One year on: how can working in partnership with people living with chronic (persistent) pain improve care?

One year on from the launch of our Chronic Pain Experience-Based Co-Design (EBCD) project, Natasha Callender, Senior Project Manager at the Health Innovation Network South London (HIN), and Natasha Curran, HIN Medical Director and Consultant in Pain Medicine share reflections on their learnings from working with people living with chronic pain. The EBCD project provided an opportunity to gather views about participants’ lived and learnt experience. From getting a diagnosis to practical daily challenges which informed the approach to co-designing improvements for chronic pain management.

In modern healthcare we conceptualise treatment as a linear pathway, starting from diagnosis to treatment. In our EBCD project we found that some patients waited more than 10 years to have a diagnosis for their chronic pain. However, chronic primary pain may be the diagnosis - pain lasting more than 12 weeks with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease (NICE 2021). Thus, pain management should not be dictated by needing another diagnosis, as chronic pain is a diagnosis itself. In the NHS only a small proportion of the 15.5 million people living with chronic pain will see a specialist about their pain.

Patients often present to their GP when they initially experience pain and, in some instances, acute pain transitions to chronic pain. After ruling out sinister causes of pain, the same principles of good-supported self-management apply whether patients are managed in primary or secondary care (see below). As clinicians, it is important to acknowledge the impact that living with chronic pain has on every aspect of wellbeing. Clinicians should be aware of the range of services available in the locality (often in the voluntary, community, or social enterprise (VCSE) sectors) and how to refer patients. A learning point from the EBCD project was that patients and staff felt that bringing people together was the best solution for improving chronic pain management in south London.

“For me personally, feeling that things may change to assist others has been a big mental boost for me. I have since signed up to become a volunteer with Mind and am seeking more support for my own mental health. Having the opportunity to be part of this project meant I have more knowledge in my volunteer roles.” Project participant living with chronic pain.

Secondly, systems partners recognised the need to leverage existing services to establish peer support and group education alongside input from health and social care teams to support people living with chronic pain. With our project participants, the following recommendations for peer support and group education were developed:

Co-designed recommendations for peer support and group education 

  • Support every aspect of wellbeing

    Focus on treating people as a whole person including chronic pain and on all aspects of wellbeing.

  • Multidisciplinary

    Involve a variety of health and care staff.

  • Accessible

    Hold sessions online or in locations that are easily accessible by public transport and held at times that avoid peak travel.

  • Guided

    Sessions should be facilitated by health and care professionals who have experience supporting people living with chronic pain.

  • Funded

    Peer support and group education for people living with chronic pain should be funded.

Many participants in the project said they benefited from hearing the experiences of others who live with chronic pain as well as from healthcare staff involved in managing chronic pain:

“During the course of the past year we have learnt what is important to people living with pain and begun to understand the array of different services available in south London. We look forward to continually working with those in pain and those in different sectors so that people do more of the things which are important to them and live with less interference from pain.”Natasha Curran, the HIN Medical Director and Consultant in Pain Medicine

Chronic pain supported self-management resources

For further information about the HIN chronic pain EBCD project, please click here.

Listen to the national Health Innovation Network podcast on engaging patients as partners in patient safety on the HIN chronic pain EBCD project here.

Read a pan London blog on reducing harm for people with chronic pain by reducing harm from opioids here.

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View the resource pack on Reducing harm from opioids by reducing prescribing in chronic pain


Addressing the challenges of interpreting services in maternity care


Post Title

Darzi Fellow Dr Ella Caine writes about her experiences on the programme, how she used the opportunity to shine a light on health inequalities, focusing on the provision of interpreting services in South West London maternity services, and makes her recommendations to support ongoing work.

Having worked as a midwife for nearly 24 years, alongside helping to educate the next generation as a lecturer at the University of East Anglia, I was on the lookout for a new challenge when the opportunity arose to participate in the Darzi Fellowship.

The Fellowship, which is sponsored by South West London Integrated Care System (ICS) and the Health Innovation Network (HIN) South London, involves studying for a postgraduate certificate in healthcare leadership while addressing a challenge in maternal health inequalities. The challenge I chose to address was provision of interpretation services for women and birthing people who do not speak English.

This group experiences significant differences in health outcomes in the UK compared to English speakers. Furthermore, a language barrier can increase misunderstanding and even fear during what can already an intense and life-changing period. Within this group there are further challenges experienced by members of refugee and asylum seeker communities, who not only face language barriers but have often had traumatic prior experiences. My aim was to shine a light on the difference in provision between the four South West London Trusts and beyond, highlighting best practice and suggesting improvements.

Even for native English speakers, navigating NHS maternity services and labour can be confusing. While efforts had been made to improve alternate language provision, it is predominantly available by telephone and online, and is often problematic during emergencies or unexpected situations.

My first few months were dedicated to immersing myself in the four maternity services in South West London, which each provide care in the births of over 3,000 babies per year. There are also significant differences in demographics and wider contexts between the trusts, and my first challenge was familiarising myself with the South West London landscape, as well as identifying and engaging with key stakeholders.

Another important challenge was engaging with the women and birthing people who used maternity services whilst speaking little or no English. To do this I collaborated with third-sector organisations and community groups to reach them through trusted and established channels. It was not always clear in advance who would turn up to sessions, so I had to remain flexible. I also took the ethics of my research very seriously. Sponsorship by the HIN and South West London ICB ensured fair reimbursement for participation, obtaining consent and engaging with participants in an open, honest and transparent way. Overall. I felt very privileged to be welcomed into these spaces and to be trusted by these communities.


While it was challenging to work on the project in an unfamiliar part of the country while studying at the same time, after an intense year I was able to provide a comprehensive summary of the support available and make a series of recommendations.

While all trusts used phone-based translation services through Language Line, some also employ video interpreters, which added a more relational touch. However, not all interpreters understood maternity care and its terminology, leading to gaps in understanding, and some women and birthing people using the services felt uncomfortable with male interpreters during their care.

There are new innovations available, such as CardMedic, which consists of virtual cards with common questions to aid communication between staff and people accessing maternity services. CardMedic is in the pipeline for some London Trusts, once funding progresses, and is being trialled by another London maternity service.

Beyond London's borders, I encountered Trusts that offered multilingual doulas who stayed on hand throughout labour, offering emotional and linguistic support. In my opinion, this is the most comprehensive level of support available in labour, though it is resource-intensive. This initiative was offered through a voluntary sector organisation and anecdotally led to high levels of women’s satisfaction.

Key recommendations

  • Where possible aim for continuity of interpreter to allow trusted relationships to grow

  • Care pathways must be amended to include the interpreter as a member of the muti-disciplinary team

  • Building on this work South West London Local Maternity and Neonatal System (LMNS) should benchmark interpreting services and ensure there is no unwarranted variation across the system

  • Training and guidelines for maternity and neonatal teams should be provided, benchmarking against the Maternity pan-London guidance (pending publication September 2023)

  • Development of interpreting services must be coproduced with collaboration between:
    a) Women and birthing people
    b) Maternity and Neonatal care providers
    c) Community assets
    d) Maternity and Neonatal Voice Partnerships
    e) Maternity core connectors/community engagement practitioners

It was a difficult but immensely rewarding journey, and I am pleased to have participated in serious engagement already on how to address the problems outlined and improve services. Maternal health inequalities, though deeply ingrained, are not insurmountable. By working together to highlight and tackle inequalities when we find them, we can bridge the gap and ensure that everyone, regardless of background, receives the support they need and deserve.

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Patient Safety Collaboratives continue to support improvement across the healthcare system

The Health Innovation Network supports the delivery of the National Patient Safety Improvement Programme through its 15 regional Patient Safety Collaboratives (PSCs). The programme supports the NHS England Patient Safety Strategy. During the first quarter of 2023/24 (April to June 2023) significant progress has been made across all five improvement workstreams. See the highlights below or download the report.

Read more about how patient safety collaboratives are progressing National Patient Safety Improvement Programme work here in the latest activity report.

