New video to leave viewers stirred, but not shaken

How many shots have been fired at – and missed – James Bond over his 22-film career to date? An academic in the New Scientist has recently calculated that the 007 hero has managed to dodge 4,662 poorly aimed bullets.

Bond, famous for his gun-toting escapades, daring dalliances with villains and henchmen, and his love of a dry martini, is the unlikely but fitting inspiration behind our latest campaign film to promote awareness and prevention of a serious health condition.

While the 4,662 missed Bond bullets is a staggering number, another startling statistic in our area of interest is that every month in the East Midlands, ambulances are called to up to 500 people experiencing a hypoglycaemic event. Four out of every 10 of those people are then taken to hospital for treatment. Unfortunately this is a rising trend.

Hypoglycaemia is an abnormally low level of sugar (glucose) in the blood. When the glucose level is too low, the body does not have enough energy to carry out its activities - this is described as a 'hypo'. Hypoglycaemia is most commonly associated with diabetes, and mainly occurs if someone with diabetes takes too much insulin, misses a meal, or exercises too hard.

But where is the 007 secret agent connection you ask? How has the character of Bond inspired a video on a diabetes-linked condition? Surely episodes of hypoglycaemia are not linked to evil baddies intent on global domination, working up their heinous plots from a space station or in the crater of an extinct volcano?

The answer can be seen in the new campaign video from the East Midlands Cardiovascular Network – available at http://www.emcvn.nhs.uk/diabetes/

The video promotes a new e-learning course for clinicians from NHS Diabetes, to raise awareness of how to prevent and treat cases of hypo. The delivery of best practice, evidence-based care has the potential to significantly improve patient outcomes and save the NHS millions of pounds. It is estimated that hypoglycaemia costs the NHS (hospitalisation and ambulances) nationally nearly £17 million a year.

The video takes some of the questions contained within the NHS Diabetes free e-learning module and puts them in the entertaining context of a secret agent interrogating the manipulative Dr Low (blood sugar), about hypo. Respect is paid to the film heritage of Bond with some catchphrase references and the use of the archetypal villain’s white cat, which in our case is made from sugar cubes.

The video is designed to raise a smile of course but the important message is to highlight awareness of the problem of hypo and that action can be taken to improve clinical practice through clinicians accessing the online training available at www.emcvn.nhs.uk/hypo

The e-learning module helps clinicians understand the signs, symptoms and risk factors for hypoglycaemia as well as prevention and treatment. It is a flexible e-learning package that can be stopped and started as required and generally takes about 30 minutes to complete. Successful completion produces a certificate which can be useful for evidence of continuing professional development. I would encourage colleagues across the NHS in the East Midlands to take advantage of this free training which should help to improve knowledge and practice. After all, we now know that on average 9.3 villains die in every Bond movie. Perhaps our video might lead to the health of 9.3 lives being improved with every view…

Culture eats strategy for breakfast!

Last week, the Network held its ‘Gold Standard in Cardiovascular Services’ conference. Having kicked us off in the morning with a Benjamin Franklin quote asking ‘what good shall we do this day’ I was delighted that the event evaluated extremely well and that we developed outline proposals for a small number of cardiovascular improvement projects. We will be sharing more information on these in the near future together with all the outputs from our day.

In the meantime, what struck me most about the conference were our discussions on patient experience. In particular one of our speakers shared a story of a friend who had recently been in hospital and was being cared for in a bed near the nurses’ station. Unfortunately this patient hadn’t been able to get much rest as the phone at the nurses desk had being ringing constantly and on one occasion alone he had counted nine doctors walking past it without answering it (the speaker advised that many nurses and other healthcare professionals had also ignored it too but his friend didn’t know who they all were).

In response to such stories we also heard how, in one area of the country, a hospital is inviting patients to give real time feedback of their experiences via social media such as twitter in order that they can improve issues like this straight away.

We’ll be giving some more thought to this, and what our role might be as a Network, because after all our best laid plans to support the continuous improvement of cardiovascular care are only going to achieve a first class service for each and every patient if the culture is right!

Five minutes of fame!

Stroke is this country’s third biggest killer and single largest cause of adult disability. In 2007, when the National Stroke Strategy was published, England was spending more on stroke care and getting worse outcomes than most other European countries.

