ACCELERATE - REFLECT & REDISCOVER

Reflect & Rediscover
Accelerate
A LOCAL SUCCESS STORY
REDISCOVER
ACCELERATE
acceleratecic.com

Reflect and Rediscover Accelerate
REDISCOVER ACCELERATE
The aspiration to be part of an alliance
committed to ensuring a health and social
care system that works effectively for all its
residents, resonates at the heart of Accelerate.
As a social enterprise, the drive towards
creating visible and tangible social impact is
critically important when measuring the value
an organisation can bring to the communities
it serves. Tower Hamlets is the home
ground and flag ship for Accelerate: a health
economy that has always been recognised
for being at the cutting edge of change,
innovation and new approaches to care.
Alison Hopkins
Chief Executive
Six years post spin out we present to you
our reflections on the changing population
of and dynamics within Tower Hamlets, our
achievements in the past year [2016/17] and
our forward view for change and integration in
the context of the emerging alliance model.
2

acceleratecic.com
Our values
Our values guide and reflect the
approach and attitude we take in
our daily work and interactions.
Our patients are at the core of all
we do and we strive to create a
welcoming, professional service in
which everyone feels recognised
and able to grow.
Our community is...
• People with or at risk of wounds
• People with chronic swelling or
lymphoedema
• Clinicians who work with this
community
• Family and friends of people
within this community
Leadership & Discovery
Demonstrating our skill and care
commitment through our professionalism,
expertise and desire to innovate for the
continual improvement of our service.
Preparedness and Resourcefulness
Thinking ahead, anticipating near and
long term needs, and finding impactful
solutions to new challenges so that our
resources are put to best use.
Accountability & Reliability
Empowered to take ownership and
responsibility for our work and the
services we offer to our patients.
Care & Nurture
Committed to the quality of care we
offer to our patients, the sharing of our
expertise and care knowledge with the
wider healthcare community, and the
growth and support of our staff.
Appreciation & Respect
Valuing every person in their own right and
valuing listening to each other to deliver the
best care and work environment for all.
3

Reflect and Rediscover Accelerate
THE STORY FOR 2016/17:
HOW DID WE DO?
4
The audit undertaken in June 2016 highlighted the
challenges both we as a contracted specialist provider
and the system faced in terms of delivering a strong
performance against a contract that perhaps, for
Accelerate certainly, was somewhat out of date in
terms of perspective and expectation. Notwithstanding
that we delivered strongly against our performance
requirements for both service and the Dressings
Optimisation Scheme and introduced Patient
Activation together with engagement in the overarching
Personalisation agenda. However whilst we had a
significant learning from the audit, it was difficult to
implement the required changes and begin to impact
patient experience and improve the use of
system resources.
Kilborn C and Hopkins A (2017) Dressings
Optimisation Strategy: Meeting the needs of the
patient and the population. Nurse Prescribing 15, 4:
188-191
Dressings Optimisation: after a significant number
of years, Tower Hamlets still boasts the lowest cost
per head of population for dressings nationally and
across the STP at £1.49: now that’s a scheme that
works!
We achieve this by administering a formulary based
scheme that supports local clinicians, allows approved
off formulary prescribing, provides home delivery and
joins the dots linking resource management to clinic
decision making and education.
Let’s remind ourselves of the
objectives of the scheme:
No GP or Nurse prescribing for wound
dressings
Provide equity, efficient and effective access
to dressings where and when required
Reduce waste
Improve practice and analysis
Provide home delivery
Stay within the set budget

acceleratecic.com
FASCINATING FACTS ABOUT
THE DRESSINGS OPTIMISATION
SCHEME:
• There has been no change to the budget since
2010 when it was initiated
• Over the last 6 years the scheme has enabled
a reinvestment of £45,000 in local services
• The scheme connects home care, nursing
homes, primary care provision and specialist care
to clinical decision making, needs analysis and
education
• Over time we have become significantly more
proficient in the management of scheme and
related issues management
• We place the analysis of dressing usage within a
context of creating system change
• With an increase in population and the ageing
component of that we came close to an
overspend in 2016/17. However we pulled it back
to come in just under budget: a real achievement
on a budget that has not seen any increase over
a period of 6 years
Want to know more?
For further information simply email:
NELCSU.acceleratedressings@nhs.net
• We manage a hybrid version of this scheme in
City and Hackney
5