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If you have any questions or would like more information about medicines safety in care homes, please contact Alison White, Head of Patient Safety.

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MatNeoSIP: collaborating to improve maternity and neonatal outcomes post-pandemic

The Health Innovation Network held its fifth Maternity and Neonatal Quality Improvement (QI) Series event: ‘Sustain and Share’ in October 2023. The Maternity & Neonatal Safety Improvement (MatNeoSIP) team at the HIN has been working with trusts across south London, improving clinicians’ working knowledge of quality improvement methodologies and facilitating project work. Our newly appointed MatNeoSIP Lead, Hebe Davies-Colley shares key outcomes and reflections from the event.

The Perinatal Optimisation Workstream is a set of 9 interventions that all maternity and neonatal units nationally are aiming to successfully implement. The workstream aims to reduce the rates of neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025 and to reduce the national rate of preterm births from 8% to 6% by 2025.

We were delighted to host colleagues from trusts across south London who came together to share their progress towards reducing maternal and neonatal harm ambitions, learn from the last year of collaboration, and collectively look forward to what the perinatal optimisation workstream will bring next. We heard three local project presentations, a reflective fishbowl discussion, and further presentations from our south east and south west London Local Maternity and Neonatal System (LMNS) leads and the National NHS England MatNeoSIP team.

Since the pandemic, many maternity teams have been running on maintenance mode. This event showed us how the tide is starting to turn; now there is an ever-increasing motivation to start improving outcomes and learn from each other in a collaborative, multi-organisational, multi-disciplinary community. It was inspiring to see great successes in several south London trusts, with notable improvements in rates of delayed cord clamping (DCC) and maintenance of normothermia for preterm babies.

DCC is where clamping of the umbilical cord separates the baby and the placenta is delayed 60 seconds after birth. This allows time for extra blood to flow from the placenta to the baby and evidence shows that DCC reduces death in preterm babies by nearly a third. Normothermia is maintaining the normal body temperature which is important because hypothermia (temperature too low) carries risks including sepsis and respiratory distress. At the same time, hyperthermia (temperature too high) can have significant metabolic consequences. DCC and normothermia are 2 of 9 elements measured as part of the perinatal optimisation workstream in the MatNeoSIP.

Dr. Mirna Krishnan, Neonatal Registrar at King’s College Hospital (KCH), gave an excellent overview of their QI project named ‘Optimum Cord Management: “Hurry-up and Wait"’. In a year, KCH successfully increased the rates of DCC for babies under 34 weeks at the Princess Royal University Hospital site and Denmark Hill site by 12% and 27%, respectively. Both sites are achieving 90% documentation of cord management and the rate of DCC is now sitting just below the average across the patient safety collaborative area.

Dr Yogita Shanmugharaj, Neonatal Clinical Fellow at the Queen Elizabeth Hospital site of Lewisham and Greenwich Trusts (LGT) also gave a presentation on optimal cord management titled ‘Improving compliance with Delayed Cord Clamping (DCC) for preterm babies < 34 weeks’. Yogita reported that after 2 improvement cycles to raise staff awareness and introduce measures where basic newborn life support (NLS) was initiated (stimulation and airway support) to the baby to perform a heart rate assessment at 30 seconds while still attached to the cord, the overall rate of DCC increased from 49% to 83%!

Dr. Drupti Jogia Paediatric Registrar and Dr. Alina Petric Paediatric SHO of Croydon University Hospital (CUH) also presented their successful work. They spoke about their audit project entitled ‘Maintaining normothermia on Admission to the Neonatal Unit.” Through implementing a checklist for admission temperature, rates of hypothermia dropped from 32% in Q1 2022/23 down to 4% in Q3.

We then used a “fishbowl” technique to hold a reflective discussion exploring the experiences of those who had participated in the projects at a trust level with engagement from the HIN.

Looking at the factors which made the process work, it was clear that the dedication of the project team and working group members was key. Challenges discussed included trying to sustain the measures to become ‘business-as-usual’ after QI programmes had ended. The participants also discussed difficulties with juggling clinical responsibilities and project work.

Dr Justin Richards, Consultant Neonatologist at St George’s Hospital and south west London (SWL) Neonatal Network Lead presented clear updates from the SWL LMNS workstream. He reported that the appointment of two Neonatal Quality Leads has incurred drastic improvement in the SWL engagement with the perinatal optimisation interventions and therefore steep improvements in the rate of uptake across SWL trusts.

Mel Howie, Maternity Project Manager from the south east London (SEL) LMNS set out SEL priorities for 2024 including a parent passport, integrating neonatal parents into the maternity voices partnership, and further progressing the preterm birth pathways.

Finally, we were pleased to hear from Charlie Merrick, Senior Improvement Manager in the national MatNeoSIP team at NHS England. Charlie provided clear insight using the Preterm Optimisation Dashboard (available on the MatNeoSIP page on FutureNHS) and displayed outcome data of some huge achievements since the start of MatNeoSIP in 2018. These included the potential lives saved, brain injuries prevented and cost savings to welfare and society in south London. Looking forward, MatNeoSIP will have a new ambition for 2024/25 starting next April, the details of which will be confirmed in due course.

I feel that we had an incredibly positive event. It was brilliant to bring our colleagues together celebrate their successes and collaborate in a positive space. Delegates reported that the ‘energy for improvement was palpable’ and a real appetite for change in the south London region. We at the HIN hope to continue providing practical and facilitative support to improvement teams at the trusts, and we’d like you to watch this space for news of our next round of workshops sharing learning about quality control and sustainability of interventions within QI projects so the improvements in practice are maintained.

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If you have any questions or would like more information about Maternity and Neonatal Safety Improvement Programme, please contact Hebe Davies-Colley, MatNeoSIP Lead.

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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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Relationship building to reduce restrictive practice: a visit to Avery Ward


Post Title

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, Ward Manager Lola Bakare, and Expert by Experience Igoche Ikwue about the programme team’s recent visit to a female acute mental health ward and their reflections on how sharing personal experiences and perspectives are key for further reducing restrictive practice.


In my capacity as project manager for the Mental Health Safety Improvement Programme at the Health Innovation Network, I have had the opportunity to visit a few mental health wards in south London with my colleague Igoche Ikwue, who is an expert by experience.

One of the wards I was privileged to visit was Avery Ward, an acute female psychiatric ward. Despite their busy schedule, the staff welcomed us and we had the chance to meet the ward manager Lola, who later introduced us to other busy members of staff including the clinical consultant.

We had a fruitful conversation about the Ward’s approach to minimising restrictive practice. It was notable that the ward manager makes herself accessible through an open-door policy to both service users and staff. She described her unique approach as ‘we discuss, negotiate and we agree’.

This seems to be a working solution, despite experiencing the same challenge of high staff turnover which is common across these types of services. Situated in a deprived borough, the ward also faces system strain, evident in the long waiting list and pressure for beds.

Despite the dedication of staff, we learned that instances of violence and aggression affect both staff and patients. However, the team employs a range of verbal de-escalation techniques and other activities to de-escalate such as taking fresh air in the garden, and facilitating escorted leave, to manage and defuse tensions.

It was acknowledged that the pressures surrounding the ward can contribute to relapses among patients. We observed that the absence of a sensory room or equipment in the gym and the garden was in need of refurbishment. Nevertheless, plans were already underway to address these improvements and refurbish the ward.

We were told that staff experience emotional trauma from insults and violence from the service users (particularly the male staff). However, body-worn cameras have now been introduced to help take recordings of real time events.

It was evident that the staff have to daily work through a maze of challenges while trying to give quality care to the service users. We were very grateful for the open and honest conversations we had with Lola the ward manager and noted their laudable commitment to providing a safe and collaborative environment for both staff and patients.


When I arrived at the ward, I had a positive interaction with a young man who was being discharged. We had a pleasant conversation, and he expressed his excitement about returning to his music. It set a promising tone for my visit.

As I continued exploring the ward, I noticed a slight tension in the atmosphere. There was a central glass office where the staff members and administrators worked. However, it was evident that there was a shortage of staff, which understandably was causing some challenges. Despite this, the ward manager Lola demonstrated true dedication to their role, striving to provide the best care and support possible.

