Putting it into practice: enabling great ideas to succeed in health, care and beyond Caroline Angel, Director of Patient Safety at Health Innovation East, shares how we have worked with integrated care systems to help develop and sustain high-quality, evidencebased practices, processes and innovations. Integrated care systems (ICSs) can transform health and care by encouraging long-term thinking. Successfully implementing ICSs requires muti-agency collaboration on areas such as population health, reducing inequity and improving access each having been built on a foundation of safe, effective services (1). To help achieve effective collaboration the importance of adopting innovations that help relieve system pressures, support workforce development and nurture culture change cannot be underestimated. Our direct experiences and trusted relationships mean that we understand not only the policies and processes that underpin health and care, but also the practicalities of delivering meaningful change in real world settings. This year we have worked with system partners to explore how doing things a little bit differently and collaborating even further can lead to a big difference for patients and colleagues. Equity, diversity and inclusion in the workforce: The East of England Minority Maternity and Neonatal Staff Development programme Unquestionably, the talents and dedication of the 1.4 million staff in the NHS are a 19 participants completed the development reflection of a diverse workforce where over 100 nationalities are represented. Inequalities programme. Follow up of the programme in any form are at odds with the values of the NHS and the fair treatment of NHS staff is revealed that having participated six linked to better clinical outcomes and better experiences of care for patients (2). colleagues secured new roles at an NHS In 2022 The NHS Workforce Race Equality standard (WRES) reported a fall in the band higher than that at which they entered number of black and minority ethnic executives in the NHS. It also pointed to a steady the programme. Two participants decline in race disparity among staff being referred into disciplinary processes, but that collaborated to establish a neonatal that very same race disparity still remains in 50% of the organisations surveyed (2). focused non-profit organisation, alongside In 2023, we partnered with the East of England maternity & neonatal ethnic minority their NHS roles. workforce working group to launch the East of England minority maternity and neonatal staff development programme supporting NHS band six and seven staff to move into I have just secured a job as EDI lead for 30 leadership roles (3). hours a week, this job is at band 7. I have It was hoped that enabling more leaders and executives from ethnic minority groups would help address some of the inequities that colleagues in the region experience. also secured another post as Lecturer of These are further highlighted by data in WRES focusing on midwifery in the East of Midwifery for one day a week. Prior to England 55.6% of black and minority ethnic staff believed that their Trust provided starting on this development course I had equal opportunities for career progression or promotion, falling to just 26.7% for black been a band 6 for the last 13 years. This program has really enhanced my confidence midwifery staff. and opportunities to networking. Delivered between May and October 2023, the staff development programme offered 157 hours training per participant. Maternity and neonatal departments in most NHS trusts in the region were represented and delivery partners included the NHS Leadership The development programme was shortlisted Academy and the Royal College of Midwives, alongside the regional chief midwife and for outstanding achievement of the year award the national maternity lead for equality. in the 2023 National BAME Health and Care Awards, and has now been adopted regionally for nurses, allied health professionals and social care staff. Elements of the programme have also been adopted for the NHSs national maternity leadership development programme. This development programme has truly been life transforming. The experience gained has enabled me to recognise other career opportunities I could pursue. Ive been able to partake in other leadership work - presenting at meetings and chairing meetings. I am putting myself forward more. Collaborating with regional Heads of Innovation During 2023/24 we have part-funded or collaborated with Heads of Innovation in four Enhancing wellbeing at BLMK ICS ICSs - Suffolk and North East Essex, Bedfordshire Luton and Milton Keynes (BLMK), BLMK ICSs Digitising Social Care team (DiSC) Cambridgeshire and Peterborough and Norfolk and Waveney. In each instance, the introduces technologies to benefit residents role promotes the piloting and adoption of innovations according to the needs of receiving adult social care that prevent problems that local populations. Not only are the heads of innovation