Achieving innovation at scale in the NHS
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Panel led by Professor Sir Bruce Keogh Expo 2016 Day Two FutureNHS Stage
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Achieving innovation at scale in the NHS
- 1. Achieving Innovation at scale in the NHS @NHSAccelerator
- 2. @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 CSU Royal Manchester Children’s Hospital Dr Keith Grimes, General Practitioner & Digital Healthcare Innovator Eastbourne, Hailsham and Seaford CCG / Hastings & Rother CCG
- 4. Episcissors-60 Mr Ashish Pradhan MRCOG Consultant Subspecialist Urogynaecologist Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- 5. EPISCISSORS-60® first scissors designed to give an accurate mediolateral episiotomy; patent owned by Plymouth Hospitals NHS Trust www.medinvent.net email:info@medinvent.net
- 6. Results from UK hospitals that completely replaced all old episiotomy scissors with EPISCISSORS-60 • 20% 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Croydon University Hospital (Ying Yiing 2016) • 40-50% reduction at Royal Free and Barnet Hospitals (Kate Mayers 2016, unpublished audit)
- 7. Why Hinchingbrooke decided to adopt the EPISCISSORS-60 • Bowel 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*
- 8. Why Hinchingbrooke decided to adopt the EPISCISSORS-60 • A 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.
- 9. How we overcame barriers to adoption • Making the case internally for investment • Which 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 practice • Introducing the comprehensive SUPPORT training programme led to ‘buy-in’ from the midwifery and medical staff • Replacement of all episiotomy scissors with the EPISCISSORS-60
- 10. Benefits seen by the Trust post-implementation • 20% reduction in Childbirth anal sphincter injuries within 5 months of introduction • Corresponding increase in number of episiotomies performed due to increased confidence among doctors and midwives • Now it has become the norm • Has influenced neighbouring trusts like Cambridge to adopt the EPISCISSORS-60 • Funding remains a huge obstacle • INNOVATION TARIFF will greatly help
- 11. i-Thrive Maria Slater, General Manager - CAMHS CSU Royal Manchester Children’s Hospital
- 12. Components of an i-THRIVE Model of Care Single point of access with multi-agency assessment & effective signposting Digital ‘front – end’ Self-help and peer-support Short, evidence based interventions aligned with NICE Guidance Schools and primary care in-reach Outreach to Hard-to-reach groups Creating a comprehensive network of community providers: Youth Wellbeing Directory Wide variety of choice of modality and location, provided by health or alternatives (3rd sector, community providers) Longer, evidence based interventions Provided by health primarily Outcomes plus goal based measures Outcomes plus goal based measures AMBiT: Integrated multi-agency approach with joint accountability for outcomes Self-help and peer-support Safety plans co-produced between agencies & young people Emphasis on developing Personal support network • Core 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 dissemination Getting Advice & Signposting Getting Help Getting More Help Risk Support CYP IAPT CYP IAPT
- 13. AliveCor Dr Keith Grimes, General Practitioner & Digital Healthcare Innovator Eastbourne, Hailsham and Seaford CCG / Hastings & Rother CCG
Notas del editor
- Please add Hinchingbrooke and/or Addenbrookes logo
- Please read the slide
- 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 don’t have very successful treatments to deal with fecal incontinence. So I was convinced that prevention is better than cure.
- 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.
- Please don’t read the slide contents…just read this…We 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.
- 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.
- Please add Hinchingbrooke and/or Addenbrookes logo
- THRIVE is the conceptual framework that will help us move to the ‘next’ world where…… In an integrated care model we need to…….
- Please add Hinchingbrooke and/or Addenbrookes logo