Speeding up the best in health and care, together

The HIN has found great benefits from working with Darzi fellows over the years in partnership with our local member organisations. The Darzi fellowship supports clinicians who are looking to explore a challenge in depth to develop long term, sustainable solutions.

Between September 2021 and October 2022, Darzi fellow and midwife by background, Rosie Murphy, undertook work in Croydon to explore the inequalities that women and birthing people from Black, Asian, or mixed ethnic backgrounds experience during their maternity journey.

A series of interviews with people who experience these inequalities identified the most common themes as access barriers and failure to listen to women and birthing people. Working in partnership with the HEARD (Health Equity And Racial Disparity) campaign, Croydon NHS Trust, South West London Local Maternity and Neonatal System (SWL LMNS), the HIN and other passionate people looking into perinatal equity, Rosie hosted a “Whose Shoes” event to engage interested citizens and wider health and voluntary sector staff, to establish a network and start discussing solutions.

Rosie has written a series of blogs discussing her journey, key findings and recommendations. To further this research, the HIN, in partnership with SWL LMNS, recruited another Darzi fellow for September 2022 to October 2023. Ella Caine, also a midwife and university lecturer by background, has been working on improving interpreting services for Black, Asian and minoritised women and birthing people. Ella is planning on setting up a series of listening events across SWL with key stakeholders to understand barriers and facilitators to using interpreters and experiences of the process.

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.

The South London Maternity and Neonatal QI collaborative was set up in June 2022 to bring together frontline clinical and managerial staff in maternity and neonatal care to deliver a learning programme to build practical QI skills, confidence and cross-unit connections. The focus of the series is to improve the opportunities to optimise and stabilise the outcomes of the preterm infant through the seven interventions recommended by the British Association of Perinatal Medicine (BAPM).

Multidisciplinary teams from across south London, ranging from patient safety midwives and neonatal physicians to preterm birth champions, obstetric consultants and theatre staff at a range of different levels have come together to learn how they can improve the care they deliver to women and babies locally. Visiting teams on site and helping them to map out their activities and processes has been beneficial to understand the gaps and areas for improvement. The accompanying photo is from a successful process mapping session with our maternity and neonatal colleagues at St George’s NHS Trust.

The series has shown the importance of cross-unit working, learning and collaboration between teams and hospitals. Practical recommendations of best practice are now being clearly communicated across teams through posters, message of the week, simulated practice and training which has resulted in significant improvements in outcomes for preterm babies. Find out more about the series, slides and recordings. A newly developed dashboard by the National Maternity and Neonatal Patient Safety team demonstrates the local impact of the optimisation QI series and dedicated work from our staff across south London.

We delivered a series of national programmes around cardiovascular disease and significantly built on these to address specific local needs.

The National Blood Pressure Optimisation and National Lipid programmes were delivered with local partners to support detection and optimisation for hypertension, lipids, and familial hypercholesterolemia.

Within south west London the HIN delivered the South West London Hypertension and Lipids Forum, working closely with the ICS and the SWL Training Hub. Key statistics:

• eight sessions delivered
• 689 attendees across the sessions–average attendance of 86 people
• 38 Primary Care Networks (PCNs) supported

Within south east London the HIN worked with Clinical Effectiveness South East London (CESEL), and the South London Cardiovascular Network to support PCNs in their delivery of hypertension care. Thirty-four of thirty-five PCNs in south east London have signed up to participate in order to improve the detection and management of hypertension care, reduce inequalities and support Covid-19 recovery. The partnership with CESEL and the South London Cardiovascular Network obtained ICS inequalities funding for participating PCNs, and commissioned Mabadiliko Community Interest Company (CIC) to codesign culturally sensitive, community-based hypertension testing protocols with residents and health care professionals.

In lipids we have worked with17 PCNs across south London to test new approaches to lipid management and familial hypercholesterolaemia in primary care. We have supported over 70 per cent of south London PCNs to work on lipid optimisations. The HIN also supported successful bids for lipid transformation across our patch for a total of £586K.

South West London Integrated Care System has worked with schools and colleges since 2018 to provide earlier support for children and young people’s mental health. In its independent evaluation, the HIN Insights team gathered feedback from 422 stakeholders, including teachers, mental health service providers, children and young people, parents and carers. These stakeholders provided considerable qualitative evidence of positive change associated with the programme in all eight Whole School Approach domains.

Evidence from quantitative data demonstrates a good deal of new activity aimed at improving emotional wellbeing in schools. Though limited in quantity, clinical outcomes data indicates improvements in pupil and staff wellbeing following introduction of the Programme.

SWL ICS welcomed the evaluation report and has already acted on some of the recommendations, such as addressing the issues identified with quantitative success measures. There is an action plan in place to take forward our recommendations.