closely integrated with the lead to serious health issues and extended stays in infrastructure of their ICS to optimise the chances of success, but they are also hospital. Thanks to a 1.1 million funding boost from connected to Health Innovation Network colleagues around the country. Their work the National Adult Social Care Technology Fund, spans culture and behaviour change, building local networks, encouraging innovative the teams Enhancing Wellbeing Through Digital colleagues and engaging industry for the best possible patient impact. initiative worked with stakeholders to identify and Emma Brown: spotlight on adopting innovation Emma is head of innovation at BLMK ICS, and her work with pilot two innovations that support adults experiencing communication difficulties, dementia or cognitive impairment to live independently. colleagues across the ICS and Health Innovation East has Robopets, robotic companions to provide comfort shown great results in this second year of her role. Emma is and decrease loneliness - will be provided to 1,300 passionate about embracing innovation and believes that adults in BLMK living CQC-registered care settings. adopting innovations focused on prevention, early diagnosis Studies have shown the potential of Robopets for and enabling system capacity is essential for delivering the supporting dementia patients and the wellbeing of best care for BLMKs fast growing and diverse population. older adults (4)(5)(6). Alongside the delivery of Robopets an independent study is investigating the Among many successes, this year Emmas work has contributed to: impact and outcomes of Robopets. z A collaboration between BLMKs Digitalising Social Care (DiSC) team, Health PainChek, uses artificial intelligence (AI) to recognise Innovation East and the University of Hertfordshire that secured 1.1 million to and measure small changes in facial expressions and evaluate the impact of the Painchek and Robopets innovations across BLMK ICS. peoples voices to quantify a pain score and guide z Securing funding for the implementation of Spectra Optia, an apheresis, cell carers to provide the correct care (7). The innovation processing and cell collection platform. Introducing the device at Bedford supports people who are unable to reliably verbalise Hospital made sickle cell services more accessible across the region. pain. Early identification and treatment of the causes of z Funding and piloting GaitSmart, an innovative gait analysis technology that uses data to provide personalised intervention plans to improve mobility, at four sites pain can help reduce hospital admissions and ensure medications are used appropriately. across BLMK. Working with Emma and GaitSmart, we are delivering a 12-month PainChek will be made available to care staff real-world evaluation of the technology. To date 85 people have benefitted working with adults living in care settings - 1,000 across the four sites and 2024/25 will see this number increase significantly. people will be assessed. In a previous evaluation z Securing and delivering the DHSCs Research Engagement Network (REN) 85% of respondents reported an improved ability to Development Programme. A joint bid for 100,000 alongside Diabetes UK identify pain, increased knowledge of how pain and the four Healthwatch organisations in BLMK. Supported by Health affects people with dementia or cognitive Innovation East and the Clinical Research Network East of England, the impairments and improved health outcomes for care REN will help understand barriers to research participation from within home residents (8). underserved communities. Working regionally to support the safety of patients By working alongside ICSs to further implement the National Patient Safety Improvement programmes (NatPatSIPs) across the region, we are supporting our shared commitment to patient safety and quality improvement by nurturing a culture of safety, learning and improvement within and across organisational boundaries. The NatPatSIPs are funded by NHS England and delivered by Patient Safety Collaboratives (PSCs), which are hosted by the Health Innovation Network. In 2023/24 PSCs worked on five core programmes, two of which and their outcomes are outlined below. The Patient Safety Incident Response framework (PSIRF) We have facilitated first-of-kind opportunities for the regions health and care professionals and are proud of the value we have added in the East. Working with the regional team, we established the regional approach for the PSIRF programme using systems thinking, connecting colleagues via innovative, collaborative webinars and delivering in person workshops to help develop a shared understanding around implementing the national PSIRF guidance (9). Further, our team co-ordinated regular regional meetings for leaders from ICSs in our region to celebrate successes and offer each other advice on overcoming the challenges of system transformation. Connecting expertise, accelerating understanding, and delivering frameworks around