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Newsletter
May 2021
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Collaborating with clinicians to
improve services for people
This month’s newsletter contains another positive example of how our networks are uniquely placed to move quickly to improve health and care services for people across Greater Manchester.
When paediatricians alerted the Children and Young People Network to the possibility that children with long Covid were not accessing the support available, they worked with the Respiratory Network to send out guidance to help busy GPs identify symptoms and know where to refer patients.
Working closely with clinicians, we can act quickly as both a radar, scanning the health and care environment for concerns and problems, and then work collaboratively with clinicians to agree how to resolve the issue.
This process has taken place on many occasions over the past 14 months or so, as our health and care professionals have faced fast-moving problems dealt by Covid-19.
Elsewhere in this month’s newsletter, we have news about the launch of an asthma app for children, an e-learning programme to help clinicians manage frailty, our first Q&A with clinical leads and advisors, starting with one from us, and a look back at Dying Matters Awareness Week 2021.
Once again, many thanks for your interest in our networks, and see you next month.
Best wishes
Julie Cheetham - Director
Dr Peter Elton - Clinical Director
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The Respiratory Network is continuing to support clinicians and health professionals in Greater Manchester manage long Covid in patients and has recently offered guidance about the condition in children and young people.
Paediatricians in Greater Manchester believe there could be a number of children who have not seen GPs or been referred for further assessment in specialist clinics, because their symptoms, such as headaches or fatigue, have not been identified as possibly being long Covid.
The Network, working with the Children and Young People’s Network and its clinical lead for non-elective care, Julie Flaherty, sent out information and guidance for GPs, to help them refer patients onto the pathway.
The Respiratory Network and its clinical lead, Dr Jennifer Hoyle, and clinical lead for respiratory disease in primary care, Dr Murugesan Raja, have also been working with the Greater Manchester Health and Social Care Partnership to help widen the understanding of long Covid among the public, collaborating with the Manchester Evening News on an article about the condition.
The Respiratory Network began work late last year with the Greater Manchester Medical Executive Leadership Team to agree, plan and co-ordinate a model of care for long Covid that could be delivered to help local populations.
This work has been supported with fortnightly virtual meetings with clinicians and a regular bulletin which highlights the latest guidance and support. If you would like to join the meeting or receive the bulletin, please email the team.
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The Children and Young People Network marked World Asthma Day on May 11 with the inaugural meeting of the Greater Manchester Children’s Asthma Working Group, followed by the soft launch of a new app.
The working group was chaired by Dr Kal Dixit, GM Children’s Asthma clinical advisor, and was well-attended by a wide range of clinicians and non-clinicians who contributed to discussions about the purpose of the group and its deliverables.
The meeting led into a soft launch of the GM Asthma App pilot, and many more colleagues from across Greater Manchester joined to hear about this digital health passport for children with asthma, which is being piloted in Manchester for six months.
The app has been developed by Tiny Medical Apps and will support children and young people aged 14-18 years to self-manage their condition.
Fran Carbery, the Children and Young People Network’s programme manager, said: "It was excellent to see so many people who are passionate about improving children’s asthma care and we look forward to working with them all to take forward this important piece of work.
“The presentation by Tiny Medical Apps offered a very poignant reminder of the importance of improving asthma outcomes for our children and young people.”
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Also on World Asthma Day, a campaign was launched to raise awareness with healthcare professionals, the public and the media about the importance of using inhalers correctly.
National bodies, such as the Primary Care Respiratory Society and Children and Young People’s Transformation team, joined forces with the Healthy London Partnership London to highlight the issue.
You can find out more about the #RightInhalerImage campaign on this website.
The photos at the top of this story show how to use inhalers correctly and the photos below depict the incorrect use of inhalers.
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Health and social care professionals across Greater Manchester are being encouraged to learn about frailty via a free e-learning programme.
Here, Dr Martin Vernon, our clinical lead for frailty, explains the importance of understanding frailty, especially in the context of integrated health and care systems, and how the online programme could help:
“Frailty is a long-term health condition rapidly becoming everyone’s business across integrating health and social care systems.
Though associated with ageing it’s important to be aware that not all older people are clinical frail and not all people with frailty are old. Importantly, frailty recognition and the delivery of evidence-based care interventions form key components of the 2019 NHS Long Term Plan.
In addition, newly announced national Same Day Emergency Care (SDEC) standards require early identification of frailty and delirium among acutely unwell older people to reduce unwarranted hospital admission and expedite optimal recovery in community settings where this is possible.
To help all health and social care colleagues across Greater Manchester better understand this condition, equip themselves with the necessary skills for its identification and take first steps towards its multidisciplinary care and treatment, we are highlighting a new freely accessible e-learning resource developed by the London Clinical Network for Frailty in collaboration with Imperial College Healthcare NHS Trust and Wessex Academic Health Science Network (see details below on how to access the resource).