During our conversation with the ward manager, Ayo and I clarified that our purpose was to support the ward and its service users. We discussed several concerns, including issues with the quality of food and the need for improvements, such as the functionality of facilities. Additionally, we addressed the struggle to find bed space for service user babies as the facilities were not designed to accommodate both mother and baby. The manager also mentioned plans to relocate the facility to another building, along with a positive update on recent recruitment. There is a specialised service for mothers and babies, so patient who requires a mother and baby bed will have to be transferred out.

As someone with expertise through personal experience, I firmly believe that staff members play a crucial role in providing care and reducing restrictive practices. It is essential to prioritise the well-being of both the service users and the staff themselves. Creating a safe and open space for caregivers to express their concerns without fear of negative consequences is vital.

Despite the strain caused by system constraints, the dedication and commitment of the staff members were evident. I also observed that the ward manager maintained an open-door policy, encouraging collaboration and engagement among service users and staff.

One particular moment stood out during our visit. As we were leaving the ward, a service user approached me, expressing her strong desire to see her children. Recognising the urgency of her request, I directed her to speak with the ward manager, who promptly attended to her with responsiveness and compassion.

My experience at Avery ward highlighted the importance of providing comprehensive support and care to service users while prioritising the well-being of staff members. The ward manager and their team demonstrated a commitment to creating a safe and collaborative environment throughout our visit. I am grateful for the opportunity to contribute my expertise and be part of the ongoing efforts to improve the ward.


As a ward manager, my philosophy is that personal relationships are at the heart of creating a calm, safe and positive environment for staff and service users, where the use of restrictive practice is minimised.

I have found that building those personal relationships tends to rely on flexibility and trying to have an understanding of the whole person.

For example, I have my own ‘open door’ policy. Staff and service users can always come to me with their problems and we will do our best to figure out a solution.

Often that means negotiating; realising that both sides have to give and take in order to find a position that works for everyone.

Sometimes it is finding a way to be flexible about the small details which can make the biggest difference. Allowing more flexibility with meal times has been one way where we have seen really positive impact with service users – from a practical point of view it raised some challenges, but I am so glad we worked through them to achieve something that the people on our ward wanted.

We try and make the ward as close to home as possible, whether that means encouraging staff to make the time for escorted visits off site or building relationships with the other people who are important in the lives of our service users.

Often, we find that working with family to overcome challenges is a really effective tactic. We have multi family groups which run once a month. Family/carers and patients are invited to this meeting. Our aim is to try and create one team of people all working together for a positive outcome; that strong team is I think a big reason why we have reduced the level of complaints and of the use of restrictive practice.

Our ward – like many others – has experienced difficulties with staffing in recent years. Our staff are well trained and skilled to deliver job role. As part of my team, I have a professional nurse advocate, who provides restorative supervision for staff, and we offer monthly training days for staff.

The Ward Manager also acts as our See Think Act consultant, helping to develop relational security. This has improved the way we deliver care to our patients; our staff maintain safe and effective relationships with patients in a professional, therapeutic and purposeful way, with understood limits.

Despite the difficulties we sometimes face, I am so proud of my team; they understand how to deliver great care (including reducing the use of restrictive practice) and they are motivated and committed to continuing to get better.

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Looking after the NHS podcast: Episode 4

Looking after the NHS is a podcast produced by the Health Innovation Network which discusses how we can make the NHS even better. Whether you are a health and care professional or simply have an interest in innovating healthcare, Looking after the NHS aims to motivate and reassure listeners that change within the health and care sector is possible.

Key Statistics

  • There are over 1.5 million full time equivalent staff working in NHS in England

  • The theory of Dunbar’s number tells us that in our lifetime we can only maintain a stable social relationship with 150 people

  • The Chaos Report found that of 50,000 projects around the world, 71 per cent failed to meet these three criteria: being on time, on budget and with satisfactory results.

The podcast is hosted by Catherine Dale, Deputy Coordination Director at The AHSN Network, and Ayobola Chike-Michael, Senior Project Manager at the HIN.

In episode four Catherine and Ayo were joined by Sam Hudson, Director of Überology Ltd and recognised expert in patient participation and experience. The episode discusses Communities of Practice (CoPs), which are groups of people who share a passion for improving practice in health and care. Practitioners from different backgrounds, with different perspectives, come together across organisations and across hierarchies to meet as equals to create new knowledge and develop potential solutions to problems that go beyond what each of us can address in isolation.

Sam is currently leading the HIN and Q Network's Communities of Practice Leadership Development Programme, and was able to provide some useful insight into the real-life improvements in health and care that can be achieved through CoPs.

The impact Communities of Practice can have is really powerful. There's a kind of magic in the room when it's really in its flow.Sam Hudson, Director, Uberology

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Catch up on previous episodes of Looking after the NHS

Listen now

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Looking after the NHS podcast: Episode 3

Looking after the NHS is a podcast produced by the Health Innovation Network which discusses how we can make the NHS even better. Whether you are a health and care professional or simply have an interest in innovating healthcare, Looking after the NHS aims to motivate and reassure listeners that change within the health and care sector is possible.

Key Statistics

  • In the NHS there are around 164,000 full-time doctors and 360,000 nurses and midwives
  • Between June 2021 and June 2022, the NHS saw a 25 per cent increase in the number of nurses leaving their role
  • It costs around £9,250 per year to become a nurse.

The podcast is hosted by Catherine Dale, Deputy Coordination Director at The AHSN Network, and Ayobola Chike-Michael, Senior Project Manager at the HIN.

In episode three Catherine and Ayo sat down with Hazel Steele, a Matron in Medical Specialities at Guy’s and St Thomas’ Hospital and former Project Manager at the HIN. The episode discusses the importance of clinical and non-clinical roles collaborating during projects which aim to improve outcomes for patients.

Hazel, having worked in both clinical and non-clinical positions, sheds some light on how projects can be more beneficial to the needs of patients by involving nurses and clinicians in the initial scoping of projects.

“It’s all about understanding the scale of the problem at the point of delivery.”Hazel Steele, Matron, Guy's and St Thomas' Hospital

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Introducing Lived Experience Partners at the HIN

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

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

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

- Faith Smith, Lived Experience Partner

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

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

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

- Aurora Todisco, Lived Experience Partner

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

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

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

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

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

– Faith Smith

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

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

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

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

– Faith Smith

Find out more

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

Get in touch

Working with patients as equal partners to improve chronic pain management

Natasha Callender, Senior Project Manager and Medicines Workstream Lead at the HIN, writes about how we are using co-design to expand our work to improve chronic pain management and reduce harm from opioids.

Improving chronic pain management by reducing harm from opioids is a priority for the NHS. That is why in October 2022 we launched a Quality Improvement Collaborative, in response to the NHS England Medication Safety Improvement Programme (MedSIP) workstream. The Collaborative is helping to reduce harm from opioids by speeding up the adoption of innovative harm prevention initiatives and improving care of people living with chronic pain across south London. By providing participants with expert clinical advice and QI support, we are helping them to become Opioid Stewards within their practice, Primary Care Network or Trust.

In October 2022, the HIN’s Ayo Chike-Michael, Senior Project Manager in Patient Safety and Experience, wrote about the Collaborative in more detail, including the complexity of pain management and the need to enable patients as key partners. We are now taking this one step further with a chronic pain experience-based co-design (EBCD) project with patients and clinicians across south London.

Clinicians who work with people living with chronic pain know that the best way for them to reach their goals is for clinician and patient to work in true partnership. A person with pain is the expert on their life, what is important for them, how pain affects these and what types of treatments and solutions suits them best. It’s also the most rewarding way to enable people to most effectively manage their pain.

- Natasha Curran, Medical Director at the Health Innovation Network and Consultant in Pain Medicine, University College London Hospitals

NHS England's statutory guidance for working in partnership with people and communities states that people with ‘lived experience’ are often best placed to advise on what support and services will make a positive difference to their lives. This is particularly true for patients living with long-term conditions that require a multifaceted approach to managing conditions such as chronic pain. You can find out more about the HIN’s commitment to involving people with lived experience in our Involvement Strategy.

