This week’s leadership blogs come from Sarah Chadwick and Dr Tarun Narula

Posted on: 12 May 2023

This week’s leadership message comes from Sarah Chadwick, Antimicrobial Resistance Programme Manager at NHS West Yorkshire Integrated Care Board. We also have a blog for May Measure Month from Dr Tarun Narula, a GP in Wakefield with an interest in cardiovascular disease prevention.

Sarah Chadwick Hello, my name is Sarah, and I am Antimicrobial Resistance Programme Manager at NHS West Yorkshire Integrated Care Board.

I’m delighted to have been asked to write this week’s leadership message, to be given the opportunity to raise awareness of antimicrobial resistance and discuss why it matters to us all.

Antimicrobial resistance or AMR for short, happens when bacteria, fungi or viruses find ways to stop antimicrobial medicines working, making then harder or impossible to treat.

The process itself is a natural phenomenon; microbes adapt and develop resistance to survive. In 1945, Alexander Fleming, who won a Nobel Prize that year for his discovery of penicillin, predicted that misuse of the drug could result in selection for resistant bacteria.

Yet despite his warning, in the years that followed, bacteria were overexposed to antibiotics in healthcare, agriculture and the environment. The availability of antibiotics was taken for granted. The World Health Organisation (WHO) has now declared that AMR is one of the top 10 most urgent global public health threats facing humanity.

When and why did it become a problem?

My own awareness of antibiotic awareness began during my first role at Trafford General Hospital – a small District General in Manchester, famously opened in 1948 by Aneurin Bevan and proudly known as “The Birthplace of the NHS". I had always aspired to have a career in healthcare, and really wanted to work in an area of hospital science where I could see that difference being made. So, I became a Healthcare Scientist and specialised in Medical and Molecular Microbiology – the diagnosis of microbes that cause infection.

Antimicrobial resistance was beginning to become a clinical problem for many of our patients – in particular, those receiving life-saving cancer treatments on the haematology wards. Before this, until the 1980s, there had always been new types of antimicrobials in production which meant alternative treatments were available for resistant infections. However, there were suddenly no new antibiotics on the horizon. In the five years from 2017-21 just twelve antibiotics were approved and there are presently only 2 under development that target multi-drug resistance (MDR), extensively drug-resistance (XDR) and pan drug-resistant (PDR) bacteria which are resistant to most currently effective antibiotics.

Why is it a problem for me?

Infections caused by resistant bacteria cannot be treated with routine antibiotics, making them harder and sometimes impossible to treat. And this is happening more often. Antimicrobial resistance causes 1.3 million deaths and contributes to 5 million deaths every year. The impact of AMR affects all sectors including human and animal health, the environment and food security. By 2030, it is estimated that AMR could force 24 million people into extreme poverty.

Our commitment to this work is driven by the fact that antibiotics do more than cause resistance – they save lives. Maybe someone in your family has had surgery, chemotherapy, or a transplant - which are only possible because antimicrobials have been available for managing infections. Antibiotics saved my mother and my neonatal self after premature delivery, kept my younger brother alive during his childhood cancer treatments, prevented infection for my grandfather after heart surgery and protected my father during hip replacement. We have all witnessed or experienced the benefits of antibiotics in our lifetime and will probably do so again in the future. So, we need to keep them working.

What is being done about it?

Governments and scientists around the world are acting to tackle this issue. The first five-year AMR National Action Plan launched in 2019, to help move towards the 20-year vision of containing and controlling antimicrobial resistance by 2040.

Here in West Yorkshire, our health and care partnership recognised the importance of AMR prevention and selected it as one of its 10 big ambitions. Subject matter experts from our local area places and trusts came together with key partners to develop our AMR Steering group – the aim being to consider the long-term impact of Covid-19, tackle health inequalities and build resilience and readiness for the health threat that is AMR.

