New report shows remote mental health consultations make care more accessible but are not the right solution for all patients

Published on October 11, 2021 by Simon Ellery

Clinician pictured in remote consultation with patient

Remote technology has transformed mental health consultations during Covid-19 but it’s not the solution for every situation nor for all patients.

Key stats

6,030 patients responded to the Trust surveys
554 clinicians that responded to the Trust surveys
The report included a synthesis of 77 papers from 19 countries

A new report has found the shift to remote mental health consultations held by telephone or video, rather than face-to-face because of the pandemic, led to improved access, reduced missed appointments, and reduced travel stress. However, it also highlighted challenges, including access to technology, issues around broadband connectivity and data packages.

The report, produced by the NHS’s Health Innovation Network, NIHR Applied Research Collaboration South London, King’s Improvement Science and involving experts by experience, South London and Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust and Oxleas NHS Foundation Trust, makes several recommendations to inform clinical practice and to determine ongoing gaps in knowledge.

Key findings from the 6,030 patients who responded to the Trust surveys on remote consultations in mental health settings were that they allowed the flexibility of varying levels of support during the pandemic, and care was more accessible to populations who may have previously found travel to appointments challenging and some patients felt more relaxed in their own home during the consultation.

From the 554 clinicians that responded to the Trust surveys, including psychologists, psychiatrists, psychotherapists and nurses, training to use technology was raised as a need for both clinicians and patients.

Patients, carers, and clinicians said remote consultations were more convenient, reduced travel time, saved travel costs and meant family members were readily able to attend family sessions. In particular, remote mental health consultations were acceptable to people during Covid-19 to continue their treatment.

However, there is no ‘one size fits all’ and an individualised approach will always remain the gold standard, especially for new patients and children, those with a psychosis diagnosis, learning difficulties or the digitally excluded. Other barriers to remote consultations included where patients or clinicians could not access a private space where they were confident they would not be interrupted.

The report includes three evaluations:

Two evidence reviews of research both before and during Covid-19 were conducted jointly with the NIHR Mental Health Policy Research Unit.
Thematic analysis of patient and staff surveys from across the three Trusts, which received 6,608 responses.

The results of an e-survey on 32 projects with a focus on patient and/or staff perspectives on experience.

“Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments. ”Dr Natasha Curran, Medical Director Health Innovation Network

Health Innovation Network Medical Director Natasha Curran said:

“Access to mental health services during Covid-19 has been disrupted as patients were isolated and clinicians were unable to hold face-to-face consultations. Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments.

“This study also shows that remote consultations don’t work for everyone for a variety of reasons: the nature of some patients’ condition, technological barriers, or privacy, for both clinicians and patients. This comprehensive report points to the benefits of a hybrid system, the importance of patient choice, where some consultations can be carried out remotely and others face to face, that could support vital ongoing mental health treatment both during Covid-19 and beyond.”

Delve into the report

See the full report on our website.

Click here to see the report

Deep dive into digital advance care planning

Published on September 21, 2021 and last updated on November 9, 2021 by Simon Ellery

What are the benefits of advance care planning using digital tools and how challenging is it to implement an effective system? In this Q&A discussion, NHS South West London CCGs Digital Urgent Care Planning Project Officer Lucy Colleer and NHS England Assistant Director for Enhanced Health and Care Homes and Care Sector Support Fay Sibley answer key questions in the aftermath of Covid-19 and its impact in care homes. The conversation centres on the advance digital care record, Coordinate My Care (CMC).

Photo above: Fay Sibley

Why is advance care planning and having a digital urgent care record important for care home residents?

Fay:

I think it's incredibly important that care home residents have a digital urgent care record. We know that care home residents are often in the end phases of life. Even those that aren’t, are living with often extremely complex health and social care needs. So to have a single place where information is recorded about their wishes and preferences as well as their medical needs, including their medication, diagnosis and CPR status means that we are able to look after care home residents in a more holistic way.

"I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves."Fay Sibley

It means that all of the health care professionals who are involved in that person’s care, and look after that person have access to information about that person. I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves. Or may not be well enough at the point in which they're accessing care to be able to advocate for themselves, or to put forward their needs and preferences.