A few months ago our Strategic Health Authority Cluster, NHS Midlands and East, launched a stroke review aimed at achieving a ‘step change’ in the quality of stroke services across the whole pathway of care (i.e. from prevention through to end of life care).

This review has attracted a flurry of media interest, firstly from the Health Service Journal, then two radio stations and more recently an approach from BBC East Midlands for an interview….YIKES!!

I’m very relieved to say however that, having made a couple of appearances on the BBC whilst in the crowd at Wimbledon, it seems I’ve already had my five minutes of fame with the journalist wanting to interview clinicians and patients - phew J

As such, Professor Philip Bath and Dawn Good, from Nottingham University Hospitals NHS Trust, stepped up to the mark and represented us on the news. Philip was a true media professional, and just like the Queen in her recent appearance with James Bond at the Opening Ceremony of the Olympics, only needed ‘one take and it was in the can’ while Dawn’s ‘piece to camera’ was superb and ‘a wrap.’ Huge thanks to them both.

As I had prepared three key messages, about the review, just in case I was needed, I thought I would share them here:

1)      We have some really good strokes services and fantastic clinicians in the East Midlands but there is always opportunity for further improvement: saving lives, reducing disability and improving patients’ experiences of care;

2)      We have already spent considerable time and energy over the last few years developing specialist hospital stroke services. So, for us, this review is about building on the work we’ve done to date and looking at opportunities for further improvement, for example in longer-term aspects of care as there are approximately 27,000 people in the East Midlands living the impact of stroke;

3)      This review keeps stroke in the spotlight as a priority locally, which is great as it enables us to go further, faster in delivering the best services possible for all our patients and their carers.

Further information on our stroke programme of improvement including Our Ambitions for Stroke Services 2012-2017 can be found on this website. 

This week’s top tips!

Top tip for anyone who is invited to give a ‘friendly, community feel presentation,’ if the context is 50 suited and booted healthcare professionals sat around tables in the imposing grandeur of the Royal College of Obstetricians and Gynaecologists main hall, there is nothing ‘friendly and community feel’ about it!!

However, it was fantastic to be given the opportunity by the Health Foundation to present our learning from the development of our Cardiovascular Network, at their inaugural Network Leadership Forum. It was even better to hear about their research into what makes an effective network. As we are constantly promoting the need for evidence based clinical practice, everyone can be reassured that we also recognise the need for our Network to be effective in line with the evidence too.

For anyone else who is interested, the Health Foundation has confirmed the design features of effective networks are:

·  Shared purpose and identity

·  Addresses big issues / has a compelling purpose

·  Meets members needs

·  Adapted leadership

·  Strong relationships and ties

·  Generates helpful outputs

Probably no surprises with any of this but as the NHS Commissioning Board is investing heavily in networks (Academic Health Science Networks and Strategic Clinical Networks) in supporting the achievement of outcome ambitions for patients, it is good to know what works!

And for further information I could highly recommend checking out the Health Foundation’s website where further information, on the network programme, can be found.

‘And the prize for the most boring service goes to…’

The NHS Atlas of Variation in Healthcare highlights unwarranted variation in the quality of NHS care provided.

At a recent Network development session, facilitated by the Health Foundation, we pondered why the NHS struggles to provide uniform basic quality care for all. It was suggested that this could be, in part, due to the fact that getting basic quality care right, for all patients, wasn’t as exciting as concentrating on the latest innovations. We even went as far as to say that routine evidenced based care, whilst of paramount importance, wasn’t going to receive any sexy awards and actually we should be giving all the plaudits to the most boring services – namely those that deliver the fundamentals of what we know to be good quality care day after day, to all their patients.

Now I’m not sure anyone would want to put themselves forward for the most boring service accolade, not least because it conjures up thoughts of Gerald Ratner, who became famous for making a speech in which he denigrated his own company’s products. And so I expect we need to think of a better name for any prizes. But anyone who has read the Network’s recently published ‘Our Ambitions for Stroke Care – A Strategy for 2012-17’ will have seen our quote: “New knowledge is important but the reality on the ground is that patients are not getting the care we know we could provide.”