Reflect and Rediscover Accelerate
EDUCATION MATTERS: IT’S
NOT WHAT YOU DO IT’S
THE WAY THAT YOU DO IT...
THAT’S WHAT GETS RESULTS
We are passionate about what we do at Accelerate
and equally passionate about the fact that we can
change people’s lives and motivate clinicians to want
to learn more about complex wound management
and lymphoedema. During 2016/17 we delivered 21
education sessions to 318 clinicians across Tower
Hamlets. This was a 43% increase over the number
of contracted sessions and is testimony to the
commitment of the organisation to Tower Hamlets.
We were very proud to receive the CEPN Training
Team of the Year award in 2016.
Leg Ulcer
Management
Competency
Workshop
Pressure
Ulcer Related
Wound
Management
Clinical
Champions
Bespoke
Sessions
NUMBERS COUNT: THE WOUND PICTURE
The trend continued regarding the increase in referrals for pressure ulcers and surgical wounds: possibly
evidencing the trend towards earlier discharge from hospital.
The increase in leg ulceration referrals perhaps points to a lack of focus on this cohort in the community and
the fact that these leg wounds are often prioritised behind pressure ulcers.
96% of pressure ulcers seen in the required timeframe
91% of all referrals seen within the required timeframe
61% of referrals to wound coming from District Nursing and 15% from General Practice Nursing
78% of referrals for wound were over the age of 60 and 51% were female
87% of those presenting with pressure ulcers were over 60 years of age
Aetiology overall caseload - April 2012-March 2017
140
120
100
80
60
40
20
0
2012-13
2013-14
2014-15
2015-16
2016-2017
6

acceleratecic.com
LYMPHOEDEMA: A SUCCESS STORY IN ITS OWN RIGHT
• The Accelerate lymphoedema team manage
a case load of 520 patients across Tower Hamlets
Site of oedema
• We undertook 1,256 reviews: an increase of 10%
• Lymphorrhea [wet legs] has been decreasing
demonstrating effective care plans and our
approach to early intervention
• 95% of those known to have chronic swelling are
in compression therapy with an amazing 86% of
those in hosiery
• 76% of the caseload are in maintenance therapy
• In 2016/17 we assessed 243 patients, an increase
of 13%
• Because Tower Hamlets enjoys a comprehensive
Lymphoedema service only 10% of patients have
cancer related lymphoedema
• We are seeing an increase in the number of patients
with complex co-morbidities
• In line with the drive to ensure we are keeping
our maintained patients on track we have increased
our telephone reviews by 85%
• 91% of residents have lower leg oedema affecting
their mobility and quality of life - see chart on the
right
Bilateral lower limb
Left lower limb
Right lower limb
Upper and lower limb right
Right upper limb
Left upper limb
Breast
Truckal
7

Reflect and Rediscover Accelerate
CHANGING LIVES
The experience of living with a non-healing
wound or unmanaged oedema with
repeated infections is often described by our
patients as ‘scary’, ‘disabling’ and ‘hopeless’.
We understand how difficult the experience
can be and we know that with the Accelerate
approach we can reassure our patients that
with perseverance and working together their
lives can be improved.
The joint plans we put in place to provide
effective treatment complement the
conversations to help patients understand
their condition and how together we aim to
move them to a maintained state of wellness.
PATIENT ACTIVATION [PAM] AND
PERSONALISATION CAME JUST AT
THE RIGHT TIME FOR US
During 16/17 we committed to engaging with PAM
for our annual Local Incentive Scheme. As a result
of our involvement with PAM we then linked into the
Personalisation programme. Two staff have been trained
in both skills and we now look to creating a Health and
Nutrition Coaching role to enable us to better support
our patients in the drive towards self-management. This
involves a clear understanding on the part of the patient
in regard to both prevention and early intervention in order
to help us move them towards understand what wellness
looks like for them.
8

acceleratecic.com
WHAT OUR PATIENTS SAY
We aim to bring the greatest
impact to those with or at risk
of wounds and lymphoedema
so we realise the views of our
patients count:
Why not take a look at what our
patients have to say in greater
detail by going to our website
acceleratecic.com and watching
our patient videos
I value every aspect of the way I was treated
I now feel in charge of my leg again
It was what I would hope every consultation to be. Perfect
Really helpful, efficient clinicians. Lots of help
and information to help myself
WHAT OUR COMMUNITY TEACHES US:
We learn a great deal from our community about how
care and therapeutic interventions can be improved.
Listening to their experience of services helps us to
bring in change, directly through Accelerate, working
with our partners and the Alliance or through our
education programme.
Our community is keen to support any initiative that will
create this change; they have been part of educating
nurses in the use of compression therapy and telling
their stories via online videos. Watch their videos.
Like us, you will gain insight into their experience and
cannot fail to be inspired by their stories.
9