Our new EBCD project aims to make the most out of chronic pain management improvement activities and ensure that services are responsive to patients’ wishes. The project will involve up to 10 people with lived experience of chronic pain and up to 10 health and care professionals. Participants will be able to take part through a range of online and in-person methods, including one-to-one interviews, feedback events and group co-design sessions. We will use small working groups who will be guided by professionals such as GPs, pharmacists and physiotherapists.

Experience-based co-design (EBCD) involves patients and staff working together throughout a project, so we can focus on what it is most important to improve services. I have found it to be an inspiring and energising approach to tackling complex challenges in the NHS.

- Catherine Dale, Programme Director for Insights and Patient Safety and Trustee for The Point of Care Foundation

Through this project we aim to identify areas for service improvement based on first-hand, real-life experiences of day-to-day pain management. This will help to inform what new services and care pathways could be established, together in partnership. This will feed into the National Patient Safety Improvement Programme (NatPatSIP)’s priority of enhancing chronic pain management. We hope that clinicians and patients will work together to make small yet meaningful improvements to existing care.

You can see the timeline for this project below. There are a range of opportunities for both patients and staff to feed in. If you are interested please contact Natasha Callender.

At the HIN we aspire to be partners with people as we believe that, by sharing their insights and knowledge, people with lived experience of health and social care services can help us to improve health and social care. Involvement of people with lived experience helps us focus on the needs of service users whilst also addressing inequalities and ensuring better outcomes.
– Sophie Lowry, Implementation and Involvement Manager at the Health Innovation Network




Project interviews

Weeks starting 6 and 16 February 2023 (virtual/online)

Staff feedback event

Wednesday 15 March 2023 (virtual/online)

2 - 4.30pm

Patient feedback event

Thursday 23 March 2023 (virtual/online)

2 - 5.30pm

Joint patient-staff feedback event

Thursday 30 March 2023 (in person/face to face)

2 - 4.30pm

Group co-design sessions

Tuesday 25 April 2023 (virtual/online)

2 - 4.30pm


Tuesday 16 May 2023 (virtual/online)

2 - 4.30pm


Tuesday 6 June 2023 (virtual/online)

2 - 4.30pm


Tuesday 27 June 2023 (virtual/online)

2 - 4.30pm

Celebration event

Thursday 13 July 2023 (Time and venue to be confirmed)

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

Find out more

For more information, please get in touch with Natasha Callender, Senior Project Manager for Patient Safety and Experience.

Get in touch

Recommendations for improving perinatal health inequalities: A Darzi journey

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

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

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

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

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

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

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

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

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

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

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

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

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

3. Invest in effective data capture at a local level

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

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

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

4. Listen, hear and take action

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

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

5. Invest in staff

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

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

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

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

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

Find out more

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

Read the Marmot Review

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

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

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

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

The Context in Croydon

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

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

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

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

Tackling a ‘wicked’ problem through involving people and communities

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

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

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

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

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

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

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

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

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

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

Find out more

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

Find out more

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Want to involve patients in your project?

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

Read our strategy

Medication Safety: How patients and healthcare professionals make safety work

Medicines are the most common healthcare intervention in the NHS. It is increasingly important that healthcare professionals work collaboratively with patients to minimise harm from medicines. Natasha Callender, Pharmacist, and Medicines Workstream Lead for Patient Safety shares some reflections on what the opportunities are.

Key stats:

  • 54% of errors occur in administration, 21% in prescribing and 16% in dispensing

  • 72% of medication errors have little or no potential for harm, and only 2% have potential to cause severe harm

Source: Prevalence and economic burden of medication errors in the NHS in England

More than 200 million medication errors occur in the NHS each year. Most errors occur in administration, prescribing and dispensing. Most medication errors have little/no potential for harm, and only two per cent have potential to cause severe harm. The majority of errors are associated with administration. Tried and tested safeguards such as the 5 Rights of Medication Administration - the right patient, drug, dose, route, and time – are widely accepted ways to reduce medication administration errors.

While humanistic safeguards can mitigate risk of medication errors, there is increasingly a place for using technology to improve the safety of systems, for example during transfer across traditional care boundaries between hospitals and general practices/primary care networks; or closed loop medication and administration prescribing systems in hospitals. I recently attended the Patient Safety Congress where speakers who shared their progress on implementing closed loop medicines administration, and suggested that standardisation was the way forward to reduce medication errors.

However closed loop administration and other digital solutions will not reduce all medication risks. At the Health Innovation Network, we have been facilitating our Opioid Stewardship Quality Improvement Collaborative with the aim of helping healthcare professionals improve chronic pain management for patients. As part of this programme, we watched a video about asking the ‘5 Whys’ to reach the root cause of a problem. Fixing the actual root cause may be far more simple and inexpensive than the alternatives.

Improving pathways or services to reduce harm from medicines does not always require complex or expensive solutions, but collaboration remains a crucial part of the process. By involving patients and allowing them to personalise their own care, we can make simple changes that have a significant impact. It is important to engage and co-develop improvements with patients when improving services. There is a lot we can learn from their experiences to inform changes for the better.

At the core of the Medicines Safety Improvement Programme (MedSIP) that drives our local medicines workstream, is a quality improvement approach. But it is through reporting of adverse events to national data schemes that trends can be identified as areas of improvement. Both patients and healthcare professionals are encouraged to report suspected and actual adverse events from medicines and vaccines via the Yellow Card MHRA reporting service. Together we can work to ensure adverse experience with medicines drive the improvements we strive to make.

Find out more

For more information, please get in touch with Natasha Callender, Senior Project Manager for Patient Safety and Experience.

Get in touch


Yellow Card scheme or via the Yellow Card app (download from the Apple App Store or Google Play Store) – only a suspicion is needed to report a suspected reaction.

For suspected adverse reactions associated with COVID-19 vaccines and medicines, as well as suspected incidents with medical devices and test kits, report directly to the Coronavirus Yellow Card reporting site or use the Yellow Card app.


  1. EEPRU 2018: Prevalence and economic burden of medication errors in the NHS in England
  2. NHS England: Enduring standards that remain valid from previous patient safety alerts

How getting people involved can help make the NHS even better

Post Title

Catherine Dale, HIN Programme Director for Patient Safety and Experience and Sophie Lowry, Implementation and Involvement Manger, provide an update on the HIN’s Involvement Strategy – also a key theme of lively discussions in episode 2 of our Looking After The NHS podcast series now available for listening.

Catherine Dale reflects on episode two of our Looking After the NHS podcast:

“The mechanic doesn’t ask me where they need to put the fanbelt. So why should healthcare experts, who have trained for years, have to listen to someone else?” 

Ayo Chike-Michael and I get to grips with this issue in Episode 2 of our podcast series ‘Looking After the NHS’ which I am delighted to say you can now listen to below.

In this episode we are joined by Cristina Serrão – Lived Experience Ambassador in the Experience of Care Team at NHS England and Improvement. If you want to find out the answer to this question – give it a listen.

We have a great discussion about how involving people in the design and development of services can make the NHS even better. We cover a range of topics including why we should involve patients and what co-production actually looks like in reality. We also grapple with a range of challenges around involvement and consider the benefits, including reducing health inequalities.

I loved recording this episode, Cristina has a real wealth of insights and her passion for involvement is truly infectious! Involvement really is a real priority for me and for the HIN, and I hope this episode brings to life why it is such an important topic for us to address.

Sophie Lowry provides an update on the HIN's Involvement Strategy:

Over the last few months Catherine and I have been working with colleagues and people who live and work in south London to develop the HIN’s Involvement Strategy. We heard:

“No one person, no one part of the system knows the 'right' answer.”
“Patients are people who are more than their condition and diagnosis.”
“You can’t do innovation without involvement.”

Well, here at the HIN we wholeheartedly agree with all of these statements.