Putting in place a system

To have that in a systematic way that's consistent and that everybody is familiar with, really does help them with transfer of care. This means we can make sure that we do meet those wishes and preferences and just means we can deliver the right care. Whether that's keeping somebody comfortable at home, or whether that's escalating and transferring them to hospital. If you can access that information, it allows you to consider that on a very individual basis.

Bitesize info

A series of short case study videos have been produced to demonstrate the value of individual patients having advance/urgent care plans brings to the wider health and care system.

Photo above: Lucy Colleer

Lucy:

We conducted a case study recently with a care home in Kingston, to look at how they were using CMC. How they got on with setting up CMC in the care home as well as getting their staff trained and using it. I think the biggest benefit, is that [CMC] puts the resident’s wishes first.

From a technical point of view, having a digital urgent care plan allows everyone to have access to the same information. It’s updated automatically, which means that you don't have to worry about bits of paper going out of date or going missing.

Saving time in an urgent situation

One of the things that the care manager we interviewed spoke about, was that it saved them so much time in an urgent care situation. In one instance, they had a resident who had a fall, and they called the ambulance service. Normally they would get phone calls from A&E saying, ‘What are the patient’s medical details?’, ‘What medication are they taking?’ But having it in that digital care record just meant that they didn't have to spend time printing documents, or taking those phone calls. And also for the staff in A&E as well, it was really helpful to have that information. Having an End of Life care plan really saves time and can strengthen decision-making.

It's just about putting the resident and the patient first. It also helps make life easier for clinicians who don't have an awful lot of time on their hands, and the care home staff as well.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

In July 2020, the HIN was commissioned to deliver a programme to increase use and quality of shared electronic advance and urgent care plans using Co-ordinate my Care (CMC). The programme concentrated on clinical engagement. Read about the Advance and Urgent Care Plans – London Accelerator

Fay:

I used to work for the ambulance service and one of the most difficult things was going to a care home in the early hours of the morning after being called to a resident. In one instance where this happened to me, the resident was acutely unwell, had a complex medical history and wasn't able to communicate. I was faced with trying to make an informed clinical decision with no access to information. Often at night in a care home they're operating with skeleton staff and, quite often, agency staff or bank staff because there are challenges in the care sector workforce. So they might not even be able to access patients records because they would be locked in the manager's office.

The problem with limited information

What we would know about that resident would be so limited that often as a paramedic, you end up taking people to A&E despite having concerns about whether the distress that course of action entails would justify the benefits. At that point it comes down to questions around what is “right” or “fair”, which are very difficult to answer as a clinician.

You are so limited to be able to make any other choice, because you didn't know their medical history. You didn't know what their wishes were. Nor which family member to call or who might have some more information about that person.

Seeing the info on an iPad

When paramedics first started to be able to access urgent care records we used to have to do that by phoning up the control centre. Amazingly, now paramedics can actually see it in real time on an iPad. But even when I left the service, you could call up the control centre and ask for that information. It just meant that you could make a different decision and you could justify that decision.

It was an informed clinical decision that was backed up and supported by the input of that person's GP. The input of that person's family, the input, hopefully, of that person themselves, as it allows you to make different decisions. And as Lucy said, a decision that really puts the person at the centre.

"There was real recognition that care needed to change quite quickly [because of Covid], and that those effects would probably be lasting."Fay Sibley

Bitesize info

The HIN, in partnership with the End of Life Care Strategic Clinical Network, secured funding from the NHS England (NHSE) personalisation team to work with Marie Curie nurses to create CMC records for care home residents in three nursing homes in south east London over a five week period. Read Increasing the number of care home residents in Lambeth supported by a Co-ordinate My Care plan

How is the HIN doing in terms of speeding up the spread and adoption of digital urgent care records in south London?

Fay:

The HIN has been working in this space for a long time, probably since the HIN started (in 2016) and more formally with CMC for the last two and a half years. Through a small pot of funding, through The Health Foundation, we were able to do a pilot project with about 10 care homes looking at different methods of getting care homes access to CMC. We also looked at the things that care homes would need to do in order to be able to access CMC. Either to view it or to put information into the record.

The challenges for care homes

From that project we learnt an awful lot about some of the process aspects of this that are challenging for care homes. Things like Information Governance (IG) requirements, the hardware requirements, having a laptop or a device to use and the Wi-Fi requirements. I think that learning has then helped us to try to move this conversation on.