The group is made up of professionals from healthcare, academia & research with the passion, motivation, and mandate to act and drive change forward. Whilst our strategy supports the national vision, it is built around local key objectives. We know that there is a link between deprivation and infection burden. Many people are at increased risk of infections, particularly with a type of bacteria called E. coli causing bloodstream infections associated with high mortality. We also know that people with drug-resistant infections talk about the fear they feel when they’ve run out of antibiotics to try. So, as well as mitigating and adapting prescribing, we are taking action to increase awareness, build resilience and provide support for our healthcare providers and citizens. We will do this through co-production and improvement projects aimed at enhancing hydration awareness, good hygiene, access to diagnostics, support, and availability of appropriate alternative treatments.

What can I do?

AMR is everyone’s problem. We need to change our behaviour and recognise that antibiotics are now a precious resource that should only be taken when prescribed for specific infections by a healthcare professional. The West Yorkshire AMR Steering group has developed a series of animation videos providing education about AMR and outlining steps we can take to keep healthy, prevent infection and reduce antibiotic resistance in our community.

Seriously. We have also commissioned a public facing 'Seriously' campaign to raise awareness of this issue amongst public and patients. So whether you are an individual member of the community, a doctor or pharmacist or an educator, you can also make a difference by supporting the movement to #TakeAntibioticsSeriously, pledging to become an Antibiotic Guardian or sharing key messages from the Seriously campaign with family and friends.

Throughout May, I will also be joining the “West Yorkshire Antibiotic Warriors” on the “Step-up” Challenge, coming together to raise awareness and support the fight against AMR. So, if you see me, my family and dogs climbing a slope near you, please say hello!

Wishing you all a wonderful restful weekend,
Sarah

May Measure Month

Dr Tarun Narula Hello, my name is Tarun and I'm a GP based in Wakefield.

CVD or cardiovascular disease is a disease of the heart and blood vessels that includes life changing or life-threatening conditions like heart attacks and strokes. Many CVD conditions could be prevented or better managed with lifestyle changes like smoking cessation, regular exercise, weight loss and keeping blood pressure under control.

High blood pressure, what’s the fuss?

Blood pressure is measured in units called mmHg. The target blood pressure is under 140/90mmHg for adults under the age of 80 years and 150/90mmHg in those over 80 years old. This target may also vary depending on your other health conditions or if you are doing home blood pressure monitoring.

High blood pressure or “hypertension” is very common: one in four adults suffer with this condition. Prevalence increases with age and it is more common in people over 40. It’s also more common in people of Asian and Black ethnic minority heritage as well as less affluent populations. It does not have any specific symptoms so is easily missed. It is estimated for every ten patients diagnosed with hypertension, a further seven are not diagnosed and hence untreated.

Hypertension is associated with 50 % of strokes and heart attacks. If left untreated it can also lead to complications like heart failure, kidney disease and dementia.

However, the good news is that high blood pressure can be reduced by lifestyle changes and medications. Every 10 mm of Hg reduction in blood pressure lowers the risk of stroke or heart attack by nearly 20%. Global Burden of Disease studies have consistently found high blood pressure, lifestyle and high cholesterol as major modifiable risk factors in premature deaths and disability for CVD.

Graph showing the effect of high blood pressure on life expectanc

World Hypertension Day is on 17 May. The theme this year is to measure your blood pressure accurately, control it, live longer, focusing on combatting low awareness rates worldwide, especially in low to middle income areas, and accurate blood pressure measurement method. So if you have not had your blood pressure check done recently, why not consider getting checked this month? You could get it done at GP surgeries, local pharmacies, workplaces, pop-up community clinics and some sports centres.

Thanks for reading,
Tarun

What else has been happening this week?

Partnership allocates further £2.8 million to support the vital work of voluntary, community and hospice care in West Yorkshire

Rob Webster and Cathy Elliott Our NHS West Yorkshire Integrated Care Board has agreed further funding of £1.8 million for charity led hospices across West Yorkshire and £1million of additional support for its local voluntary, community, and social enterprise (VCSE) partners – which will focus on helping sustainability and tackling health inequalities.

The Board has done this through the West Yorkshire Health and Care Partnership.

Following the focus on the future sustainability of the VCSE sector at its last Board meeting in public on 21 March 2023, the funding will be shared across West Yorkshire as part of the Partnership’s Harnessing the Power of Communities Programme and the West Yorkshire Hospice Collaborative.