The e-learning programme aims to standardise training and knowledge of frailty as a complex multi-system, long-term condition. This education programme is compliant with ‘Frailty, A framework of core capabilities’ (2018) and has been funded through Health Education England’s Urgent and Emergency Care Workforce Collaborative for London.
It promotes a common language in frailty care and is designed to support enhanced clinical skills and competencies to be embedded within the existing workforce. It will therefore help support health and social care staff to meet the needs of individuals living with varying degrees of frailty and to deliver improved health outcomes for older people across Greater Manchester.
Ensuring that there is equity in the understanding and knowledge of frailty across our workforce is of paramount importance to enable delivery of consistent best practice outcomes and person experience. This learning resource is therefore designed to meet the need for consistently aligned training about frailty with national and regional Ageing Well strategies for improvement.
It explores the multi-system complexity of frailty via a simple ‘5Ms’ framework, comprising Mind, Mobility, Medications, Multi-complexity and what Matters most, encompassing the key elements which are important when considering holistic care for older adults whatever setting you are in or profession you come from.”
How to enroll on the e-learning programme
Log-in to ESR, go to ESR navigator/employee self-service and search in the learning section for ‘000 Frailty’ and enrol.
If you don’t have access to ESR, you can access the programme via E-learning for Health (ELFH), by registering with your organisation.
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Covid 19 Q&A
In the first of a regular series, Dr Peter Elton, our clinical director, answers questions about the Covid-19 pandemic.
In future newsletters, we will be asking our clinical leads and advisors similar questions about their experiences of working in health and care during the pandemic.
When did you first become aware of Covid-19?
As I was cruising around South America. Before then, it had seemed a distant danger which changed when news spread of outbreaks in other cruise ships.
Do you remember when you first realised this would be the first worldwide pandemic in over 100 years and change your working life for months?
It was not until the pandemic hit Italy, that it became apparent that the UK needed to respond more urgently.
What has been the most challenging aspect of working in your area during Covid-19?
Worrying that clinicians' commitment to both to patients with Covid-19 and other patients was putting them at personal risk.
Has there been a low point during the pandemic professionally and if so, what was it and how did you overcome it?
The underuse of local public health expertise for track and trace. I tried to advocate for a change in policy.
Are there any positives you can take from the pandemic professionally?
The commitment of the Strategic Clinical Networks’ clinical leads has been tremendous. For example, the work on developing services for long Covid showed the strength of the Network approach.
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 This month saw us marking both International Nurses Day and International Day of the Midwife on social media.
Our teams highlighted the work of our brilliant colleagues in Greater Manchester, posting tweets and promoting messages from our partners (see above).
International Nurses Day is held every year on May 12, Florence Nightingale’s birthday, to mark the contribution nurses make to society.
International Day of the Midwife was held on May 5 with the aim of highlighting the incredible work midwives and maternity staff provide, especially since the Covid-19 pandemic.
The NHS Low Calorie Diet Programme, which is led by the Diabetes Network in Greater Manchester, is seeing some encouraging results among people taking part.
Hundreds of people nationally have taken part in the programme and there has been an average weight loss of 10kg at session 5, halfway through the total diet replacement phase (TDR), and a 7.3mmol/mol HbA1c reduction.
This shows the programme is making a real difference to some of the participants.
Roll out of the new NHS Low Calorie Diet Programme started across Greater Manchester in November 2020. Part of the NHS Long Term Plan, the programme follows on from two previous studies; DiRECT and DROPLET.
What does the programme entail?
It is a one-year programme to support a healthier lifestyle, weight loss, and remission of Type 2 diabetes. Eligible participants are offered low calorie, TDR products including soups and shakes consisting of up to 900 calories a day for up to 12 weeks. During this time participants will be expected to replace all normal meals with these products. Alongside this, participants will receive support for 12 months including help to re-introduce food after the initial 12 week period.
Who is the programme for and how do I offer the programme to a patient?
People aged 18-65 years who are overweight and living with Type 2 diabetes. Individuals must also meet other eligibility criteria to be referred to the service.
For more information about the programme including the eligibility criteria visit our website or if you are interested in offering this programme to your patients contact the team.
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Are you interested in working with diabetes programmes in Greater Manchester?
Three fixed-term vacancies are available for primary care engagement officers to support the Healthier You National Diabetes Programme and the Diabetes My Way self-management portal for people with the condition.
Click here for more details. For further information or an informal discussion, please contact Krista Williams.
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The Network supported the national Dying Matters Awareness Week 2021, May 10-16, in a different way this year.
In acknowledgement of the difficult year faced by so many, the team felt it was important to pause and reflect and a reflection, resilience and wellbeing event was held for all staff across Greater Manchester who have been supporting palliative and end of life care.