This week we brought together some of the people who have contributed to our Involvement Strategy to update them on the progress we have made and also to gather feedback on our emerging approach and delivery plan. This was the first opportunity we had to meet some people in person, and we felt such a buzz being able to socialise in person and use real post-it notes! We were also able to trial a “hybrid” approach, with some people dialling in to join in the discussion. It provided a great opportunity to connect, and our Chief Executive Rishi Das Gupta was able to thank people first hand for their insights, ideas and experiences that are centre stage of our Strategy.

We were delighted to hear that there was broad consensus that we have the basis of a strong strategy, one that will make a real difference to the way which we work and to the impact we have on local health and care systems. We were also pleased to hear that people were encouraged by the fact they could see the outputs from the workshop feeding into the strategy.

You may be asking “why does the HIN need an Involvement Strategy”? Well, we want to build on the HIN’s history of involvement and co-design activity and create a more embedded and consistent approach. We truly believe that the best way to achieve the HIN’s mission to ‘speed up the best of health and care together’, is to work in partnership with people in south London. As we believe that, by sharing their insights and knowledge, people with lived experience of health and social care services can help us to improve and innovate health and social care.

That is why this strategy, and the plan that will deliver it, has been co-developed with people with lived experience, HIN colleagues, other partners and stakeholders (over 65 people in total). We have had some incredibly open and honest discussions looking at both the psychological and practical barriers to involvement and how they can be overcome. And we believe that this transparency has been vital in developing a meaningful strategy that will make a genuine difference.

Catherine and I are so grateful for everyone’s ongoing support in helping to get this right. We will now work to finalise the Strategy and look forward to publishing it shortly and working with our colleagues, both at the HIN and wider, to put it into practice!

Get in touch

More information about the HIN's Involvement Strategy

Contact us

QUiPP app improving outcomes for women in threatened preterm labour

Quipp App

Creating a toolkit for effective implementation of the QUiPP app

‘Better care for women at risk of pre-term labour 

The QUiPP app @theQUIPPapp (Quantitative Innovation in Predicting Preterm birth) determines the risk of pre-term labour more accurately, helping to improve care for women at risk. Funded by the HIN Innovation Awards, this project tested the app in selected maternity wards in south London and created a toolkit to support wider adoption across other sites.

QUiPP at-a-glance

Key achievements

  • “This project was successfully funded by the HIN Innovation Awards which allowed the QUiPP app to be rolled out in selected maternity wards in south London and create a toolkit to support wider adoption across other sites.”
  • QUiPP Toolkit is now been recommended both locally and nationally by NHS England and the British Association of Perinatal Medicine.
  • Version one of this toolkit was rapidly rolled out during Covid-19 in April 2020 as it helps decrease unnecessary admissions and transfers.

The app is an innovative and evidence-based diagnostic tool that uses analytics to help clinicians understand the risk of pre-term labour more accurately. This improves the lives of women and babies by identifying those who truly need medical intervention and reassuring those who don’t.

The app was tested across 20 UK sites and the QUiPP Toolkit has now been recommended both locally and nationally by NHS England and the British Association of Perinatal Medicine.

Pre-term labour is a clinical conundrum: it’s very common for women to be at-risk of pre-term labour, but the actual number of women who go on to deliver early is very low. To be safe, this means that many women are currently over-managed: they are treated as though they will deliver early even if the risk is low in reality. Because it is very dangerous to move an early baby once it is delivered, women at risk of pre-term labour are often moved to specialist hospitals further from home with specialist cots for early babies and are given more invasive care.

"Your idea is a good idea!"Naomi Carlisle, NIHR Clinical Doctoral Research Fellow

This tool has the potential to make a big difference and to improve care for these women. Whereas currently women are simply either ‘high’ or ‘low’ risk, the app calculates a percentage score so that clinicians can understand risk to a much higher degree of accuracy. This reduces the need for women at lower risk to move far from home and frees up the cots for the women who genuinely need them, so that people receive the care that is most appropriate to their risk and are not moved from their family and familiar midwife team if it is not necessary.

How does it work? 

It’s a clinical decision support tool based on a validated algorithm that incorporates existing point-of-care tests and risk factors. A clinician enters information about a number of biomarkers, such as the scan that measures the cervical length and the swab on quantitative fetal fibronectin. QUiPP uses all the data across risk range for each variable and provides a user-friendly clinical interface. This is more useful for making management decisions and women find it very useful to see and discuss their risk as a percentage, with a highly visual aid to support discussions and decisions around treatment. The QUiPP app is free and has significant cost-savings associated with reducing unnecessary admissions and interventions. By freeing up NHS capacity for patients in the most need of care (eg maternal beds, neonatal cots), this intervention can save money and transform maternity pathways beyond the preterm birth setting. Qualitative findings suggest that the majority of clinicians involved in triaging threatened preterm labour found using the QUiPP app time-saving, simple and that it increased confidence in decision-making.

Quipp App

Innovator Spotlight

Professor Andrew Shennan, Professor of Obstetrics at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, said:

“This is a great example of the way that technology doesn’t replace clinicians, it makes our lives easier and helps us to care more effectively for our patients. QUiPP calculates the risk in a quick and visual way, giving women reassurance at a worrying time in their lives. What you really want is an exact chance of what’s going to happen. That way women and clinicians can make the most informed choices.

“These kinds of real-world testing are so important for scaling innovation. We hope that through this work, we can show the value of a tool like this and support others to use it in their practice.”

We also spoke to Naomi Carlile about the project one year on…

Tell us what has happened since the Innovation Grants:
I recently co-develop a toolkit to enable hospital sites across England to implement a best care pathway (the QUiPP Toolkit) for women who arrive in threatened preterm labour. I am now working on my NIHR Clinical Doctoral Fellowship, which is looking at how the Preterm Birth Surveillance Pathway is implemented across England (the IMPART study).

What has been your proudest moment so far:
I am proud that our QUiPP Toolkit has now been recommended both locally and nationally (by NHS England and the British Association of Perinatal Medicine), ensuring that more mothers and babies are receiving optimum care.

What your advice for future innovators:
Your good idea is a good idea! Get in touch with organisations like HIN south London to help advise on how to get it off the ground!

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Deep dive into digital advance care planning

What are the benefits of advance care planning using digital tools and how challenging is it to implement an effective system?  In this Q&A discussion, NHS South West London CCGs Digital Urgent Care Planning Project Officer Lucy Colleer and NHS England Assistant Director for Enhanced Health and Care Homes and Care Sector Support Fay Sibley answer key questions in the aftermath of Covid-19 and its impact in care homes. The conversation centres on the advance digital care record, Coordinate My Care (CMC).

Photo of Fay Sibley

Photo above: Fay Sibley

Why is advance care planning and having a digital urgent care record important for care home residents?


I think it's incredibly important that care home residents have a digital urgent care record. We know that care home residents are often in the end phases of life. Even those that aren’t, are living with often extremely complex health and social care needs. So to have a single place where information is recorded about their wishes and preferences as well as their medical needs, including their medication, diagnosis and CPR status means that we are able to look after care home residents in a more holistic way.

"I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves."Fay Sibley

It means that all of the health care professionals who are involved in that person’s care, and look after that person have access to information about that person. I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves. Or may not be well enough at the point in which they're accessing care to be able to advocate for themselves, or to put forward their needs and preferences.

Putting in place a system 

To have that in a systematic way that's consistent and that everybody is familiar with, really does help them with transfer of care. This means we can make sure that we do meet those wishes and preferences and just means we can deliver the right care. Whether that's keeping somebody comfortable at home, or whether that's escalating and transferring them to hospital. If you can access that information, it allows you to consider that on a very individual basis.

Photo of Lucy Colleer

Bitesize info

A series of short case study videos have been produced to demonstrate the value of individual patients having advance/urgent care plans brings to the wider health and care system.

Photo above: Lucy Colleer


We conducted a case study recently with a care home in Kingston, to look at how they were using CMC. How they got on with setting up CMC in the care home as well as getting their staff trained and using it. I think the biggest benefit, is that [CMC] puts the resident’s wishes first.

