Greater Manchester Health & Social Care Partnership

Latest news from the Greater Manchester and Eastern Cheshire Strategic Clinical Networks

Greater Manchester Integrated Care Partnership sent this bulletin at 26-10-2020 07:07 AM GMT

October 2020

A new approach to tackling delirium

This month, we throw the spotlight onto an important area of our work – delirium.

Delirium is a distressing condition that often occurs in older people when they become ill. It is too often undetected whilst early recognition can enable clinicians and carers to take action to ameliorate its worst effects. In response, the Strategic Clinical Networks’ (SCNs) Dementia team, working with Dementia United, has been raising awareness of its symptoms with clinicians.

This partnership working has also seen the development of the GM Approach to Delirium, which aims to see care for people improved and standardised across Greater Manchester.

Also in this newsletter, we have news about our palliative and end of life care team’s series of virtual events to highlight care for ‘inequality groups’, the diabetes team managing a new low-calorie programme, improved support for BAME mothers and a new pregnancy app trial, support for parents and the paediatric system over winter, as well as the launch of a new stroke organisation.

Also, as Greater Manchester moves into tier 3 of Covid-19 regulations and the virus continues to challenge us, we remind our clinicians of where to go if they need mental health and wellbeing support.

Take care.

Best wishes

Julie Cheetham - Director

Dr Peter Elton - Clinical Director

Raising awareness of delirium in Greater Manchester

The Strategic Clinical Networks’ Dementia Network has led on a variety of pieces of work, in recent years under the remit of Dementia United (DU).

Delirium has been one of the key focus areas of work. Clinically led by Dr Emma Vardy, the delirium programme has evolved and developed into a robust body of work, with support from Lyndsey Kavanagh (SCNs) and Helen Pratt (Greater Manchester Health and Social Care Partnership).

Delirium is a common condition characterised by altered arousal and can present either as new confusion which may be accompanied by agitation and hallucinations or by excessive drowsiness or sleepiness, which denote hyperactive or hypoactive subtypes respectively.

Delirium is common, affecting 1 in 8 hospital inpatients and is associated with a number of poor outcomes including increased falls, increased rates of institutionalisation, longer length hospital stay and significant mortality rate. It is distressing for patients, carers and staff and carries with it significant healthcare costs.

The SCNs and DU together have supported awareness raising of delirium since 2017, with the hosting of three events held on World Delirium Awareness Days in March 2018 (see image below), 2019 and 2020. These have been attended by a variety of professionals from medical and nursing staff, social care and care home staff, as well as carers and people living with dementia.

The World Delirium Awareness Day events have been used to develop the programme of work, including the development of the GM Approach to Delirium, with seven GM standards for delirium which were then endorsed and published, via DU governance, noted below:

1.     People >65yo or who have a dementia diagnosis are provided with information on signs and symptoms of delirium and prevention measures
2.     100% of patients >65yo or who have a dementia diagnosis that are admitted to the acute care setting/mental health are assessed for delirium using 4AT on admission
3.     Every care organisation should have a standardised pathway for assessment and management of delirium
4.     Family carers are provided with information to help support relative with delirium
5.     Evidence that non-pharmacological de-escalation techniques are used before medication for agitation/distress
6.     Delirium diagnosis should be conveyed at all transitions of care
7.     All people with delirium should have multidisciplinary follow up

The World Delirium Awareness Day event in 2020 just managed to get across the line before the Covid-19 lockdown was implemented. The main theme at this event, was the development of the GM Community Delirium Toolkit and the public information GM Delirium leaflet, with 80 delegates attending the event, from a variety of health and social care backgrounds and services along with experts by experience.

A focus on the provision of safe and timely care in the community facilitated fast tracking these pieces of work, as requests were made of the team to ‘go live’ particularly with the GM Community Delirium Toolkit. The GM Community Delirium Toolkit is being piloted by three locality community teams with a further four teams due to launch in the near future.

Standardised measures are being collated by these community teams and it is hoped there will be some data to report early in 2021. The GM Community Delirium Toolkit is being utilised with enthusiasm by the locality community teams and we have had a number of requests nationally to share this work.

If you are interested in finding out more, please contact Emma Vardy or Helen Pratt.

The latest Dementia United newsletter can be viewed here.