Obviously in terms of the [Covid-19] pandemic, it changed lots of things. Particularly the work that care homes are doing and the focus being put on care homes by the Government. So at the beginning of the pandemic the HIN was really instrumental in trying to pull together various stakeholders who were looking at the key questions ‘How do we create records for care home residents?’ There was real recognition that care needed to change quite quickly, and that those effects would probably be lasting.

Collaborative working

The other thing we did was we worked with the End of Life Care Strategic Clinical Network to secure some funding and ran a small-scale pilot with Marie Curie. That was really interesting because Marie Curie had a number of frontline clinical staff who were shielding themselves because of the pandemic. Those staff were at risk of being furloughed and not able to work because they weren't able to do their frontline job. So what Marie Curie did was give them some additional training and upskilling. This meant they could support care homes to create CMC records for residents.

Working with care homes

We worked with three care homes in Lambeth, one GP practice and Marie Curie to deliver a small kind of, ‘proof of concept’ project around the use of CMC in a care home. We learnt lots. We realised that to create quality records remotely with another organisation that doesn't perhaps know that person or have access to all of their clinical information has its challenges. They were able to do a fantastic job in starting the record off, but they still required a fair amount of input from the GP. It was not a perfect model, but we learnt a lot from the project. It was really interesting to use voluntary sector organisations to support this work. In particular, organisations like Marie Curie that really have a lot of knowledge around end of life and advance care planning. And to use a staff group that otherwise, perhaps, wouldn't have been working during the pandemic and certainly couldn't do their main role.

Bitesize info

The HIN Healthy Ageing and Informatics Teams were commissioned to create a user friendly and useful digital maturity dashboard for care homes across London. This project was led by the Health Innovation Network and funded by the Digital First London region team.

Since then we've been doing a lot of work with Lucy and trying to support the coordinated pan-London effort around care homes and CMC. So it's absolutely brilliant to see this is on the commissioners’ radar and the work that Lucy’s doing. Lucy's pulled together a steering group that now meets monthly, and the HIN is also trying to help with some of the analysis of the data.

A dashboard for care home digital maturity

We've developed a Care Homes Digital Maturity Dashboard. This is a tool to be able to monitor each care homes maturity status, in terms of their digital abilities. A key part of that for London care homes is CMC. 'Do they have access to CMC?' 'Do they have the right IG requirements that allow access to CMC? 'How many residents in their home have CMC?' We’re pulling all of those data sources together and presenting that information in a way that's useful to Lucy and other colleagues across London working in this space.

I think the HIN’s moved more into a supportive role, trying to share the lessons that we've learned from some of the early work. And then really letting the commissioner drive it forward in a way that we don’t have the reach to do.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

View the collection of resources. Coordinate My Care has provided a wealth of info to support the patient-led portal to create an end of life care plan. MyCMC: your plan, in your own time, in your own home

How many digital urgent care records have been created through CMC?

Lucy:

It’s in the region of thousands (see chart below). There are lots and lots of residents who do have care records, so the focus of our pan London work at the moment is actually getting care home staff themselves to look at those records. At the moment the majority of those records are created by the GPs and sometimes in the acute trust. So we're trying to encourage care home staff to start looking at those resident plans and keep them up to date.

The power of data

We have been working really closely with Fay and the HIN and I would say that the HIN has been more than just support. We're trying to lead the way from where you paved the way and the Care Homes Digital Maturity Dashboard is really, really helpful especially from a commissioning perspective because we can look at how it's affecting the ambulance call-outs and the conveyance rates and use the information to make commissioning and transformation decisions. From a commissioning point of view, obviously patient-centred care is the most important thing, but financial return on investment is important too. It’s been really great to be working with it with the HIN and supporting work that Fay and the team have been doing.

Fay:

I think the other thing that's really helpful is about data, and CMC actually produce a fair bit of data. Again we could debate the data set of course we could, but they do produce a commissioners’ workbook, again on a monthly basis. One of the useful things about data is it allows you to look at different areas and make those comparisons.

Incentivising GPs and the role of the ICS's

For example in south London, south west London do particularly well in terms of the number of CMC records they’ve created. So you can look at some of the models that they've put in place over the last, let's say five years, that have really led to that. For example they incentivised GPs to do some of this work, so you saw a really big increase in that they've got a really established enhanced health and care homes programme and End of Life care programme within their Integrated Care System (ICS).

