Dr Alanna Hare: KHPeople

Sleep expert Dr Alanna Hare [pictured] discusses her love of helping people to improve the quality and quantity of their sleep, and how she wouldn’t have been made President of the British Sleep Society last year without her passion for relationship building and multi-professionalism.

What is your role within King’s Health Partners (KHP)?

I’m a Consultant in Respiratory Failure and Sleep Medicine at Royal Brompton Hospital, and I’m also involved in education delivery at KHP. I’ve been working with KHP to help generate a programme of educational events across the partnership, which have been really successful.

Our most recent event was the Tracheostomy Invasive Ventilation course, which was held at Chelsea Football Ground in October and led by our Outreach consultant nurse, Debbie Field. This is the second time we have run this hands-on event and it was hugely popular, with lots of really good feedback.

When we do these educational programmes it’s important to me that they’re fully multiprofessional and represent the whole team delivering care. They should also involve the patients in care, which we achieved with the tracheostomy course.

Last year I chaired a national multiprofessional group of sleep professionals to develop the National Outpatient Pathway for Sleep Medicine on behalf of NHS England and GIRFT - Getting It Right First Time. GIRFT is a national programme designed to improve the treatment and care of patients through in-depth review of services.

I have a strong background in service improvement and optimising service delivery through my time as a Darzi Fellow, so I’ve really enjoyed being part of that national piece. It’s been brilliant to take that experience at national level and bring it back to the partnership. I'm really proud of it and the pathway has already been beneficial for the partnership.

We've been looking at how we can become early adopters of some of the advice and guidance across KHP – trailblazers in sleep medicine. For example, how can we best use our diagnostic capabilities across the partnership to get people tested and diagnosed quickly, and get them to the right person, first time, to look after their sleep problem.

What is sleep medicine?

It’s understanding why somebody may be struggling with the amount or quality of their sleep, and running different diagnostic tests to understand the problem before developing a personalised plan to improve their sleep.

There is a huge spectrum of treatments for improving sleep. There are devices, for example continuous positive airway pressure (CPAP) machines, to treat sleep apnoea, and medication to treat movements at night that disrupt sleep and parasomnias, which is abnormal behaviours in sleep. There are also psychological treatments like cognitive behavioural therapy for insomnia.

What do you enjoy most about your role?

I think sleep medicine is really fascinating. It’s a relatively new field in medicine and so there’s lots that we’re discovering all the time about what happens when we sleep.

I think it’s deeply rewarding to treat somebody with sleep problems. Often patients have been struggling with their sleep for years before they reach us, and that can really affect your mental health, and of course your broader physical health.

Sleep feeds into everything–- how we perform at work, our relationships–- so it’s deeply rewarding to be able to help somebody sleep better. They see the benefits not just in terms of their sleep, but in their physical and mental health, their work, their relationships, and every aspect of their life.

What inspired you to get into this work?

My background is as a respiratory doctor and lung specialist. Sleep medicine is interesting because we come from a lot of different professional backgrounds. It involves respiratory doctors, and that’s because we have traditionally treated sleep-disordered breathing problems. There are neurologists, who traditionally treat nocturnal epilepsy, parasomnias, and other neurologic sleep issues.

We have ear, nose and throat (ENT) surgeons, who are involved in the treatment of sleep apnoea when people, for example, may have enlarged tonsils, and psychiatrists, who tend to work alongside the neurologists, particularly in the treatment of insomnia disorder, post-traumatic stress disorder-related sleep problems, and parasomnias.

I come at it as a respiratory specialist. But at Royal Brompton Hospital we don’t just treat sleep disorder breathing, we treat all forms of sleep disorder, so my practice has expanded over 10 years and we've also trained in the delivery of cognitive behavioural therapy for insomnia.

Last year I was made President of the British Sleep Society, so I now lead our national work in sleep medicine. I love it because I get to work with a mixture of people from different specialties and from across the UK. I hope it will be beneficial for us as a partnership as well.

What are the benefits of working in partnership?

In my field of sleep medicine there are long waiting lists for diagnostic tests and treatments, particularly since the pandemic. There has also been a national issue with the supply of CPAP machines for treating sleep apnoea.

So being able to work across the partnership means that we can be much cleverer about how we utilise our diagnostic tests and our broader resources.

And because we can do lots of diagnostic tests at home and there are loads of different devices now coming onto the market, we can be innovative about how we test and treat patients so that we can get patients sleeping better more quickly.

As I mentioned because we are very much a multiprofessional specialty, we've got the advantage and unique positioning in the partnership in terms of the spectrum of specialists that we have available to us now.

One of the really lovely things that we’re doing across Guy’s and St Thomas’ NHS FT is multiprofessional meetings once a month, one in sleep apnoea and the other in complex sleep disorders. We all sit together and use the benefit of our expertise across the sites to help treat more complex patients.

I think what we’re able to offer now in sleep medicine across the partnership is probably not replicated anywhere else in the UK.

What would be your career top tips?

I would say a huge amount of it's about relationship building. There’s so much to be gained personally and professionally from building effective relationships with others.

I've gained so much personally in terms of my own development and knowledge in the field from talking to other people who come at the specialty from a different background. Additionally in terms of taking a broader national view, I have learnt a lot working on the national sleep outpatient pathway and leadership roles at the British Sleep Society and the British Thoracic Society. It’s being able to look up from where you work locally to understand the broader national picture–- I think it's hugely important.

It's very easy to get blinkered in terms of what's going on locally and the challenges, but if you can look up and see the national picture and start building relationships with people across professions and organisations, you find new ways of seeing old problems and new solutions present themselves. That is what keeps me motivated and has got me to where I am today.

Last year KHP interviewed Dr Hare to find out her top tips for a good night’s sleep, you can read the article here.