We can and we should adopt NEWS

Spreading Innovation to Save Lives

Our NHS and social care system are one of the country’s greatest assets. They are a fantastic gift that we give to each other and one that is envied across the globe. However, the world is changing and the need for us to continue to review, reset and reinvent our health and social care system has never been greater. The demands we are placing on it are huge and it is beginning to fail. Whilst this is, in part, a reflection of us all living longer and increased potential through new technologies and new drugs to diagnose and treat more and more conditions and diseases, we have to face up to the challenges that this brings. More people are accessing services and there is often greater demand than we are currently able to meet.

The creation of Academic Health Science Networks by NHS England back in 2013 was an attempt to create partnerships to help us to better collaborate, innovate, disseminate and spread learning and best practice. It was done at a critical time as much of the infrastructure that had formerly been in place to facilitate this kind of learning and sharing had been dismantled in successive reorganisations. The uncomfortable truth was that the system had become fragmented, staff and expertise had been lost, resulting in us facing significant financial, social and staffing challenges.

Recent media reports have highlighted yet again just how fragile our health and social care eco-system is. It is difficult to ignore the reports when so many dedicated staff who have committed their whole lives to the service are signaling we have a problem. For those of us in the system it is heart-breaking to watch. We are working hard yet no matter how hard we try we are not gaining enough ground.

This is made worse when you listen to reports that seek to apportion blame in one direction or another. We are one NHS. The problems we face are not just about the funding – it is also about the structures, the interfaces, the mechanisms for collaboration, and the relationship between the government, the professionals and importantly the citizens. We all have a stake in this and it is important that we seek a collective solution to create the integrated and joined-up services that are required 365 days a year, 24 hours a day.

So how can we help, how can we get beyond the current ‘blame, denial and shouting’ culture that is so evident at the moment? How do we come together to really create solutions that are sustainable, affordable and acceptable to all the stakeholders? One of the answers is to look at what currently works. Where have we cracked some of this and can learn and spread this knowledge?

The West of England Academic Health Science Network (AHSN) is one of 15 AHSNs across England that has been innovating and spreading best practice. Each AHSN will have examples of best practice and innovation that have improved services locally. Our challenge now is spreading these beyond our local geography and partnerships.

Recently I read with sadness and frustration reports of critically ill patients dying on trolleys in over-crowded Emergency Departments. Sadly this is not new. But there are things we can, and have done, that is reducing the risks and has even eliminated the problem in some of our hospitals. I want to shout about the National Early Warning Score (NEWS), which the West of England AHSN is supporting all our healthcare providers in the region to adopt and spread. I urge our political and clinical leaders to stop arguing and blaming each other, and to wake up and work with us to spread this approach to every Emergency Department, every Ambulance Service, and every Community and Primary Care setting across the country. No more ‘lost’ critically ill patients need to die on trolleys for lack of basic care. In the Emergency Departments in the West of England we now use NEWS alongside an Emergency Department safety checklist which should be universally adopted too. This means care can be monitored across every handover of care throughout the system. This will ensure time is not wasted, and instead we are saving lives.

Resources: http://www.weahsn.net/what-we-do/enhancing-patient-safety/the-deteriorating-patient/news/

As published on the WEAHSN website, 17/01/17.

The impact of social media on the mental health of students

Steve West recently gave this presentation to MPs and Peers

The use of social media is increasingly pervasive in the UK and across the globe, particularly in the lives of our students. At present, Facebook has the highest number of users – 32m in the UK, with 1bn people across the world using Facebook in a single day.

Clearly social media brings a number of benefits to its users – enabling connections to be maintained or new networks to be built that would not have otherwise been possible. Social media can also help boost young people’s self-confidence and social skills.

At UWE Bristol, like many other universities, we use social media to help support recruitment and transition to university – sharing information and enabling students to build connections with their peers before they arrive. It is also a great tool in facilitating communications, supporting teaching, and of course it provides a valuable means of maintaining alumni networks.

However, research and user experiences are exposing a highly negative side to social media – in particular the link between social media and challenges to mental health and well-being. With 18-19 year olds spending an average of 2.55 hours a day on social networking sites, this is clearly a major concern.

We already know that mental health is a very important challenge facing the health and education sectors, with one in four people experiencing a mental health problem in any one year. We also know that there are particular circumstances that students face that put them at increased risk in relation to mental health. This is something we have been striving to address at UWE Bristol, introducing modes of delivery for our well-being service that provide an improved outcome for users and also allow us to cope with the increased demand that we have seen across the sector.

There are a number of reasons for this increase in referrals and applications for well-being support, which has been in the region of 50% over the past 5 years. One potential factor we cannot ignore is the use of social media.