Again, they're really driving that work forward from a ICS strategic point of view, so having data allows you to look at factors such as where’s doing well? And ask questions like 'What are they doing?' 'Who’s lagging behind and 'what might be the reasons for that?'

The quality of the record

And then one of the other things that the HIN has really been focusing on is thinking about the quality of the record. Creating a record is one thing that's really important, but the record is only really as good as the information that's in it. 'How do I make sure that the information that I include in that record is of quality and is useful?' 'Does it make sense as a kind of complete picture?'

The HIN developed a checklist of the non-mandatory information that would be most useful to clinicians. And then from that we've done some work with south west London to try to refine that. Again, we pulled together a steering group with various clinicians from south west London to look at how can we use something like a checklist to drive up and standardise the quality of CMC records. This is so they are a useful, high quality, advanced care planning record.

"Creating a record is one thing that's really important, but the record is only really as good as the information that's in it."Fay Sibley

What would you say has been the biggest challenge in setting up more CMC records?

Fay:

I think capacity of the workforce to really do this, is the biggest challenge. As Lucy said, at the moment the vast majority of CMC records for care home residents are created by GPs. But GPs are an incredibly over-stretched workforce and it's not a quick five-minute job. It can take up to an hour to really have a meaningful conversation and then translate that into a record and publish that record. When you start talking about thousands of records across London, that's thousands of hours of GP time.

Who else can support the programme?

But I think the thing that may help us around that is understanding who else within the primary care and community services workforce can support this work. Care homes themselves absolutely play a vital role and can feed into the record and do some of the data entry and have the conversations, but also, say, palliative care teams often do this kind of work; hospices, they've got brilliant teams that can support with this. Voluntary sector organisations; Macmillan, Marie Curie and GP practices are now starting to grow their workforce. Through the Primary Care Networks, we've now got paramedics working in GP practices. We've got highly skilled nurses that are really, really knowledgeable. There is a growing pool of professionals who could support the creation of urgent care records.

Getting patients and their families involved

We’ve also got an opportunity through MyCMC potentially as well which is something that was set up to be a patient-led record. Somebody would initiate that record for themselves, and there are roles within a GP practice where that could be a supported process, so social prescribers for example have the potential to be able to support somebody, even living in a care home, to initiate that record. People have a bit more agency. This includes setting up a record in mental health care homes and learning difficulty care homes. It may be appropriate sometimes to use MyCMC.

Lucy:

I take your point on capacity in terms of creating and maintaining those care plans. Once the plan is there, it’s fairly easy to update and maintain it and we've seen that with some of the care homes that have been using it. They include it as part of the weekly rounds when the GP comes along, they include it at the Multi-Disciplinary Team (MDT) meetings that take place. And actually it's not too much work once the initial plan is filled out. In some of the more successful care homes using CMC the biggest thing, is just being engaging with them, and that's quite difficult to do from a commissioning perspective.

Resource challenges

I work in a very small commissioning team of just two. We’re covering the whole of London, including all health and care organisations across London. So between us, it's very difficult to do that engagement. CMC does have a very strong engagement team, and they are successful, but they're still quite a small team for the whole of London. Some of the more successful care homes have been the ones that the CCG has provided resource, such as project support officers that have literally been hand holding those care homes to support them with all sorts of digital maturity aspects, like the Data Security and Protection Toolkit (DSPT) compliance and also, they've been really helpful with getting the care homes access to CMC.

I think engagement is one of the biggest success factors, but also a huge challenge. I think there's such a variety of resources across London. I know some STP's simply just don't have the resource to hand hold care homes with it.

Care homes 'left behind'

I think care homes have been left behind a little bit in terms of digital maturity. That's one of the key things - being able to have access to a computer, good internet, the IG (Information Governance) - all in place. I think that they've been a bit left behind. I don't know what the historical reasons behind that are, but I think the digital maturity side of things is a big challenge for some care homes, especially the smaller ones.

Fay:

I would agree wholeheartedly with that around the kind of digital maturity aspects.

And I think there's lots of reasons. Obviously, many of them are private providers. Historically, social care hasn't received the same level of funding as the NHS. It perhaps hasn't been seen as a priority or our job.