Virtual events to address inequalities

A series of virtual events have been announced by the Greater Manchester and Eastern Cheshire Strategic Clinical Networks’ Palliative and End of Life Care team to address inequalities in access to care.

With an event every month on Wednesday afternoons, 1pm-3pm, from next month to April 2021, the team will discuss the ‘inequality groups’ which were highlighted in the 2016 CQC Report “A Different Ending”.

The aim of this series is to keep these inequality groups in people’s awareness, to stimulate action to address any inequalities and build upon the excellent work undertaken by St Ann’s Hospice, Manchester, and Springhill Hospice, Rochdale, which resulted in the recorded ‘Vulnerable population’ lecture series, which is available here.

While the series is Greater Manchester and Eastern Cheshire focused, the team is certain it would be beneficial to other geographical areas as the issues discussed will be similar.

The first event is called ‘Homelessness and people who use substances - Exploring challenges and opportunities through research and practice’, and will be held from 1pm-3pm on Wednesday, November 11.

Book here to join the first live event.

Diabetes team to run new low-calorie programme

The SCNs’ Diabetes Network is gearing up to manage the new NHS Low Calorie Diet Programme in Greater Manchester.

The programme provides a low-calorie diet treatment for people who are overweight and living with Type 2 diabetes, helping them to improve their diabetes control, reduce diabetes-related medications and even achieve remission.

Greater Manchester has been chosen as one of ten national pilot sites and has been allocated 500 places on the programme.

Eligible participants will be offered low calorie, total diet replacement (TDR) products including soups and shakes consisting of up to 900 calories a day for up to 12 weeks.

Alongside this, participants will receive support for 12 months including help to re-introduce food after the initial 12-week period. Group based sessions will initially be offered online in Greater Manchester to comply with social distancing guidelines but may move to face-to-face in the future.

The programme and TDR products are free of charge to participants and commissioners.

People living with Type 2 diabetes who have been diagnosed with the condition in the last six years will be considered for the pilots.

The Diabetes Network will be running online training sessions, outlining the programme and referral process for GP practices, over the coming months, as the programme is rolled out. Further information will be sent out in due course and updates provided on the Diabetes My Way website.

Email the team if you would like to express interest in further information about the programme or for attending an information session.

For more information about the programme, which will be provided by ICS Health and Wellbeing, , visit the ICS website for information for patients and information for healthcare professionals.

Mothers to get new virtual support

Greater Manchester and Eastern Cheshire Local Maternity System (GMEC LMS) - which the SCNs’ Maternity Network is a part of - has been selected to trial a pregnancy and postnatal app

The app, called Peppy, provides a platform to connect people to peer support, content and practitioners through a range of channels, including chat and video, on a one to one or group basis.

Peppy was one of 18 awardees of the TechForce19 initiative, a UK government cross departmental initiative to support vulnerable and isolated communities during the Covid-19 crisis and beyond.

The GMEC LMS was the only LMS in the country to bid successfully for this phase two Peppy trial.
St Mary's Managed Clinical Service will be the lead maternity provider for this trial, which will allow 250 women in Manchester to use the Peppy app from 36 weeks’ gestation to 8 weeks postpartum.

The support offered via the app will be specifically around infant feeding, mental wellbeing/mental health and postnatal physiotherapy. The trial will last for three months.

Julie Cheetham, the GMEC SCNs’ director, said: “We are pleased to be part of this digital initiative and to see how Peppy can help women and their families in late pregnancy and throughout the early postnatal period to feel supported.”

The LMS and Peppy are currently discussing eligibility criteria for the free trial of the Peppy app. It is currently available for anyone to download and use, although there is a subscription charge for people not involved in the trial.

Meanwhile, the GMEC LMS has also produced a series of communications to reassure pregnant women during the Covid-19 pandemic.

The Covid-19 pandemic required the many pathways for maternity care to be adjusted to reduce the footfall in hospital and community care locations to protect staff and reduce the spread of the virus, but it was important these changes did not impact on care.

The LMS wanted to reassure families that although things may look and feel a bit different, safe and caring maternity care is of paramount importance to them and they should access it if they have any concerns at all.

The team was also acutely aware following the last MBRRACE-UK report, that Black and Asian women have a significantly higher risk of poor outcomes in pregnancy. Research has shown that Black pregnant women are eight times more likely to be admitted to hospital with Covid-19, while Asian women are four times as likely.