From a technical point of view, having a digital urgent care plan allows everyone to have access to the same information. It’s updated automatically, which means that you don't have to worry about bits of paper going out of date or going missing.

Saving time in an urgent situation

One of the things that the care manager we interviewed spoke about, was that it saved them so much time in an urgent care situation. In one instance, they had a resident who had a fall, and they called the ambulance service. Normally they would get phone calls from A&E saying, ‘What are the patient’s medical details?’, ‘What medication are they taking?’ But having it in that digital care record just meant that they didn't have to spend time printing documents, or taking those phone calls. And also for the staff in A&E as well, it was really helpful to have that information. Having an End of Life care plan really saves time and can strengthen decision-making.

It's just about putting the resident and the patient first. It also helps make life easier for clinicians who don't have an awful lot of time on their hands, and the care home staff as well.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

In July 2020, the HIN was commissioned to deliver a programme to increase use and quality of shared electronic advance and urgent care plans using Co-ordinate my Care (CMC). The programme concentrated on clinical engagement. Read about the Advance and Urgent Care Plans – London Accelerator


I used to work for the ambulance service and one of the most difficult things was going to a care home in the early hours of the morning after being called to a resident. In one instance where this happened to me, the resident was acutely unwell, had a complex medical history and wasn't able to communicate. I was faced with trying to make an informed clinical decision with no access to information. Often at night in a care home they're operating with skeleton staff and, quite often, agency staff or bank staff because there are challenges in the care sector workforce. So they might not even be able to access patients records because they would be locked in the manager's office.

The problem with limited information

What we would know about that resident would be so limited that often as a paramedic, you end up taking people to A&E despite having concerns about whether the distress that course of action entails would justify the benefits. At that point it comes down to questions around what is “right” or “fair”, which are very difficult to answer as a clinician.

You are so limited to be able to make any other choice, because you didn't know their medical history. You didn't know what their wishes were. Nor which family member to call or who might have some more information about that person.

Seeing the info on an iPad

When paramedics first started to be able to access urgent care records we used to have to do that by phoning up the control centre. Amazingly, now paramedics can actually see it in real time on an iPad. But even when I left the service, you could call up the control centre and ask for that information. It just meant that you could make a different decision and you could justify that decision.

It was an informed clinical decision that was backed up and supported by the input of that person's GP. The input of that person's family, the input, hopefully, of that person themselves, as it allows you to make different decisions. And as Lucy said, a decision that really puts the person at the centre.

"There was real recognition that care needed to change quite quickly [because of Covid], and that those effects would probably be lasting."Fay Sibley

Bitesize info

The HIN, in partnership with the End of Life Care Strategic Clinical Network, secured funding from the NHS England (NHSE) personalisation team to work with Marie Curie nurses to create CMC records for care home residents in three nursing homes in south east London over a five week period. Read Increasing the number of care home residents in Lambeth supported by a Co-ordinate My Care plan

How is the HIN doing in terms of speeding up the spread and adoption of digital urgent care records in south London?


The HIN has been working in this space for a long time, probably since the HIN started (in 2016) and more formally with CMC for the last two and a half years. Through a small pot of funding, through The Health Foundation, we were able to do a pilot project with about 10 care homes looking at different methods of getting care homes access to CMC. We also looked at the things that care homes would need to do in order to be able to access CMC. Either to view it or to put information into the record.

The challenges for care homes

From that project we learnt an awful lot about some of the process aspects of this that are challenging for care homes. Things like Information Governance (IG) requirements, the hardware requirements, having a laptop or a device to use and the Wi-Fi requirements.  I think that learning has then helped us to try to move this conversation on.

Obviously in terms of the [Covid-19] pandemic, it changed lots of things. Particularly the work that care homes are doing and the focus being put on care homes by the Government.  So at the beginning of the pandemic the HIN was really instrumental in trying to pull together various stakeholders who were looking at the key questions ‘How do we create records for care home residents?’ There was real recognition that care needed to change quite quickly, and that those effects would probably be lasting.

Collaborative working

The other thing we did was we worked with the End of Life Care Strategic Clinical Network to secure some funding and ran a small-scale pilot with Marie Curie. That was really interesting because Marie Curie had a number of frontline clinical staff who were shielding themselves because of the pandemic. Those staff were at risk of being furloughed and not able to work because they weren't able to do their frontline job. So what Marie Curie did was give them some additional training and upskilling. This meant they could support care homes to create CMC records for residents.

Working with care homes

We worked with three care homes in Lambeth, one GP practice and Marie Curie to deliver a small kind of, ‘proof of concept’ project around the use of CMC in a care home.  We learnt lots. We realised that to create quality records remotely with another organisation that doesn't perhaps know that person or have access to all of their clinical information has its challenges. They were able to do a fantastic job in starting the record off, but they still required a fair amount of input from the GP. It was not a perfect model, but we learnt a lot from the project. It was really interesting to use voluntary sector organisations to support this work.  In particular, organisations like Marie Curie that really have a lot of knowledge around end of life and advance care planning. And to use a staff group that otherwise, perhaps, wouldn't have been working during the pandemic and certainly couldn't do their main role.

Bitesize info

The HIN Healthy Ageing and Informatics Teams were commissioned to create a user friendly and useful digital maturity dashboard for care homes across London. This project was led by the Health Innovation Network and funded by the Digital First London region team.

Since then we've been doing a lot of work with Lucy and trying to support the coordinated pan-London effort around care homes and CMC. So it's absolutely brilliant to see this is on the commissioners’ radar and the work that Lucy’s doing. Lucy's pulled together a steering group that now meets monthly, and the HIN is also trying to help with some of the analysis of the data.

A dashboard for care home digital maturity

We've developed a Care Homes Digital Maturity Dashboard. This is a tool to be able to  monitor each care homes maturity status, in terms of their digital abilities. A key part of that for London care homes is CMC. 'Do they have access to CMC?' 'Do they have the right IG requirements that allow access to CMC?  'How many residents in their home have CMC?' We’re pulling all of those data sources together and presenting that information in a way that's useful to Lucy and other colleagues across London working in this space.

I think the HIN’s moved more into a supportive role, trying to share the lessons that we've learned from some of the early work. And then really letting the commissioner drive it forward in a way that we don’t have the reach to do.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

View the collection of resources. Coordinate My Care has provided a wealth of info to support the patient-led portal to create an end of life care plan. MyCMC: your plan, in your own time, in your own home

How many digital urgent care records have been created through CMC?


It’s in the region of thousands (see chart below). There are lots and lots of residents who do have care records, so the focus of our pan London work at the moment is actually getting care home staff themselves to look at those records. At the moment the majority of those records are created by the GPs and sometimes in the acute trust. So we're trying to encourage care home staff to start looking at those resident plans and keep them up to date.

The power of data

We have been working really closely with Fay and the HIN and I would say that the HIN has been more than just support. We're trying to lead the way from where you paved the way and the Care Homes Digital Maturity Dashboard is really, really helpful especially from a commissioning perspective because we can look at how it's affecting the ambulance call-outs and the conveyance rates and use the information to make commissioning and transformation decisions. From a commissioning point of view, obviously patient-centred care is the most important thing, but financial return on investment is important too. It’s been really great to be working with it with the HIN and supporting work that Fay and the team have been doing.


I think the other thing that's really helpful is about data, and CMC actually produce a fair bit of data.  Again we could debate the data set of course we could, but they do produce a commissioners’ workbook, again on a monthly basis. One of the useful things about data is it allows you to look at different areas and make those comparisons.

Incentivising GPs and the role of the ICS's

For example in south London, south west London do particularly well in terms of the number of CMC records they’ve created. So you can look at some of the models that they've put in place over the last, let's say five years, that have really led to that. For example they incentivised GPs to do some of this work, so you saw a really big increase in that they've got a really established enhanced health and care homes programme and End of Life care programme within their Integrated Care System (ICS).