Reflect and Rediscover Accelerate
THE FINDINGS OF THE 2016
COMMUNITY WOUND CARE AUDIT
GAVE US FOOD FOR THOUGHT:‘THINGS
AIN’T WOT THEY USED TO BE’
What did we learn about the burden
of disease?
We know the population is increasing in Tower
Hamlets and aligned to that is an increase in the aging
population. Putting this into context 6% of residents in
Tower Hamlets are over the age of 65 and within the
patient cohort [812] from whom we captured data,
52% were over the age of 65 – an increase of 10%
since last audited in 2012. Wounds are becoming
more chronic and complex as the population grows
and ages: the majority of chronic non-healing wounds
are leg ulcers.
Some key findings from this audit include the following
interesting data:
• 316 patients had one or more wounds
• 54% of active wounds greater than 6 weeks
duration were known to the Accelerate Wound
team. However there remains a cohort of patients
unknown to Accelerate, with wounds of a duration
greater than one year that would benefit from a
more proactive approach
• At the opposite end of the scale 92% of residents
with chronic oedema were known to the Accelerate
Lymphoedema Team
• Community nurses saw 171 patients with one or
more wounds. The total number of wounds were
239 giving a ratio of 1.39 per patient.
• 55% were leg ulcers
• 20% were pressure ulcers
• Of the patients seen by community nurses:
• 30% had diabetes
• 20% were smokers
• 22% were obese
• 34% were mobile
• Specialist services need to continue to target
patients that require dressings several times a week.
This carries a significant burden to the workforce.
Within Tower Hamlets this appears, in the main,
to be due to pressure ulcers and surgical wounds
rather than leg ulcers demonstrating effective
management.
KEEPING QUALITY ON TRACK:
Tower Hamlets continues to demonstrate good wound management:
• Good recording of medical history such as diabetes and mobility
• Making sure that the reason why a wound is non-healing is documented and that the aetiology is clear.
88% of patients in the audit had a documented diagnosis, much better than published studies
• Ensuring a treatment plan is in place for all patients. 75% had a clearly documented careplan
• Ensure pain is assessed at assessment and each dressing change. 58% of patients in the audit had
undergone pain assessment in the last 4 weeks
• Make compression therapy the rule in lower limb for all except ischemic limbs. The 79% achieved increased
to 89% when there was involvement from Accelerate
10

acceleratecic.com
IN NUMBERS: LYMPHOEDEMA IN TOWER HAMLETS
• 520 patients on the caseload, of which 95% are
managed by Accelerate alone
• The age range spans from 16-98 years
• 56% of this cohort are obese
• 35% [160] have had lymphoedema for 6 years or
longer thus recognised as a long term condition
• Only 35% are fully mobile
• 95% are in compression therapy and 82% of those are in
compression hosiery: this is a significant achievement
WHAT CHALLENGES DID THIS HIGHLIGHT?
Community Nursing vacancy rates and daily caseload
sizes are impacting the ability of all teams to undertake
timely and efficient joint visits.
All community nurses need to regain their skill in
therapeutic compression bandaging and earlier
intervention.
Early discharge from hospital is impacting on
community services.
The effort needing to be given to the management
of Pressure Ulcers in order to comply with national
requirements is impacting on the delivery of
comprehensive and appropriate care for those patients
with venous leg ulcers in the community.
In essence the landscape has changed on numerous
parameters: now is the time to make a change to
benefit both the system and the patients.
More fully mobile patients are seen at home than are
seen in the leg ulcer clinics [total of 55 fully mobile
patients being seen at home]. This raises the question
of availability of clinics, accessible hours, Capacity of
the clinics and /or gaps in the pathway.
11

Reflect and Rediscover Accelerate
AS THE NHS ENTERS A PERIOD OF
SIGNIFICANT CHANGE, NOW IS THE
TIME TO REDISCOVER ACCELERATE
What did we learn about the burden
of disease?
Having reflected on our learnings and achievements
during 2016/17 we must consider what the future could
hold for Tower Hamlets, the wider alliance, the STP
and for Accelerate. As an organisation we continue to
build on our national reputation taking an active role in
the development of the recently launched CQUIN for
wound assessment and the Legs Matter campaign;
we continue to make a significant contribution to
the production of the lymphoedema commissioning
document for London. Now is the time for Tower
Hamlets to rediscover the value of Accelerate to the
health system locally and take the opportunity to lever
the expertise in lower limb management to make an
even greater difference for our residents and without a
doubt increase the impact the organisation can have
on productivity and community resources.
Better legs, better lives!
As District Nurses struggle to deliver care for both
housebound and mobile patients across the breadth
and depth of both wound and lymphoedema we offer
a creative solution which, we believe is achievable.
The focus for community should align to pressure
ulcers and housebound. The focus for Accelerate
should align to lower limb and mobile. This would allow
Accelerate to align with Primary Care yet still provide
the specialist oversight required for housebound and
PU patients. What this would mean in reality is that
leg ulcer clinics would be managed and delivered by
Accelerate and a revitalised approach to leg ulcers
would emerge. It makes sense to lever the expertise
that sits on your doorstep.
12