Indeed, there is a growing body of research exploring the links between social media and mental health covering a number of areas, including bullying, harassment, self-esteem, negative body image and normalising self-harm.

At UWE Bristol, researchers from our world-leading Centre for Appearance Research have carried out a number of studies in this area, focusing in particular on social comparison theory – where people compare themselves to others to know where they stand. One example, includes investigating the causal effect of Facebook on women’s mood and body image, compared to viewing a body-neutral site. The study found that viewing Facebook had a more negative impact on mood, and for those who had a pre-existing tendency to make more appearance comparisons, ‘spending time on Facebook led to a greater desire to change their face, hair and skin-related features’. Facebook provides a huge range of lifestyle and image social comparison opportunities, and it is different to other sources as the comparison is with direct peers. It is also important to note the significance of reports about the frequency of the ‘comments’ made on Facebook being appearance focused.

Given the huge popularity of Facebook, clearly more research is needed to understand the effect on appearance concerns and mental well-being. And as we increase our understanding of the effects, it is clear that the digital literacy of our students and their ability to manage their interactions with their peers through social media will be critical. Prevention is paramount.

At UWE Bristol the digital literacy of our students is a key part of our graduate attributes and our focus on nurturing ‘ready and able graduates’, which informs the design and delivery of our academic programmes. We are also drawing on our experience introducing high-profile preventative programmes, such as bystander intervention in relation to sexual harassment. And we have worked to embed an ethos of respect in our Welcome Weekend programme for new students. It is important that more continues to done by educators and policy makers to boost social media literacy, and beyond this, to increase awareness among parents that social media is yet another source of influence on perceptions of body image.

Clearly this is a societal issue that spreads far beyond universities and involves the whole education system. The launch of the Mental Health and Wellbeing Project at Universities UK last week was a great step forward, which I am very pleased to be leading on. This involves taking a whole university strategic approach to mental health and well-being, starting with a review of the sector, identifying best practice, and the potential development of tools to support future progress. The importance of working together to tackle the issues and support our young people to flourish couldn’t be clearer.

Building healthy cities: the role of universities

It is no secret that the National Health Service is under immense pressure. An ageing and expanding population, combined with increases in chronic illness and multiple disorders, is placing strain on services and pushing up costs. There is a gap between spending and demand. Yet to meet the Government’s expectations, NHS England must make savings of £22 billion by 2020. At the same time local authority funding continues to be squeezed, as an area of unprotected spending, with implications for public health and social care. A perfect storm is heading our way unless we can find innovative ways of improving the health of our nation quickly, reducing the demand on our already stretched services.

In response, health leaders are having to work smarter and more creatively, harnessing technology where possible, to achieve efficiency and productivity gains. They are also shifting the focus of services towards prevention, rather than cure, to relieve pressure on services. This means addressing public health challenges like obesity at source instead of dealing with the higher costs of medical and surgical interventions down the line.

How well this is working in practice will vary across the country. But it is possible to observe some good examples of the NHS and local government working effectively with others to promote health and wellbeing. The crucial part about this is the “working with others” – because that is the only way to achieve impact on the scale required. In a new report from University Alliance, the first in our four-part Regional Leadership series, we examine the contribution of universities.

As the main suppliers of doctors, nurses, allied health professionals, health scientists and social workers, universities have long been instrumental in health and social care policy and planning. Collectively, we turn out a vast volume of health relevant research and innovation and are responsible for many of the lifesaving technologies used in clinical settings. But less acknowledged, perhaps, is the contribution universities make as anchor institutions within local health economies.

In this unique role, universities are able to unite the complex array of organisations that make up the ‘health ecosystem’ within a city or city region. They can then help to make health and wellbeing provision more efficient and more responsive to the needs of the surrounding population. In Bristol, where my institution UWE is situated, there are positive signs of this happening. Through Bristol Health Partners, for example, the city’s universities have joined forces with providers and commissioners as well as Bristol City Council to integrate provision and improve health and wellbeing through innovation, research, adoption and spread.

Our report also identifies how the research capacity of universities is being harnessed to produce healthier communities. The scope of this activity is exceptionally broad, covering everything from applied clinical medicine, to studies on improving the urban environment through effective planning, to the development of robots that enhance patient care or assist those with permanent health conditions.

Because of the cross-cutting nature of health and wellbeing challenges, there is a growing volume of interdisciplinary research at UK universities. Many institutions also work closely with non-academic partners including businesses, charities and social enterprises.  Incubation spaces on campus enable entrepreneurs to design products and innovate with the support of specialists at the university. This type of engagement will be further enhanced by the soon-to-be-opened University Enterprise Zones like the one at UWE which will focus around MedTech, Robotics and Autonomous Systems.