Equality of access to care

But I think when we talk about and think about equality of access to care and the world that we now live in, and the fact that many health services have been forced to, at least in some ways, move to a more virtual remote delivery then actually it's no longer the responsibility of social care alone because we're denying people access to the care that they have a right to.

I think that's probably why there is such an increased focus throughout the pandemic on getting care homes up to that basic level of digital maturity; that same digital standard that we would expect of our NHS. It's not easy, and I think one of the reasons we started the dashboard was because at the beginning of the pandemic, what we didn't know is what we didn't know (i.e we didn't know whether this home in Southwark had Wi-Fi even, or if they even had a laptop and that information wasn't anywhere). There were no agreed datasets around the care homes. There was no kind of central repository to go to and just put in the care home name and it will bring that up, so we didn't even know how to support them, because we didn't know what they had to start with. So that's part of the reason we initiated that dashboard work because we were like how we can support the central government functions - health and social care, public health and other involved organisations?

This was a joint interview that took place remotely in April 2021.

NB: Fay Sibley was speaking in her previous role as the HIN's Head of Healthy Ageing.

Table showing number of care home residents in London with a CMC plan

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Hospital staff use ‘nudge theory’ to boost health and wellbeing during Covid-19

Published on July 27, 2021 and last updated on September 20, 2021 by Simon Ellery

Featured on BBC London TV news and in the Revealing Reality-produced film above, King’s College Hospital (KCH) has adopted the HIN’s behavioural science workforce support campaign #OnlyHuman to help prevent staff burnout caused by the pressures of the Coronavirus pandemic.

Key statistics

King’s College Hospital NHS Foundation Trust employs over 11,000 staff.

Hundreds of staff at King’s College Hospital have embraced ‘nudge theory’ to help protect their wellbeing during the pandemic.

The hospital has become the first to adopt a workforce-wide campaign called #OnlyHuman that uses behavioural insights to prompt frontline staff to take action that helps protect their physical and mental wellbeing. The move comes after King’s trialled the campaign last year and emergency and critical care teams reported a positive impact during a highly challenging period during the pandemic.

The campaign takes a peer-to-peer approach to prompt staff, who sometimes struggle to identify
signs of stress in themselves, to spot early signs of strain within colleagues and use these tools to then take simple actions. These include check in with colleagues regularly to make sure they’re taking breaks, drinking enough water, implementing brief huddles before and after shifts and simply showing kindness to each other.

Behavioural experts maintain that if staff can are prompted to use these behaviours, this creates a ripple effect because social cues reinforce the behaviours and embed them into the workforce.

Devised at pace over eight weeks in response to Covid-19, behavioural insight specialists worked in conjunction with healthcare professionals across multiple trusts to identify key themes to address. The themes included: Checking in, Recharging, Managing Uncertainty, Warming up and down and Kindness.

This was a joint project between behavioural research specialists Revealing Reality and the NHS’s Health Innovation Network, funded by The Health Foundation.

Dr Claire McDonald, Principal Clinical Psychologist and Lead Psychologist for Staff Support at King’s College Hospital, said:

“The Covid-19 pandemic has been an unprecedented time for our frontline health and care staff. Staff have worked tirelessly to care for patients including those who have been critically ill. There is also the broader context of fear and uncertainty about the risks and evolving situation, coupled with an erosion of our natural ways of coping due to restrictions.

“This understandably takes a toll, as we are ‘Only Human’. That’s why we rolled out the campaign, as one strand of our KCH staff support offer, to encourage staff to look after themselves and each other through various tips and simple measures. We brought the campaign into our Wellbeing Hubs and many teams and departments including Emergency and Critical Care. To provide the very best care to patients our staff first need to be well resourced. Extra levels of stress require extra levels of self-care and looking out for each other.”

KCH’s Christine Brown Intensive Care Unit (ICU) Team Leader Mairead Trant said:

“I think this is a fantastic initiative to help frontline staff cope with the emotional strain that sometimes comes with the work we do. It’s important that we take time to look after ourselves and each other and reflect on what happens each day.

“By taking time to talk to someone you trust, it can help greatly to ease the stress and improve mental wellbeing. This initiative really focuses on this theme and will have huge health benefits for staff.”