acceleratecic.com
Illness – Wellness Continuum
JW Travis MD (1972, 1988, 2004)
WELLNESS PARADIGM
REACTIVE
PROACTIVE
TREATMENT PARADIGM
EARLY INTERVENTION/PREVENTION
DISABILITY
SYMPTOMS
SIGNS
AWARENESS
EDUCATION
GROWTH
NEUTRAL
The drive to continue offering
the difference through innovative
techniques and products
Whether that be in the use of the award winning
Accelerate strapping technique, or our approach to the
importance of gait and biomechanical assessment in
ensuring not only do we treat the condition but we aim
to keep our patients mobile and active for as long as
possible.
Ina Farrelly (2017) Ten Top Tips: Improving mobility in people
with wounds. Wound International Vol 8, issue 2, 13-18
The initiative to build on the success
of the Dressings Optimisation Scheme
And add the direct management of hosiery and
garments to our portfolio. This in itself would free GPs
from the laborious process of ordering garments
and would mean that patients no longer have to wait
inordinate amounts of time before accessing hosiery
and beginning their journey to wellness.
The opportunity for Tower Hamlets
residents to experience the benefits
of the multidisciplinary clinic
Currently only a small number of Tower Hamlets
residents are catered for in the Multidisciplinary
Clinic. This is a unique offering in the field of wound
and lymphoedema care as it brings together the
expertise of our specialist nurse and therapy teams
with dermatology, psychology, gait and biomechanics
and plastics. Many CCGS outside Tower Hamlets have
significant numbers of patients going through this
clinic for assessment and onward programmes of care
can halt the pipeline of patients into District Nursing.
Hopkins, Bull and Worboys (2017) Needing more: the case for
extra high compression in the UK. Veins and Lymphatics
pagepressjournals.org/index.php/vl/article/view/6630/6336
O’Neill C (2016) Developing a Lymphoedema Service
pcnr.co.uk/articles/328/developing-a-lymphoedema-service
Hopkins A, Worboys F, Bull R, Farelly I (2011) Compression
strapping: the development of a novel compression technique
to enhance compression therapy and healing for “hard to
heal” leg ulcers. International Wound Journal 8:474-83
13

Reflect and Rediscover Accelerate
TAKE TIME TO REDISCOVER A
HIGH QUALITY ORGANISATION
THAT IS INNOVATIVE, FLEET
OF FOOT AND READY TO
WORK IN PARTNERSHIP WITH
PRIMARY CARE AND ULTIMATELY
ACROSS THE ALLIANCE
The financial impact of non-healing wounds
and lymphoedema on a local health
economy and wider NHS is considerable.
We know our early intervention and
multi-disciplinary model for wound and
lymphoedema care is highly effective and
can demonstrate in year real time savings
to commissioners and health systems.
We also know that the time is right
for aligning with Primary Care to lever the
focus on prevention and early intervention:
some simple ideas that can make a
world of difference to the patient and
the health economy.
The secret of our success lies in strong
leadership and ownership. We encourage
innovation across our staff and applaud
initiative. We constantly challenge ourselves
and recognise we cannot afford to simply
stand still.
Above all we our experts in Positive Mental
Attitude. Join us on our journey of change
and rediscover Accelerate, your own local
success story.
14

acceleratecic.com
OUR PURPOSE IS FOURFOLD:
• We are a social enterprise, committed to transforming
our patients’ lives by moving them from a position of
illness to wellness
• We consistently deliver value-based care benefiting both the
patient and the system in terms of best use of resources
• We focus on the delivery of both improved outcomes and
positive patient experience
• We make change happen
15

We are an award-winning social
enterprise working within the NHS
to serve patients. We deliver specialist
care for those living with chronic
wounds and lymphoedema.
Accelerate CIC
Mile End Hospital
Bancroft Road
London E1 4DG
Every day we’re changing
people’s lives. See how
we can change yours.
020 3819 6022
info@acceleratecic.com
acceleratecic.com