Finally, university research and innovation and the funding that enables it has the added benefit of supporting local services. Clinical research, for example, will often involve observing and trialling treatments with patients in a local hospital. From the perspective of providers and commissioners, this represents an investment additional to that coming directly from government. Similarly, university-based health academics are often specialists within a particular field of medicine, surgery or other health-related discipline. Through what is effectively a joint appointment with the NHS, their contribution is essential for maintaining the quality of clinical services in the region.

The health challenges Britain faces are multifarious, and it be would be disingenuous to suggest that universities hold all the answers. However, as this exercise proves, universities can and do make significant contributions to the well-being of surrounding populations. They are also major employers and influencers. Our staff and student populations are significant and many universities are working hard to create healthy working and living environments for staff and students alike.

The Healthy University movement is spearheading work-based health living approaches to improve the physical and mental health and well-being of university communities and importantly playing a part in spurring behavioural change in generations to come through education and action. At a time when the NHS and local government are becoming increasingly overstretched, the significance of universities in this space is likely to grow.

As published on WonkHE 25 February 2016 

Health Education – Managing the Risks

We have now had two weeks to reflect on the Government’s Green Paper, ‘Fulfilling our Potential: Teaching Excellence, Social Mobility and Student Choice’, published on the 6th November.

The Government’s recognition of the vital role universities play in driving economic growth and boosting productivity in the UK was of course very welcome. As a University that places a strong emphasis on widening participation and the employability of our graduates, the paper’s focus on these key areas was again positively received.

The changes set out for consultation will certainly have a significant impact across the higher education sector over the coming years.

However, it is important to note that much of the detail was not included in the paper. As always, this will be where the interest lies. I look forward to working with the Government over the coming months as this develops.

In contrast to the Green Paper, the Comprehensive Spending Review (CSR) sets out quite specific changes that will have a major impact on nursing and allied health provision.

The changes announced today are welcome, however given the potential implications on the shape of the future nursing and healthcare workforce, it is absolutely critical that we recognise and mitigate the significant risks that arise whenever there is major reform and change.

Changes to student funding

We learnt today that instead of continuing to be funded to study by the Department for Health, nursing, midwifery and allied health students will, from 2017/18, be treated the same as all other degree students, funding their studies by taking out fee and maintenance loans through the Student Loan Company. The financial rationale for the changes is of course clear and it is positive that the artificial cap on student numbers for nursing will be lifted through this change, increasing the training places available (the change in funding arrangements means student numbers will no-longer be controlled by the NHS). There are, however, very significant risks that will need to be worked through as this major change is implemented.

Maintaining quality 

In particular, as the future nursing and healthcare workforce is opened up to market forces, close attention will need to be paid to ensuring that the profession is sufficiently diverse and attractive to encourage students to want to study in these areas. This is essential if we are to achieve the required increase in workforce numbers forecast by the NHS, whilst maintaining the quality of applicants. The profession needs to attract candidates with the right qualifications, attributes, motivations and values for healthcare practice, supported by high quality education, meeting the standards and requirements for registration through degree award.

In relation to the latter point, as we move to the new arrangements proposed today, it will be essential that a sufficient number of quality work placements are available to support students to develop the skills, knowledge and attributes required of graduate practitioners delivering high quality patient care. In this field real and simulated practice is vital.

Improving retention

We know that the retention of staff has been a big problem for the NHS for some time. The skilled workforce has often been lured away by the private sector or temporary staffing agencies – who are perversely capitalising on shortfalls in NHS staffing. Often this can happen just a few years after graduating. Clearly this places a huge burden on NHS finances – with a limited return on investment. 

In light of the above, there is a major opportunity for the government to support the NHS by offering some sort of incentive on the loans for graduates on condition that they stay and work within the NHS for a defined period of time. This approach would ensure the investment via the Student Loans Company is retained within the NHS and the public sector and would recognise the significant public service and benefit delivered by health and social care practitioners.

 

Preventing skill shortages

We know from data published by the Higher Education Statistics Agency (HESA) that over the last 10 years the numbers of over 26 year olds studying at university has declined by 23%. The University and Colleges Admissions Service also showed that mature students, were deterred when £9k fees were introduced in 2012; seeing a drop of 5% of over 21s in that year. We also know that four in ten mature students come from disadvantaged or low participation backgrounds. It is these mature students that make up some 60% of the nursing cohort. It is absolutely critical that we don’t accelerate the decline in mature students and lose this talent and numbers from the future workforce. This is a big risk for us all and we must build in appropriate safeguards and explain the changes very carefully to potential students. 