Kim Shutler Michael Crowther The Partnership has a memorandum of understanding with the sector, backed by investment and strong ties into the way the Partnership operates.

The additional funding further supports the sector over and above the range of service provision and grant funding arrangements that are in our five Places (Bradford District and Craven, Calderdale, Kirklees, Leeds and Wakefield District).

You can read more on our news page.

Mid Yorkshire Trust secures ambition of teaching status, a boost to recruitment and innovation opportunities

Colleagues from Mid Yorkshire Teaching NHS Trust The Mid Yorkshire Hospitals NHS Trust this week announced it is officially a Teaching Trust, and will now be called Mid Yorkshire Teaching NHS Trust.

Each of the Trust’s three hospital sites; in Pontefract, Wakefield and Dewsbury and the services it provides in the community, will benefit from the status which recognises the Trust’s track record in the provision of high-quality teaching and education.

The teaching status is a new partnership with the University of Leeds and enables the Trust to enhance its education and training capacity, grow research capability and provides a platform to enable delivery of new advances in healthcare, innovative discoveries, techniques and medications. In addition, it will support the recruitment and retention of first-rate staff across all professions, all of which will ultimately result in better services and outcomes for patients.

Based on the strategic partnership with the University of Leeds, the Trust set a clear ambition in 2022 when it announced their submitted application to seek a change of establishment order, showcasing the Trust’s confidence in meeting the teaching principles set out by the University of Leeds based on the teaching principles of the University Hospitals Association.

Read the full story at https://www.midyorks.nhs.uk/news/mid-yorkshire-trust-secures-ambition-of-teaching-status-a-boost-to-recruitment-and-innovation-opportunities-2844

We are delighted to share that we are now officially a teaching Trust! 🤩

A huge well done to all of our staff members who have worked so hard for this to happen, we couldn't have done it without you! 💙

Read more for what this means for our Trust here: https://t.co/BPhoHBEhqB pic.twitter.com/9H4yL6tdCr
— Mid Yorkshire Teaching NHS Trust (@MidYorkshireNHS) May 11, 2023

Perinatal peer support workers given national award for excellence

Perinatal peer support workers The Chief Nursing Officer Health Care Support Worker (HSCW) award for Healthcare Support Excellence celebrates people who give consistently outstanding care recognised by patients, service users and colleagues alike.

In April, perinatal peer support workers at South West Yorkshire Partnership NHS Foundation Trust were presented with NHS England Chief Nursing Officer Healthcare Support Excellence awards.

The national award recognised each one of the team of nine perinatal peer support workers for their excellent support to their nursing and midwifery colleagues, commitment to delivering outstanding patient care, and their ability to demonstrate leadership and quality improvement in their role.

Our dedicated perinatal peer support workers work as part of the perinatal peer support team, who support mums-to-be, their families and loved ones across Barnsley, Calderdale, Kirklees and Wakefield, in the later stages of pregnancy and following birth, until baby is aged two.

Each support worker has lived experience of being unwell perinatally which is a vital part of the everyday work they do with their colleagues and patients. By bringing their unique experiences, and stories, our peer support workers help mums know that they are understood and not alone in their maternity journey.

Support is offered to mums in a variety of ways, including online peer support and walking groups, to sessions which focus on holistic recovery and wellness. One attendee said: “Fears are left at the door but are welcomed inside, caring hearts and understanding compassionate women run it. I can be me again, its ok not to have all the answers.”

Patients share their stories to help more people get #ReadyForRemote appointments

Ready for Remote Clinicians and patients across West Yorkshire have come together in a series of videos to help promote the use of remote appointments at hospitals across the region.

To help combat the elective backlog in the wake of the COVID-19 pandemic, NHS England introduced guidance that at least 25% of outpatient appointments should take place remotely. In 2022, the West Yorkshire Integrated Care Board (ICB) Outpatient Transformation Programme and the West Yorkshire Association of Acute Trusts (WYAAT) engaged with Trust outpatient teams across West Yorkshire, and collated feedback about what they felt would help them deliver more remote appointments.