Again, they're really driving that work forward from a ICS strategic point of view, so having data allows you to look at factors such as where’s doing well? And ask questions like 'What are they doing?' 'Who’s lagging behind and 'what might be the reasons for that?'

The quality of the record

And then one of the other things that the HIN has really been focusing on is thinking about the quality of the record. Creating a record is one thing that's really important, but the record is only really as good as the information that's in it. 'How do I make sure that the information that I include in that record is of quality and is useful?' 'Does it make sense as a kind of complete picture?'

The HIN developed a checklist of the non-mandatory information that would be most useful to clinicians. And then from that we've done some work with south west London to try to refine that. Again, we pulled together a steering group with various clinicians from south west London to look at how can we use something like a checklist to drive up and standardise the quality of CMC records. This is so they are a useful, high quality, advanced care planning record.

"Creating a record is one thing that's really important, but the record is only really as good as the information that's in it."Fay Sibley

What would you say has been the biggest challenge in setting up more CMC records?


I think capacity of the workforce to really do this, is the biggest challenge. As Lucy said, at the moment the vast majority of CMC records for care home residents are created by GPs. But GPs are an incredibly over-stretched workforce and it's not a quick five-minute job. It can take up to an hour to really have a meaningful conversation and then translate that into a record and publish that record. When you start talking about thousands of records across London, that's thousands of hours of GP time.

Who else can support the programme?

But I think the thing that may help us around that is understanding who else within the primary care and community services workforce can support this work.  Care homes themselves absolutely play a vital role and can feed into the record and do some of the data entry and have the conversations, but also, say, palliative care teams often do this kind of work; hospices, they've got brilliant teams that can support with this. Voluntary sector organisations; Macmillan, Marie Curie and GP practices are now starting to grow their workforce. Through the Primary Care Networks, we've now got paramedics working in GP practices. We've got highly skilled nurses that are really, really knowledgeable. There is a growing pool of professionals who could support the creation of urgent care records.

Getting patients and their families involved

We’ve also got an opportunity through MyCMC potentially as well which is something that was set up to be a patient-led record. Somebody would initiate that record for themselves, and there are roles within a GP practice where that could be a supported process, so social prescribers for example have the potential to be able to support somebody, even living in a care home, to initiate that record. People have a bit more agency. This includes setting up a record in mental health care homes and learning difficulty care homes. It may be appropriate sometimes to use MyCMC.


I take your point on capacity in terms of creating and maintaining those care plans. Once the plan is there,  it’s fairly easy to update and maintain it and we've seen that with some of the care homes that have been using it. They include it as part of the weekly rounds when the GP comes along, they include it at the Multi-Disciplinary Team (MDT) meetings that take place. And actually it's not too much work once the initial plan is filled out. In some of the more successful care homes using CMC the biggest thing, is just being engaging with them, and that's quite difficult to do from a commissioning perspective.

Resource challenges

I work in a very small commissioning team of just two. We’re covering the whole of London, including all health and care organisations across London.  So between us, it's very difficult to do that engagement. CMC does have a very strong engagement team, and they are successful, but they're still quite a small team for the whole of London. Some of the more successful care homes have been the ones that the CCG has provided resource, such as project support officers that have literally been hand holding those care homes to support them with all sorts of digital maturity aspects, like the Data Security and Protection Toolkit (DSPT) compliance and also, they've been really helpful with getting the care homes access to CMC.

I think engagement is one of the biggest success factors, but also a huge challenge. I think there's such a variety of resources across London. I know some STP's simply just don't have the resource to hand hold care homes with it.

Care homes 'left behind'

I think care homes have been left behind a little bit in terms of digital maturity. That's one of the key things - being able to have access to a computer, good internet, the IG (Information Governance) - all in place.  I think that they've been a bit left behind. I don't know what the historical reasons behind that are, but I think the digital maturity side of things is a big challenge for some care homes, especially the smaller ones.


I would agree wholeheartedly with that around the kind of digital maturity aspects.

And I think there's lots of reasons. Obviously, many of them are private providers. Historically, social care hasn't received the same level of funding as the NHS. It perhaps hasn't been seen as a priority or our job.

Equality of access to care

But I think when we talk about and think about equality of access to care and the world that we now live in, and the fact that many health services have been forced to, at least in some ways, move to a more virtual remote delivery then actually it's no longer the responsibility of social care alone because we're denying people access to the care that they have a right to.

I think that's probably why there is such an increased focus throughout the pandemic on getting care homes up to that basic level of digital maturity; that same digital standard that we would expect of our NHS.  It's not easy, and I think one of the reasons we started the dashboard was because at the beginning of the pandemic, what we didn't know is what we didn't know (i.e we didn't know whether this home in Southwark had Wi-Fi even, or if they even had a laptop and that information wasn't anywhere). There were no agreed datasets around the care homes. There was no kind of central repository to go to and just put in the care home name and it will bring that up, so we didn't even know how to support them, because we didn't know what they had to start with. So that's part of the reason we initiated that dashboard work because we were like how we can support the central government functions - health and social care, public health and other involved organisations?

This was a joint interview that took place remotely in April 2021.

NB: Fay Sibley was speaking in her previous role as the HIN's Head of Healthy Ageing.

Table showing number of care home residents in London with a CMC plan

Explore our website for more

See more info on our work with CMC here.

Click here for the CMC project webpage

Get in touch with our Healthy Ageing team

E-mail the team for more info.

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St George’s Hospital unveils dual electronic queue management and self check-in

Clinicians in ED

St George’s University Hospital Emergency Department unveils one of UK’s first dual queuing and self check-in system where patients see real time updates of their queue position on TV screens and smartphones.

HIN Innovation Grants supported project

St George’s installed the system after winning a HIN Innovation Grants award in 2019

St George’s University Hospital is one of the first Emergency Departments in the UK to introduce a dual queuing and self check-in.

Patients in the ED can map their queue position through real time updates on TV screens and smartphones.

In a move that reassures patients that they have not been missed or bypassed, the new system called “” helps free up emergency reception staff who handle a high volume of questions from patients about their wait and queue position. This has a knock-on delay in booking in new patients. – previously called “” – also allows patients to complete a brief assessment questionnaire while they wait, using their own smartphone, which saves time during the assessment.

The technology aims to reduce patient anxiety around waiting times and improve efficiency.

Funded by the NHS’s Health Innovation Network, a joint Emergency Department and Transformation project team at St George’s was awarded £9,928 to design and build the software system and install TV monitors in the waiting areas.

Previously, a whiteboard behind the reception desk was used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This can lead to repeated queries to reception staff about the waiting time and occasionally result in aggressive and abusive behaviours which puts additional pressure on staff.

The second function – the assessment questionnaire – has three major benefits. It empowers patients to tell clinicians why they are in the ED, in their own words using a non-verbal communication channel; reduces clinical administration workload and creates better quality, standardised medical documentation.

Through its integration with Cerner, the hospitals’ electronic health record system, sends the questionnaire responses directly into the electronic clinical notes. This reduces note-typing time by around eight minutes per patient. Therefore, if just half of St George’s 400 ED daily attenders complete, this equates to a potential saving of more than 26 hours of clinical time every day.

The Health Innovation Network grant was used to develop and implement the system. Now live, the team hope that will be adopted by other NHS Emergency Departments. There is also an opportunity to use it in outpatient departments and development projects are underway.

Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust, said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.
“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.”Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust

Health Innovation Network Programme Director for Innovation Lesley Soden said:
“Hospital emergency departments can often be highly volatile as by their nature they have anxious patients waiting to be seen. Those patients often worry that they have been missed or passed over by other patients and this can lead to repeated questions to hard pressed reception staff, who are then preventing from getting on with their work to triage.
“This is a simple system using existing technology that can improve the patient experience, free up reception staff to focus on registering arriving patients and ultimately lead to faster care in hospital emergency departments.”

HIN Innovation Grants

See more info on the HIN Innovation Grants

Click here to see webpage.

St George's

Get more info on St George’s

Click here to contact Verity Croll

Helping break unwelcome news

Helping break unwelcome news COVID-19 outbreak

Health Education England has published a set of materials and films which aim to support staff through difficult conversations arising from the Covid-19 outbreak.