Guided by national direction, it was advised that maternity units caring for BAME pregnant women needed to:

Increase support, by lowering threshold to review, admit and consider multidisciplinary escalation
Tailor communications to reach out and reassure
Ensure hospitals discuss vitamins, supplements and nutrition in pregnancy (specifically importance of vitamin D)
Ensure accurate, systematic approach to capturing specific data on maternity information systems.

In view of this, the LMS worked collaboratively with local maternity voices partnerships, maternity services and universities to develop a suite of communication materials for use across the network. They include:

General COVID-19 messages and translations in Urdu
BAME targeted messages and translations in Urdu
An infographic for GMEC COVID helplines
Antenatal education on line resource (link below)
A video message from SCN Clinical Lead midwife on behalf of Heads of Midwifery in GMEC.

The team is also working on further communications at a regional level, to develop further messages and translate into key languages.

Maternity and related COVID-19 information in different languages is available on our My Birth My Choice website.

Network supports parents and paediatric system

The Children and Young People Network has helped produce a number of videos to support both parents and the paediatric system.

The team is working with the Royal Manchester Children’s Hospital and other Greater Manchester hospitals to ensure young people get the best treatment and care possible while the NHS faces the dual challenge of Covid-19 and traditional winter pressures.

Five short films have been produced to support parents to self-manage their children’s conditions at home, if appropriate, or seek medical help.

They will be promoted on social media and cascaded to relevant organisations across Greater Manchester over the coming months.

The videos cover:

Persistent fever
Rashes
Wounds
Tummy ache
Upper respiratory tract infections (cold, sore throat)

The network is also preparing communications to advise parents about bronchiolitis. As we approach winter, we expect to see a rise in the number of babies who become ill with the condition. Bronchiolitis is a common respiratory infection that affects babies and young children under two years old. Around a third of children will have developed it before their first birthday.

Most cases are mild and will clear up within two to three weeks. The advice to parents will include:

Don’t take small babies out unless absolutely necessary and avoid contact with anyone who has cold or flu symptoms.

Ensure houses and rooms are well-ventilated, don’t over-dress babies and make sure their immunisations are up to date.

Feed smaller amounts more often and make sure they have at least two-thirds of the feed they normally have.

Please share links to our videos which are on the GMHSC Partnership' resources page and retweet our tweets, via @gmec_scn - so we can ensure these messages are circulated widely. The videos are also on the Partnership's YouTube page.

Finally, the Campaign for Disabled Children has released its October newsletter, which is full of information you may be to interested to read.

Support for mental health and wellbeing

Our clinicians are being reminded that support is out there to manage your mental health and wellbeing, as Covid-19 cases rise in the area.

Fourteen out of the 15 local authority areas with highest COVID prevalence in over 60-year olds are in the region and hospital admissions are high, with pressure remaining intense in all parts of our systems, including primary, community, mental health and social care.

The NHS ‘Our people’ webpages are a good place to start for support, offering a wide range of help, from confidential guidance over the phone, to text messages, free apps and over 20 short guides.

Also, many CCGs and Trusts have developed their own packages – check with your manager.

New stroke network launched for Greater Manchester

The Greater Manchester Integrated Stroke Delivery Network (GMISDN) was launched on October 1, as part of the NHS’s Long-Term Plan.

The organisation transitioned from the existing Operational Delivery Network that has led improvements locally since 2015 – the SCNs’ Stroke Network led on this centralisation of services.

The new GMISDN will join 19 other networks being set up nationally, which will focus on greater access to a life-saving surgical procedure called thrombectomy as well as better provision of stroke rehabilitation and life after stroke services.

Ann Bamford, stroke survivor and chair of the GMISDN’s Patient and Carer Group and Board, said: “I know from personal experience that having a stroke can completely change your life. People need to Act F.A.S.T. and dial 999 if they or a loved one have stroke like symptoms, as hospital really is the best place to be - even during the pandemic.

“I am proud to be part of the new network so we can build on what has already been achieved that has resulted in Greater Manchester’s stroke services being some of the best in the country.”

You can watch a video about the new network.

If you want to find out more, follow them on Twitter @GMISDN or visit their website.

See our website for more information on all our networks.

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