This challenge is particularly pronounced in specialist areas, which are often less attractive to 18 year old students. For example, at the University of the West of England we have been able to meet key skill gaps in vital NHS services where it has traditionally been difficult to recruit – like mental health, radiotherapy and learning disabilities – by appealing to mature students, who may also have caring responsibilities. Yet, past experience shows that these are the potential students who are most likely to be put off by the changes that are emerging.

It is clearly essential that we work together to create the right conditions to recruit and retain the very best students we can for the future nursing and healthcare workforce. We need to ensure prospective students understand the changes and the benefits of the new funding approach. It is clear that if we are to meet the additional 10,000 nurses required over the course of this parliament, universities, healthcare providers, commissioners and government are going to need to work together in innovative and creative ways to recruit, retain and energise the future workforce.

The NHS needs a strong, capable and committed workforce to sustain it through the challenges ahead, as demands for healthcare and cost pressures continue to grow. We need to recognise the public value and public good delivered by the nursing and healthcare profession. Importantly, as these changes are implemented we need to be very alive to the risks, redoubling our efforts to make the profession as attractive as possible so we pull in the talented individuals that make the NHS the celebrated institution that it is – which ultimately serves to benefit us all.

Civic Leadership, Innovation and Economic Growth

With the run up to the General Election in May and the growing debate around devolution and cities, it was very timely to speak at the UUK Conference ‘Powering the Knowledge Economy: Universities, Cities and Innovation’ today.

We need to think broadly about how we power the knowledge economy and this is not simply limited to local economic growth. It is about much more, including public learning, civic spirit, and community-based innovation. It is also about businesses playing their role in education, community and society, and being part of, rather than outside, the civic and place-based leadership agendas.

I see a major part of my role and that of the University, as facilitating a joined up approach to problem-solving, so that we are really focusing on the key issues for the region and achieving the best outcomes, rather than simply viewing things through the lens or field in which we happen to work. The key issues of today and the future are highly complex – they cannot be addressed through one sector or sphere of society working alone.

We have some great examples of where this has really worked to bring about opportunities for the whole city-region, including the collaboration that won Bristol recognition as European Green Capital 2015. Bristol also won funding for one of the UK’s first four University Enterprise Zones, led by UWE Bristol and to be located on our Frenchay campus, which will support the next generation of companies in the areas of robotics, biosciences, biomedicine and other hi-tech areas. Both universities are also working very closely with businesses and the health sector on driving forward innovations on the assisted living agenda, diagnostics and telemedicine – particularly important for a society with an aging population and very relevant to all our lives.

This is all in addition, of course, to universities powering the knowledge economy through addressing skills shortages and providing learning opportunities that transform the futures of individuals, families, and communities. We know that 80% of new jobs will be in high-skill areas so access to opportunities and different pathways to higher skills is absolutely critical – involving collaboration across universities, educational providers, businesses, the public sector, community organisations and professional bodies.

Universities think and operate long term. They are also politically neutral and represent many sectors and sections of their locality and region. This makes them well placed to be anchors for their region – joining up across the various elements of a place, coordinating and developing the high-level opportunities and catalysts that will really shape the future. That was the focus of my speech today.

In the heated public policy debate ahead of the General Election it may be that university voices are more important than ever. Universities can and should shine a light on what is possible and lead the way by building the bridges, networks and capacity to deliver.

Supporting Student Mental Wellbeing

Supporting the mental wellbeing of students is a growing concern in higher education and among healthcare providers.

As Vice-Chancellor of one of the largest universities in the UK, with an increasingly diverse student population, and through my various leadership positions in the health sector – which has included chairing the Independent Reviews of Mental Health Related Homicides across the South West for the Strategic Health Authority – I am very familiar with the need for close integration between the health, social care, probation, education and university sectors.

We know that in the general population at least one in four people will experience a mental health problem in any one year and one in six adults have a mental health problem at any one time.

But beyond that, we also know that there are very particular circumstances that students face in a university environment, that for some, means they are more at risk. And this problem has been increasing in recent years. Reports in the sector suggest an increase in referrals and applications to well-being services of between 25 and 37% since last year. At UWE Bristol, this certainly matches the increase that we have been experiencing.

Why has it been increasing over recent years? Well this includes factors such as changes to the profile of the student population, with a more diverse make-up than it has ever had before. It also includes a reduction in financial support that can place an increasing pressure on students to seek part-time work, at the same time as an increased pressure to succeed. More generally, we have also seen higher rates of family breakdown and an economic recession that has hit hard on many young people.