The AHSN Network was part of a small group of people that helped pull this resource together in less than two weeks.

The framework includes posters and films based on the evidence base from Real Talk and then filmed with willing volunteers.

You can also follow #UnwelcomeNews on Twitter.

Start here for an introduction to the framework: Discussion of Unwelcome News during the Covid-19 pandemic: a framework for health and social care professionals

You can watch the films here:

  1. The framework
  2. Community
  3. Breaking bad news
  4. Ceilings of treatment

Then access the resources here:

Follow this link for more information on patient safety during Covid-19.

Covid-19: Patient Assessment the role of physiology and oximetry

COVID-19: Patient Assessment the role of physiology and oximetry

The assessment of patients who are unwell with Covid-19 or other causes presents a significant challenge for GPs and clinicians working in Primary Care. The Royal College of General Practitioners (RCGP) and the AHSN Network are holding a joint webinar looking at the role of oximetry and other physiology in that assessment.

The webinar will be led by:

  • Dr Jonathan Leach, RCGP Honorary Secretary and Covid Lead
  • Dr Alison Tavaré, Primary Care Clinical Lead at West of England AHSN
  • Dr Simon Stockley, RCGP Lead for Acute Deterioration and Sepsis

Overview of content to be explored:

  • Clinical features of Covid-19
  • Importance of oximetry in Covid
  • Clinical judgement and physiology in Patient assessment
  • Role of NEWS2 in General Practice and Care Homes
  • Remote oximetry in the assessment and management of Covid disease in the community
  • This will be followed by a Q and A session.

The webinar will be held on Wednesday 29 April, 13.30 – 14.30pm and you can register here. The webinar will be recorded and shared afterwards.

World Mental Health Day: A story of a burning platform for change

A burning platform for change

By Breid O’Brien, HIN Director of Digital Transformation

Today is World Mental Health Day; a day observed by over 150 countries globally to raise awareness and reduce stigma around mental health. In the 17 years since the day was first conceived, society has come a long way in its understanding of mental health. However, even today, people with serious mental illness are still likely to die approximately 15-20 years earlier than other people.

So this World Mental Health Day we would like to highlight some of the incredible progress being made by mental health teams around the world, to bring about parity of esteem in this area by reflecting on a recent roundtable event we held to share learning internationally, where Martin Davis, a Clinical Nurse from New South Wales’ Mental Health Emergency Care division (MHEC), presented on the successful implementation of a virtual consultation system in a rural and remote mental health setting in Australia.

This is a story of a small team that led the way. MHEC was kick started by a government cash injection at a time when the team needed to deliver a better, more cost-effective system of care to its rural and remote population in rural Australia. Before the MHEC service was introduced remote and rural ambulances (and often other emergency services) were transporting patients hundreds of miles just for an acute mental health assessment; taking them from the comfort of their home, family and friends when they were in a vulnerable state, and often leaving their hometown without any emergency provision. Imagine living somewhere where if there was a fire, there would be no one to put it out, simply because they are effectively acting as a patient taxi? Their situation provided a clear rationale for change – a burning platform, if you will. By using virtual consultations, they could save time, save money and deliver faster patient care.

Starting with an 1-800 number 12 years ago and progressing to an online video system just under a decade ago, MHEC now prides itself on answering calls within three rings, and being able to assess patients on a video call within an hour during daytime hours. The stats continue. Every year since its inception, they have saved the combined services over $1,000,000 AUD a year; and 80% of the patients they see are discharged back into their community within a day, a direct reversal of the 20% of patients who were able to go home under the previous system.

“All just geography”

Despite the obvious differences between MHEC’s setting (their ‘patch’ is the size of Germany but has only 320,000 residents), and our urban south London area where almost three million people reside in an area a fraction of the size, when Martin shared his story the similarities were immediately apparent. In London we have a diverse population who speak an estimated 250 languages, requiring a need for numerous cultural sensitivities; the MHEC team have a large aboriginal population – almost 40% of their mental health in-patients identify as aboriginal.

Patients in New South Wales were having to travel miles away from their families to receive acute mental health care; we too have examples of this happening in acute mental health care in the UK, and while the distances in Australia may be greater, the impact on the patient and their family will be the same. The Australian health system also faces an increasing demand for acute mental services against a backdrop of challenges with staff recruitment; turns out, Julia Roberts had it right in Pretty Woman; it is “all just geography”.

The question our roundtable guests discussed cut to the heart of the complexities of digital transformation: if we have so much in common, why, over a decade later, are we still not embracing virtual consultations in the same way that they are? Distance and cost were MHEC’s burning platform, pushing them to make changes ten years ago that other services are only just catching up with. We seemingly are yet to find our burning platform, despite the pressures on our services and the progress being made in many areas.

As our roundtable participants moved the discussion on to the inevitable complexities of implementation, many of the usual barriers made an appearance; procurement, interoperability, money, time. But a few more situation-specific ones also livened the debate; what are the implications for information governance? How do you prevent reprisals of misdiagnosis? How do you train people to deliver virtual care? How do you ensure that changing a pathway won’t affect patient safety? How do you empower your teams to step outside their role? How do you get buy-in from all the organisations needed to deliver the change?

The need for systems to talk

For Martin – and MHEC – all the barriers to change raised were not only a stark reminder of how far they have come, but also how much work is still to be done. We delved into the extensive stakeholder engagement the MHEC team undertook (they visited all the GP practises in person because face-to-face meetings achieved better buy in from clinicians – an irony that wasn’t wasted on them), and listened to how the accountability process was redefined, before unveiling a key area of distinction between our two situations; how joined up their IT systems had become. A steely silence answered Martin’s assumption that we’d managed to fix the interoperability of medical records in the 20 years since he’d served at Homerton, Enfield and the Royal Free. Sadly, Martin, we have not but it is high on the agenda of NHSX and others so perhaps this time we will.

And therein lies part of the problem. The collaborative nature required to implement the MHEC system between mental health, emergency departments, General Practitioners, community mental health teams and even the police (they have supplied local police with digital tablets to ensure they can get the virtual consultations to people in their own homes, not just the local emergency department) is a testament to the power of joined-up care systems, but working together was undoubtedly made simpler by the support of a joined up technology system, something the various LHRCEs are still working hard to crack.

From the discussion, it became clear however that no one issue of technology, procurement, change management, organisational boundaries or geography on its own poses enough of a barrier, but the cumulative effect of them all risks putting off too many commissioners, clinicians and managers from implementing digital transformation. The risk made all the more terrifying by the fear that it might go wrong and that safety could be compromised.

Martin was incredibly open and forthcoming about the fact that MHEC is not yet perfect. When they started the technology didn’t work; not everyone was bought in to the system; it was not – and still isn’t – an overnight success, but none of that mattered. They were trying something new that, at its heart, was trying to improve patient care and support emergency services to deliver better support to people in a mental health crisis, whilst also saving the overall system money. It is clear that really innovative organisations are willing to tolerate failure and see it as an opportunity for learning and doing things even better. Whilst we can’t tolerate failure in terms of compromising patient safety, it does feel that perhaps sometimes this fear also stops us from implementing proven innovations. So why does the fact that something won’t work perfectly first-time round make us in the NHS feel so uncomfortable? Perhaps this is our inherent fear of failure?

We heard from some present about the fabulous work they are doing to implement similar technology and different ways of working, however, to really impact care we need to do this at scale. And to achieve anything at scale, risks will have to be taken. Perhaps our burning platform is just not hot enough. Yet.

About the author
Breid O’Brien leads HIN’s digital consultancy function. She has extensive improvement and digital transformation experience supported by a clinical and operational management background in acute care within the UK and Australia. She has supported major system level change and has a strong track record of delivering complex programmes of work whilst supporting collaboration across varied teams and organisations. With a Masters in Nursing, an MSc in Healthcare Informatics and as an IHI improvement Advisor, Breid is especially interested in the people, process and technology interface.