The day was a great success. Following an address from Professor Bee Wee CBE, (National Clinical Director for End of Life Care, NHS England and NHS Improvement) thanking staff for all their hard work and dedication over the last year, the day started with an uplifting session from Steve Head, an acclaimed inspirational speaker, who did not fail in his promise to provide practical tips and support resilience, not only in the work place, but in general life, as this pandemic has impacted on people in so many different ways.
The day then unfolded to give people chance to reflect with sessions from Reverend Anne Edwards and Rabbi Warren Elf and some wonderful words from poet J Ahmed and Lisa Riste. The day shared some inspirational examples of how GM Hospices quickly responded and adapted services to face the challenge of Covid-19.
Greater Manchester united to offer support on the day from Greater Manchester Health and Social Care Partnership (GMHSC Partnership) who presented the GM Wellbeing Offer, the GM Resilience Hub, GM Bereavement and GM Hospices for direct staff support..
Also, during the week, end of life care programme teams across the North West joined forces through a media campaign to encourage everyone to ‘tell three people’ about what matters to them #tell3people2021.
A series of videos were filmed where people across the North West have shared what is important to them and how their thoughts have changed as a result of Covid-19. Here are the links to the videos:
Introduction to the video series
What’s Important to you for the future?
What helps you make decisions about your life?
How have your views changed as a results of Covid-19?
What would you not wish to happen in the future?
If you were coming to the end of your life what would you want people to know about you?
Who have you told about your wishes?
Also during Dying Matters Awareness Week 2021, the Network, alongside North West Coast SCNs, launched the updated North West Model for Life Limiting Conditions.
The model replaces the 2015 version, which has been widely used across the region.
The model was reviewed and updated by a team of medical and nursing colleagues before going to wider engagment from the palliative and end of life care network groups (the full review process can be viewed on request).
The model now embraces and reflects personalised care and support planning and incorporates an updated good practice guide and core principles.
The Network has recently restarted its work to develop an evidence-based clinical model to help stroke survivors who develop spasticity, also known as hypotonia.
Around a third of stroke survivors develop this condition, as their nerves that control muscles can be damaged, leading to muscles contracting for long periods of time or going into spasm.
The stroke network has been working with its sister organisation for neuro-rehabilitation to develop a needs led, evidence-based clinical model that ensures it includes important aspects.
The work had been paused by the pandemic but has recently restarted with the next phase seeking to further map existing spasticity services to better understand the variation in standards of care that we know exists across Greater Manchester.
A regional proforma to ensure the key steps for management are undertaken by teams was launched in 2019 and a training programme for clinicians has been running since early 2021 which aims to upskill professionals in key areas of spasticity management.
This work has hugely benefited from the clinical leadership of Harriet Allen (pictured above left), highly specialist neuro rehabilitation physiotherapist in the Trafford Community Neuro Rehabilitation Team.
Changes in muscle tone impact the amount of resistance or tension that enables movement or the ability to stay in position. Spastic muscles are very tight which can also cause stiffness and tiredness in the unaffected side as the muscles have to work harder to compensate.
Measures to prevent spasticity where there is a risk are vital, as is early diagnosis and treatment to ensure the condition does not develop and potentially become permanent.
Early treatment usually involves non-medical/non-surgical therapies delivered by our local specialist inpatient and community teams but botulinum toxin or other drugs, or even surgical intervention may be needed. A multi-disciplinary approach to management is also critical in ensuring different kinds of intervention are considered, especially in the early stages.
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Our clinical director Dr Peter Elton explains the role of the Greater Manchester and Eastern Cheshire Strategic Clinical Networks' in plans to develop clinical and care leadership:
"Greater Manchester is developing clinical and care professional leadership as the NHS is being reorganised.
The Strategic Clinical Network's clinical leads have contributed to this development.
The clinical leads strongly support leadership coming from the full range of clinical and care professional personnel including those outside the health service whose work influences health.
This leadership should both provide expert opinion and advocate for patients, service users and carers with whom they are in regular contact.
To combat unwarranted variation, it is both important to develop standards for Greater Manchester as a whole, and important that local policy makers, including clinical and care leadership, decide the most appropriate way to meet those standards.
There should be a two way process with much of the leadership at a Greater Manchester level coming from place whilst there is challenge for Greater Manchester when place fails to reach standards.
Clinical and professional leadership should not only be integral to setting strategy and developing policies but also be instrumental in operationalising those policies working in partnership with managers and others essential for successful implementation."
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Events
The SCNs’ events continue online while Covid-19 restrictions are in place:
Celebrating Maternity Safety in Greater Manchester and Eastern Cheshire
Thursday, July 15, 2021, 1pm-4pm (via MS Teams. Full details and registration instructions to be released shortly).
If you haven’t already, please take a look at our Achievements 2013-2020 document.
The document reflects on how our clinical leads have helped shape changes which have improved the lives of thousands of people living in Greater Manchester and Eastern Cheshire.
The report looks at each network, explaining how our life course approach has seen sustainable improvements from maternity to children to end of life care, with many long-term conditions tackled in between.
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