The student population is also in some ways more vulnerable than other young people.

When they join university, they quickly have to adapt to new environments and new ways of learning.

There are also vulnerabilities beyond the individual. Disturbed behaviour by one young person (for example self-harm) can cause considerable distress and disruption to fellow students, particularly in halls of residence.

Universities clearly have legal, moral and practical reasons to provide support for students with mental health difficulties and we have a long history of providing student support, counselling and disability support.

Students are at a point in their life when their university experience is likely to hold the key to their future success. If they already have existing mental health difficulties, higher education could provide a new source of self-esteem and opportunities for engagement with peers and the wider society. Alternatively, underachievement or failure at this transitional stage in life can have long-term effects on self-esteem, and could affect the progress of someone’s future life.

Universities are about opportunities and it is important that all students are supported to succeed. However, this is at a time when the pressure on the public purse and public services is intense. How much can a university do to make up for this shortfall in the interests of its students? Clearly we need to be smart about this and take an integrated and effective approach.

We know there are important practical impediments to this, including restrictions on the transfer of confidential information between agencies. However, a number of models of collaborative working have been established across the country and we should look to and learn from these.

The UUK guidance ‘Student mental wellbeing in higher education: good practice guide’, launched last week and picked up by the Times Higher Education today, provides a great new resource. I was very pleased to give the key note address at this event, on what is a critical agenda – not just to individuals, but also to families and wider society.

Tardis arrives!

Today we welcomed the arrival a 20 foot TARDIS-like container to our Frenchay Campus. The container houses the prototype for a novel water treatment system that has the capacity to revolutionise the lives of people across the globe by providing access to clean drinking water at source.

The container will now undergo final tests before being transported to Eastern Europe where it will be tested in situ. Following these tests the aim is for the containers to go into mass production.

In this film Professor Darren Reynolds explains how the system works.

This work being conducted by Professor Darren Reynold’s team and our partners, Portsmouth Aviation, Pentair and Bridge Biotechnology is world class. This is science for the real world, addressing urgent problems through positive partnership working. It is about fixing something critical right now and transforming lives. We are immensely proud of this work – it is showcasing UWE Bristol at the top of its game.

Innovation driving patient care

Earlier this week at UWE Bristol we looked into the future – focusing on innovation in healthcare at a one-day conference organised by Health Education South West, the Royal Society of Medicine and Bristol Robotics Laboratory. In particular we considered the critical issue of how we keep pace with the ever increasing demand from our ageing population.

The good news is we are generally living longer! But that means the increased possibility of developing long term conditions or complex co-morbidity – and this costs money! It isn’t helped by our current focus on the ‘tip of the iceberg’ – treating those that are ill rather than keeping more people healthy and independent for longer so that they don’t, in effect, clog up our health care system.

So what is the answer?

Robotics, remote care and telemedicine certainly offer some interesting solutions that will help shape the future of healthcare.  

At the conference we sped into the future and looked at surgical robots – exploring the world of haptics. Whilst a surgeon’s eyes, hands and touch work together to explore a surgical site and tissues, when using robotic surgical instruments you have no haptic feedback – you’ve lost the sense of touch. Researchers at UWE Bristol are looking to develop robots that can feed back to surgeons what they are feeling – e.g. resistance, size and texture of tissues.

Of course whilst surgical robots are fascinating the real advances that can reach significant numbers of patients are in telemedicine, telehealth and telecare. We must find solutions to the chronic problems we see in A&E. We need to ensure we are creating safe environments for more patients to self-manage at home. The costs of delivering the service – £0.013p to assess digitally, against £25 to get a GP and £500 to get an ambulance! The technology is not the issue – it is the selection of patients, clarity of case management and care pathways that are critical to success.

We need to better engage with what citizens are looking for and how they are prepared to participate in the changes required.

We have to learn quickly and integrate, adopt and spread best practice much faster than we have done in the past.

Our patients are often faster than the clinicians treating them. The power of global patient networks is, as yet, untapped. The influence that such networks can have is great, but we have to learn to use them more powerfully.

Demand for healthcare is increasing and budgets are reducing in real terms. We also have a diminishing workforce. In this context it is even more critical that we design our services and systems for the future – instead of focusing on solving the problems of the past or present.

We have to change, be less precious about how things are now and open our minds to adopting different practice and different care pathways. Doing more of the same harder and faster simply will not work!

I hope the work of UWE Bristol and the Academic Health Science Network will lift heads, challenge and create novel solutions, implement and spread what is best for our patients – and importantly, we have to stop the political ping-pong game we have with health.