The programme aims to improve safety and experience in mental health wards by reducing restrictive practices such as physical restraint, seclusion, and rapid tranquilisation by 25 per cent.  Across the south London mental health trusts, the HIN has worked with seven patient wards by enabling shared learning, systematic quality improvement, codesign and coproduction and awareness of health inequalities.

Through a proactive steering group and local experts by experience, the programme designed an interactive platform (Patient Safety Network) that brings together diverse voices, organisations, and agendas to build shared learning in mental health safety. In November 2022, over 40 people across the three trusts, local authorities, police, and voluntary organisations attended the patient safety network which focused on learning from the trusts. Below is the key learning shared by trusts.

The programme actively engaged with experts by experience to improve inpatient care and reduce restrictive practice. We coproduced a video that features how communication can be improved in wards and how to make the wards become safer, calmer and more therapeutic environments. View the video.

To build good relationships with participating wards, we visited Goddington ward (Oxleas) and Churchill ward (Cygnet). The reflections of the HIN project manager, the practice development nurse of the ward and an Expert by Experience were captured in a blog here.

We ran 146 innovation clinics, of which 34 were hosted by our mental health team.

In September 2022 we held a roundtable in partnership with the Association of British Healthtech Industries (ABHI) where we invited companies to help us gather insights on challenges and opportunities for the UK healthtech  industry.

We also delivered a showcasing webinar on the use of the Organisation for the Review of Health and Care Apps (ORCHA) for our south London stakeholders, in partnership with Kent Surrey Sussex AHSN. Attendees heard from other NHS organisations who use ORCHA to select safe and quality-assured health and wellbeing apps.

We were commissioned to gather insights into the use of equality impact assessment in the procurement and implementation of new treatments and disruptive digital and technologies and produce standards for any organization completing EIAs prior to commissioning or funding new innovations. This work was commissioned following the Observatory’s rapid review in 2021 of pulse oximeters and less accurate measurements for people with dark skin. We undertook a mixed-methods research study with industry and NHS organisations to identify good practice and contribute towards producing the standards.

The Good Boost project won a HIN Innovation Grant to pilot a personalised water-based fitness programme supporting patients with musculoskeletal (MSK) conditions. It was launched in Southwark in April 2021 and also piloted at Kingston Hospital. It was open to people with long-term MSK conditions, those recovering from joint replacement surgery and older people. It used Artificial Intelligence (AI) to tailor an exercise programme to individual health condition, fitness level and confidence in the water. After five months:

• two-thirds of participants reported an improvement in their health;
• almost a quarter reported improvements in their functional capacity; and,
• more than a fifth reported a reduction in pain levels.

On behalf of the London region the HIN has delivered a series of projects to:

• Understand the use of remote monitoring technologies;
• Assess the maturity of the market;
• Support ICB procurement through the development of a technical guide; and,
• Providing recommendations on developmental partnerships with suppliers.

The first project involved a horizon scan, gathering lessons learned from early adopters of remote monitoring across London and providing market analysis around solutions available, including mapping solutions according to the level of care required, analysis of interoperability and functionality.

Recommendations were provided for future market engagement, selection and implementation. These were further were categorised into provider, system, and patient perspectives to provide insights specific to these key stakeholders.

The report findings have been presented to all London Cancer Alliances and their respective personalised care programme boards. We have been asked to present the findings of this report at the Oncology Professional Care 2023 conference.

As a result of our work, one of the included solutions (ONKO) was selected for a pilot in the Breast and Lung Cancer Pathways at Lewisham and Greenwich NHS Trust.

In 2022, NHSE London commissioned the HIN to complete an evaluation to gain an understanding of the different mental health crisis hub models that are in operation and their potential impact at a service user, carer, practitioner, and service-level within London.

Four mental health trusts in London were included in the evaluation:

• Two that provides a mental health crisis hub that allows direct access to service users who are in a mental health crisis;
• One that requires service users to attend the emergency department to be referred to the crisis hub;
• One that was a Psychiatric Liaison Service.

Although it is relatively early in the lifetime of the two hubs that allow direct access, the evaluation was able to evidence that both these hubs:

• Provide a timely service that enables service users to be seen on arrival by a mental health professional;
• Have a growing proportion of service users that go directly to the hub and are evidencing that service users who have attended these hubs once, are more likely to self-refer if they need to attend again.

The majority of service users who provided feedback on experience of these hubs said that they felt safe, had privacy, and were treated with kindness and respect by staff within the hubs who had a good understanding of mental health. There was however significant service user, staff, and stakeholder feedback on where improvements could be made for all the hubs included in this evaluation. Read the full report and plain English summary.