Innovation in healthcare has been essential to the NHS Covid-19 response. The government’s new vision for UK life sciences also recognises its importance in building out of the pandemic. As the innovation arm of the NHS, how has the Academic Health Science Network (AHSN Network) been central to this?
Tasked with supporting the adoption and spread of innovation across the health and care system, the AHSN Network has played a crucial role. During the pandemic, we pivoted our existing work programmes and redirected our support to the NHS response, working closely with health and care, and industry partners to facilitate the spread and adoption of technology in new clinical pathways.
During the first wave of the pandemic, we came together with industry partners to quickly find alternatives to face-to-face appointments and supported local healthcare services to accelerate the roll-out and uptake of online patient triage and remote consultations in GP practices. This helped control infection rates by supporting social distancing and protecting vulnerable groups and staff, as well as helping manage workforce pressures.
During the second wave, we built on this knowledge to further support frontline services with spread and adoption of remote patient monitoring. AHSNs supported the roll-out of in-home oximetry devices with the ‘COVID Oximetry at Home’ initiative1, a care pathway that uses oximetry (measuring blood oxygen levels) to monitor and identify rapid patient deterioration at home. This approach has been linked to reduced mortality, shorter stays in hospital, and fewer patients requiring intensive care admission and ventilation. It’s now recommended by the World Health Organisation (WHO) as part of a package of care2.
From the bottom up
As a clinical academic and NHS stroke physician, I’ve dedicated my career to the spread and adoption of innovation. I’ve seen first-hand the vital role that new stroke care pathways and therapies have played in improving patient care and outcomes. But I also recognise that spreading change across the NHS can be a slow process. Seeing the importance of rapidly acting on evidence and research brought me to the AHSN Network when it was conceptualised in 2013. I wanted to see the benefits of research getting to patients quicker and help the NHS adopt evidence-based treatments more rapidly.
When I completed my training in geriatrics and clinical pharmacology in the early 1990s, there wasn’t any co-ordinated stroke care, or an evidence-base in acute or rehabilitation stroke care to inform best care delivery. I established an acute stroke unit and rehabilitation ward and began undertaking research with potential novel treatments. It’s now clear that the evidence-base created in the 1990s and 2000s on the prevention and acute treatment of stroke has had a substantial impact in reducing death and disability across the NHS.
Working with the North Eastern Ambulance service, I developed a rapid ambulance protocol to enable people with a suspected stroke to be taken to our specialist unit, bypassing hospitals without dedicated teams. We also developed the Face Arm Speech Test (FAST) to help paramedics diagnose stroke, which is now used around the world to increase awareness of the warning signs of stroke. These early service innovations became key elements of the subsequent English stroke strategy.
Using a ‘bottom up’ approach where new models of service delivery are developed and evaluated, then rolled out more widely with clinical leadership support is a core element of how the AHSN Network spreads innovation across the NHS. It was key to our coronavirus response and will be vital as we support the NHS to build out of the pandemic.
“As a clinical academic and NHS stroke physician, I’ve dedicated my career to the spread and adoption of innovation”
Building out of the pandemic, the NHS will need to work in different ways. Patient backlog and major workforce capacity challenges will need to be managed through maximising opportunities for patients to self-manage conditions and receive remote support.
As an AHSN Network we need to identify, evaluate and maximise these approaches, which can often provide better outcomes than traditional methods involving face-to-face appointments in primary care.
Drawing on experience from the ‘COVID Oximetry at Home’ pathway, we are working on a programme to help primary care teams manage large numbers of people with hypertension. In blood pressure monitoring we’re seeing self-management with guidance and support from primary care showing better blood pressure control than through traditional routes. It’s about empowering people with their own care and ensuring support from healthcare professionals is there when needed.
In Oxford AHSN, we’re looking at how we can use the opportunities that arise when people attend coronavirus vaccination clinics to undertake cardiovascular health checks, as this presents a unique opportunity to see nearly all adults. The Network is using a similar approach to deliver a pilot to screen all children across England during their routine immunisation appointment for elevated cholesterol levels and early diagnosis of familial hypercholesterolaemia, as part of our Lipid Management and Familial Hypercholesterolaemia national programme³.
There’s a need and a willingness of the NHS to adopt new ways of working to deliver high-quality care. We’re committed to supporting this challenge through the adoption and spread of world-class research and innovation.