Our Ambitions Strategy also sets the Network’s aspiration to improve the diagnosis and management of atrial fibrillation (an abnormal heart rhythm) across the East Midland. This is because the evidence suggests we could save 4,500 strokes in England per annum and prevent 3,000 deaths through reducing unwarranted variation in diagnosis and management of care in this area.

The Network is currently concluding and evaluating a pilot project with Corby Clinical Commissioning Group, in Northamptonshire, on atrial fibrillation. The challenge will then be to spread the learning and best practice at scale, as needed across the region, ensuring quality care becomes the norm for this patient group. And while we’re at it, we’ll also be working on a way of celebrating success which enables boring to become the ultra new sexy!

"Hugh" Knew

Who knew it was European Heart Failure Awareness Day earlier this month? Not many people I would suspect and, in fact, even the health community that asked me to speak at their conference got the day wrong – oops! Having said that, it was an excellent event but it was only able to go some way to raising awareness of the need to significantly improve heart failure care because:

·         Who knew that heart failure is the reason why Coronary Heart Disease remains the country’s biggest killer?

·         Who knew over 900,000 people in the UK have heart failure, with many more people currently undiagnosed, and the incidence of the disease is increasing?

·         Who knew the NHS spends £625m per annum on treating heart failure, with 70% of this due to hospitalisation?

·         Who knew patients who receive care and support from integrated services and a specialist heart failure team have significantly better outcomes and a better quality of life?

·         Who knew Dr Mark Dancy, national clinical lead for heart failure, believes ‘Every network in the country can deliver heart failure services better and so improve quality of life for patients and the bank balance of the NHS’?

·         Who knew rumour has it that Mark is related to the one and only Hugh Grant? J A fact I found out recently but I digress...

·         Who knew improved quality of care for heart failure patients is now a big priority area for our Cardiac Network?

·         Who knew we are working with two acute trusts in the first instance to redesign acute heart failure care with the intention of sharing and rolling out the learning across the region?

·         Who knew the Network will be providing regular updates on this project, which it is calling Heart Felt Success, via its website and other media in the coming months...

Who knew that the first stage of achieving the service transformation required is all about raising awareness and dissatisfaction with current heart failure services? For those that knew please pass the message on because we need everyone that has a responsibility and involvement in heart failure services to know!

Networks have got Talent

This last week has not only been memorable for the climax of Britain’s Got Talent 2012, it has also seen the successful conclusion of our Cardiac Network’s specialist heart attack centre project.

In 2008, results from the Myocardial Infarct National Audit Programme showed significant variation (0-100%) in the percentage of eligible patients receiving primary angioplasty within England. At this time no heart attack patients were receiving this innovative treatment in Derbyshire, Lincolnshire and Nottinghamshire whilst Leicestershire, Northamptonshire and Rutland reported delivery for just 17% of their cases.

Since this time the East Midlands, in keeping with the rest of the country, has made the step change and now has specialist heart attack centres (providing primary angioplasty) for all our population.

Dr John Perrin, former president of the British Cardiology Interventional Society, who joined the region’s cardiology teams and myself at our learning event on Thursday, said he wasn’t aware of another NHS change project which has been implemented with such speed and success across the whole of the country. John isn’t the first to comment on this service transformation, which got me thinking about the factors that have contributed to our achievement including:

·         The development of specialist heart attack centres has been one of a small number of regional priority projects in the East Midlands, with commissioners and providers coming together in a collective, improvement effort;

·         We have had strong leadership including a proactive chief executive sponsor, well respected clinical leads together with external support from national cardiac clinical experts;

·         Our clinicians have influenced and been engaged in every stage of the project particularly the development of the new pathway, model and standards of care;

·         We put robust project and programme management arrangements in place and communicated at length;

·         Where required providers have funded additional cardiac catheter laboratories and an increase in members of the specialist cardiology multi-disciplinary team in order to be able to meet the required standards to provide the service.

It’s estimated 75% of NHS change projects fail to achieve their objectives and as such it’s not surprising the new NHS Commissioning Board will soon be publishing a change model to guide quality improvement. The learning derived from cardiac networks in changing the face of heart attack services should not be lost though as it seems it’s not only Ashleigh and Pudsey that have got talent!