Outpatient colleagues identified a need to help both clinicians and patients feel more comfortable, well-equipped and provide a greater understanding of the benefits of remote appointments. The subsequent #ReadyforRemote campaign signposts both patients and staff to tailored, video-led content, which supports both patients and staff to feel more confident in accessing or delivering remote appointments. More information is available on the Partnership website.

NHSE System-wide Co-produced Improvements: Sharing the Learning Event

Harnessing the Power of Communities and the Integrated Stroke Delivery Network attended NHS England’s System-wide Co-Produced Improvements: Sharing the Learning Event (09 May 2023) showcasing the work of the West Yorkshire & Harrogate Life After Stroke Co-Production Group. We were one of 11 systems that secured funding from NHS England’s Experience of Care Team to go further faster in co-producing improvements.

The West Yorkshire & Harrogate Life After Stroke Co-Production Group brings together health and care partners including clinicians, VCSE organisations, stroke survivors and carers. From the beginning they co-produced their own aim to design initiatives to enable stroke survivors and carers to access support and rebuild, reclaim and adapt their lives after a stroke and how they want to work together. Their first project is to develop a Life After Stroke Directory with further funding from the Integrated Stroke Delivery Network who have also agreed to continue to invest in the West Yorkshire & Harrogate Life After Stroke Co-Production Group.

To learn more about this work – you can hear directly from the group by watching this video: https://youtu.be/jIYmlc6imrY

If you would like to discuss this work further, please contact arfan.hussain3@nhs.net and katie.johnson@nhs.net. You can also see more examples of co-production work occurring in the West Yorkshire Health and Care Partnership by clicking here.

Urgent and emergency care programme board update

The urgent and emergency care programme board (UEC) met on Tuesday 9 May and was chaired by Clare Smith, Chief Operating Officer at Leeds Teaching Hospitals Trust and Senior Responsible Officer for the programme.

To support delivery of the UEC Recovery Plan, a high-level map of the key areas from the national UEC plan has been developed, with a provisional mapping of which functions and/or governance groups these could align with. As the recovery plan is very broad and comprehensive in its ambitions and scope the aim is that later into the year and into 2024 there is clarity where priorities optimally sit, whilst ensuring this remains integrated and connected, and avoids both any potential fragmentation and duplication. The map is intended as a helpful way of guiding an iterative dialogue, rather than being complete or definitive. It will be important for the WY UEC Board to have oversight of work, and therefore place based systems have been asked to provide highlight reports. These will be focused on the priorities of the UEC programme (including delivery of the UEC Recovery Plan) to help identify any improvements at place so learning can be shared across the system and ensure that any actions are having the desired impact rather than to provide assurance. The highlight reports will also provide the opportunity for systems to escalate any issues that need support from the UEC Board to unblock so delivery is not impacted. The high-level plans were also being discussed at the West Yorkshire Transformation meeting on 10 May.

The refreshed WY UEC priorities and plans on a page were shared with the Board. The agreed priorities are the WY Urgent Care service review, Same Day Emergency Care (SDEC), Yorkshire Ambulance Service (YAS) Transformation: the WY System Response. It was noted that the Delivery Plan for Recovering Access to Primary Care had also been published that day and we must ensure alignment with this in all our planning.

An update was given on the programme’s contribution of the WY Joint Forward Plan and further work will be undertaken to ensure read across between place and programme submissions.

West Yorkshire was asked to provide an overview of ICB system plans and actions which will support in the delivery of the category-2 30min mean target and these were presented at the YAS Executive Leadership Board, and again at the WY UEC Board. Plans predominantly focussed on maintaining handover performance, reducing A&E waits and bed occupancy, and further utilisation of alternative pathways. The WY UEC Programme Lead will provide a highlight report each month to the Integrated Commissioning Forum (ICF). The ICF governance structure will monitor progress of both System and YAS actions.

There is a national envelope of £250m for Capital Bid schemes to support delivery of the UEC strategy. Systems were asked to complete for any schemes that would aid delivery in 2023/24 and bids were valued between either £2m to £5m or £5m to £25m. The proposals that had been received from Places were presented to ensure members had oversight and the group discussed how these could be prioritised if required.

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