which they can operate has led to timely implementation and successful transformation for PSIRF in the region. It has also led to the development of a regional community of practice that held its first session in March 2024. Deprescribing opioids in Norfolk and Waveney Opioids are a highly effective class of analgesics and can be of great benefit to people living with pain. However, long term use of opioids can do more harm than good, particularly at higher doses, and often alternative approaches are more effective than medicinal ones (10) The aim of the medicines improvement programme (MedSIP) - a partnership between our team, Norfolk and Waveney Integrated Care Board (N&W ICB) and the East of England Applied Research Collaborative (EoE ARC) is to develop a pathway to help prescribers taper patients off analgesia by implementing evidence-based approaches. Careful planning and collaboration is required to achieve this (11). In 2018 Great Yarmouth and Waveney CCG were the eighth highest prescribers of opioid analgesics of all CCGs in England (12). In 2023/24 our collaboration continued to work on operationalising the opioid deprescribing toolkit developed in 2022/23. We also developed a clinical pathway and resources for clinicians, provided e-learning and cognitive behavioural therapy (CBT) training support practitioners and identified and helped make resources available to further the delivery of the pathway. 103 colleagues in Norfolk and Waveney took part in the training we provided and a real-world evaluation of the programme is under way and due to report in full this year. Share this article Return to About Us If you want to discuss how Health Innovation East can support a quality improvement programme in your organisation, or to understand more about our offering in 2024/25, contact caroline.angel@healthinnovationeast.co.uk, or visit our website Up next: Take a look at how we have continued to put heart health at the heart of our work. References 1 Lalani, M, et al. (2023). Assessing progress in managing and improving quality in nascent integrated care systems in England. Journal of Health Service Policy. 29(2), pp.122-131. [Online]. Available at: 10.1177%2F13558196231209940 [Accessed 6 May 2024]. 2 NHS. (2022). NHS Workforce Race Equality Standard: 2021 data analysis and report for NHS trusts. [Online]. www.england.nhs.uk. Last Updated: March 2022. Available at: www. england.nhs.uk/wp-content/uploads/2022/04/Workforce-Race-Equality-Standard-report-2021-.pdf. [Accessed 16 April 2024]. 3 NHS. (2023). NHS Pay and Benefits. [Online]. www.healthcareers.nhs.uk/working-health/working-nhs/nhs-pay-and-benefits. Last Updated: April 2023. Available at: www. healthcareers.nhs.uk/working-health/working-nhs/nhs-pay-and-benefits/agenda-change-pay-rates [Accessed 16 April 2024]. 4 Bradwell, H. et al. (2022). Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified. JMIR Aging. 24(5(3)). [Online]. Available at: pubmed.ncbi.nlm.nih.gov/35830959/#:~:text=Conclusions%3A%20Affordable%20robot%20pets%20hold [Accessed 7 May 2024]. 5 Abbott, R. et al. (2019). How do robopets impact the health and well-being of residents in care homes? A systematic review of qualitative and qu. International Journal of Older People Nursing. 14(3). [Online]. Available at: pubmed.ncbi.nlm.nih.gov/31070870/ [Accessed 7 May 2024]. 6 Tate, C. (2022). New study finds care home residents benefit from robot pets. [Online]. www.plymouth.ac.uk. Last Updated: 29 September 2022. Available at: www.plymouth.ac. uk/news/new-study-finds-care-home-residents-benefit-from-robot-pets [Accessed 7 May 2024]. 7 Babicova, I. et al. (2021). Evaluation of the Psychometric Properties of PainChek in UK Aged Care Residents with advanced dementia. BMC Geriatrics. 21(1). [Online]. Available at: www.researchgate.net/publication/351949907_Evaluation_of_the_Psychometric_Properties_of_PainChekR_in_UK_Aged_Care_Residents_with_advanced_dementia [Accessed 7 May 2024]. 8 KPMG. (2022). National Rollout of PainChek. [Online]. www.paincheck.com. Last Updated: December 2022. Available at: www.painchek.com/wp-content/uploads/2023/01/ PainChek_Evaluation_Insights-Summary.pdf [Accessed 7 May 2024]. 9 NHS England. (August 2022). Patient Safety Incident Response Framework. [Online]. www.england.nhs.uk. Last Updated: 14 September 2022. Available at: www.england.nhs.uk/ publication/patient-safety-incident-response-framework-and-supporting-guidance/ [Accessed 17 May 2024]. 10 Royal College of Anaesthetists. (2020). Opioids Aware. [Online]. www.fpm.ac.uk. Last Updated: January 2022. Available at: www.fpm.ac.uk/opioids-aware [Accessed 17 May 2024]. 11 National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. [Online]. www.nice.org.uk. Last Updated: April 2021. Available at: www.nice.org.uk/guidance/ng193 [Accessed 17 May 2024]. 12 Mordecai, L. et al. (2018). Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. British Journal of General Practice. 68(668). [Online]. Available at: bjgp.org/content/68/668/e225 [Accessed 17 May 2024].