Achieving innovation at scale in the NHS

PowerPoint Presentation

Achieving Innovation at scale in the NHS

@NHSAccelerator

@NHSAccelerator

Chaired by: Professor Sir Bruce Keogh, National Medical Director, NHS England

Mr Ashish Pradhan, Consultant Subspecialist Urogynaecologist Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust

Maria Slater, General Manager - CAMHS CSURoyal Manchester Childrens Hospital

Dr Keith Grimes, General Practitioner & Digital Healthcare InnovatorEastbourne, Hailsham and Seaford CCG / Hastings & Rother CCG

Episcissors-60

Mr Ashish Pradhan MRCOGConsultant Subspecialist UrogynaecologistAddenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom

Please add Hinchingbrooke and/or Addenbrookes logo4

EPISCISSORS-60first scissors designed to give an accurate mediolateral episiotomy; patent owned by Plymouth Hospitals NHS Trust

www.medinvent.net email:[email protected]

5

Results from UK hospitals that completely replaced all old episiotomy scissors with EPISCISSORS-6020% reduction in childbirth anal sphincter injuries (OASIS) at Poole and Hinchingbrooke Hospitals (Van Roon et al 2015)

40-50% reduction at Croydon University Hospital (Ying Yiing 2016)

40-50% reduction at Royal Free and Barnet Hospitals (Kate Mayers 2016, unpublished audit)

Please read the slide6

Why Hinchingbrooke decided to adopt the EPISCISSORS-60Bowel incontinence is a debilitating illness with significant morbidity and costs to the NHS The annual NHS bill for treating and managing incontinent persons is estimated at 500 million (NICE CG49)Women are affected 9 times more than men.Childbirth related perineal injuries are the number one cause of bowel incontinence in women.There is no satisfactory cure for bowel incontinence.Prevention is better than cure*

After reading out slide.As a specialist urogynecologist, I was seeing women with anal sphincter injuries 20 years after their deliveries. These women had bowel incontinence. They had lost control, and had accidents of leakage of stool, which were very embarrassing. If affected all aspects of their life, the foods they ate, their ability to have intimate relationships and socialise.. Some became completely housebound, and developed depression. And we dont have very successful treatments to deal with fecal incontinence. So I was convinced that prevention is better than cure.

7

Why Hinchingbrooke decided to adopt the EPISCISSORS-60A 60 degree episiotomy was recommended as a way to prevent childbirth anal injuries by the Royal College of Obstetricians and Gynaecologists (RCOG).EPISCISSORS-60 were mentioned in that guidance as being a fixed angle device that takes away the guesswork and human error in trying to estimate the angle at the time of birth.NO- BRAINER to prevent avoidable harm.

After reading slide contents.We discussed this with our obstetrics team and senior midwives, and it was felt that it would be a no brainer to adopt the EPISCISSORS into clinical practice. 8

How we overcame barriers to adoption Making the case internally for investmentWhich budget to dip into for funds? Capital or operational?Hospitals would lose income if injury rate reduced!No incentive to reduce injury rate

Changing clinical practiceIntroducing the comprehensive SUPPORT training programme led to buy-in from the midwifery and medical staffReplacement of all episiotomy scissors with the EPISCISSORS-60

Please dont read the slide contentsjust read thisWe had difficulty in making a cogent business case, because since these injuries attract reimbursement via Payment by Results, the hospital would lose income if the injury rate went down. Luckily, we were successful in getting a Regional innovation Fund grant from NHS England that enabled us to buy the scissors and train all the staff in the SUPPORT programme. Introducing the comprehensive SUPPORT training programme led to buy-in from the midwifery and medical staff. We replaced all the episiotomy scissors with the EPISCISSORS, as it was felt this would be the only way to ensure 100% compliance.

9

Benefits seen by the Trust post-implementation20% reduction in Childbirth anal sphincter injuries within 5 months of introductionCorresponding increase in number of episiotomies performed due to increased confidence among doctors and midwivesNow it has become the normHas influenced neighbouring trusts like Cambridge to adopt the EPISCISSORS-60Funding remains a huge obstacleINNOVATION TARIFF will greatly help

After reading slide contents speaking to colleagues across the country, it seems that all maternity units would adopt the scissors if there were funding available.10

i-Thrive

Maria Slater, General Manager - CAMHS CSURoyal Manchester Childrens Hospital


Components of an i-THRIVE Model of Care

Single point of access with multi-agency assessment & effective signpostingDigital front endSelf-help and peer-supportShort, evidence based interventions aligned with NICE GuidanceSchools and primary care in-reach Outreach to Hard-to-reach groupsCreating a comprehensive network of community providers: Youth Wellbeing DirectoryWide variety of choice of modality and location, provided by health or alternatives (3rd sector, community providers)Longer, evidence based interventionsProvided by health primarilyOutcomes plus goal based measuresOutcomes plus goal based measuresAMBiT: Integrated multi-agency approach with joint accountability for outcomesSelf-help and peer-supportSafety plans co-produced between agencies & young peopleEmphasis on developing Personal support networkCore THRIVE principles delivered using evidence based approaches to delivery that fit local context

Needs based care (not severity or diagnosis led)

Shared decision making at each point in pathway

Integration: multiagency teams that are trained and located together, with common processes and outcome frameworks

Training clinicians in clarity about when treatment is being provided vs. support, promoting & supporting self help, shared decision making

Community of Practice building on existing funded work with 10 sites natural route for disseminationGetting Advice & SignpostingGetting HelpGetting More HelpRisk SupportCYP IAPTCYP IAPT

THRIVE is the conceptual framework that will help us move to the next world whereIn an integrated care model we need to.

12

AliveCor

Dr Keith Grimes, General Practitioner & Digital Healthcare InnovatorEastbourne, Hailsham and Seaford CCG / Hastings & Rother CCG


www.innovation.england.nhs.uk/nhs-innovation-accelerator

[email protected]

@NHSAccelerator