership of the co-design group outputs.
  4. Map the chronic pain services in your integrated care systems.
  5. Identify services that offer alternatives to medicines for chronic pain management in your integrated care systems.

The joint priority chosen by participants was bringing people together. The project outputs intend to raise awareness of how people living with chronic pain can connect to activities, groups and support that improve health and well-being. Outputs will be available on the website from Autumn 2023.