“I think this is a fantastic initiative to help frontline staff cope with the emotional strain that sometimes comes with the work we do.”KCH’s Christine Brown Intensive Care Unit (ICU) Team Leader Mairead Trant.

Health Innovation Network Programme Director in the Patient Safety and Experience team Catherine Dale said:

“It’s great that King’s College Hospital staff found our #OnlyHuman campaign useful during Covid-19 and have since adopted it.

“When the pandemic hit we recognised the emotional toll it was taking on healthcare staff. Behavioural insights – also known as ‘nudge theory’ – encourage people to act in helpful ways. We applied this approach to develop a suite of materials to help healthcare professional support each other during these enormously challenging times.”

Further information

Download the #OnlyHuman resource pack today.

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Community-led health clinics – mass screenings across south London

Published on July 15, 2021 and last updated on September 17, 2021 by Simon Ellery

This video provides an update on a 2019 Innovation Awards grant funded project to host community-led health clinics.

Called ‘Stroke Busting Health Checks’, the project aimed to provide various health checks for up to 1,000 people at greatest risk of stroke and other conditions in Wandsworth.

This co-produced, community-led scheme saw the NHS partner closely with faith and community groups, led by Wandsworth Community Empowerment Network, to use mobile ECG devices to test people for irregular heart rhythms (a warning sign for stroke) and offer wider health advice.

The health checks included Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index.

It also provided an opportunity to talk about the risk of smoking, including the direct link to stroke.

Hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic communities at substantially higher risk of poor health and early death, including due to stroke.

Traditional NHS approaches aren’t working well enough – these communities are less likely to attend NHS health checks, despite being the most at risk. Therefore, this team worked in an innovative new way to go to these communities and work alongside local leaders to engage people.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic communities at substantially higher risk of poor health and early death, including due to stroke.

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Scaling up diabetes services in south London through partnerships, innovation and supporting choice

Published on May 7, 2021 and last updated on June 17, 2021 by Simon Ellery

The story of how south London transformed diabetes care for up to 300,000 people is one of care moving from niche to mainstream. The HIN’s Diabetes theme Clinical Director Dr Neel Basudev charts successes across 12 boroughs.

Here is a letter I recently received in the post.

I want to change and transform the care for a disease across a vast geography. I have about 180,000 people that I need to improve things for and probably a further 275,000 who are at risk of this disease. I need to get things moving from an almost non-existent baseline across the entirety of south London. I need to improve lots of things like outcomes, pathways and patient experience. I have tried calling the A-Team but they were engaged, who can I contact to make this happen and has this ever been done before? Help!

Okay, so I made the letter bit up, but if you want to know how this can be done, then I may be able to help. I am always singing the praises of the diabetes workstream at the NHS’s Health Innovation Network (HIN). Apart from the obvious bias of being Clinical Director, I think that the story of diabetes transformation is one that needs to be told. I was lucky enough to get the chance recently at our flagship conference – Diabetes UK Professional Conference.

Scaling up services for the whole of south London

My role here began in 2016. There was already good work happening at the HIN, but it never got the traction it deserved across the vast geography of south London. I was lucky that my starting coincided with regional and national transformation work and funding. The HIN acted as a glue for south London and helped with much of the bid writing, coordination and then onward management. We soon moved on from niche to mainstream.

The kick-start to a lot of this was type 2 diabetes prevention which brought together south east and south west London colleagues in a unified way. We started from the non-existent baseline I have already mentioned in my fictitious letter. That was the partnership, networking and contacts ticked off. We built a strong base of relationships and people got a sense of what we could do and what we could bring to the table.

It was a no brainer when national funding trickled its way into south London that the HIN would help transformation work and build on this impressive start. The next big thing was structured education. This required a complete revamp: a new system, new referrals, a referral hub, make things easy, better data gathering and flow. It was a big ask, but we did it and launched in October 2018 with Diabetes Book and Learn.

Choice in the NHS is a rare commodity

Geographical boundaries were broken and people were accessing support by exerting choice. Choice can be a rare commodity in the NHS. We don’t like choice. What if people choose the wrong thing? That’s like me saying to the kids “listen to me, I’m your dad” – so instructional rather than offering advice and choice. It turns out that people with diabetes like choice and choice helped them get more support for their diabetes.

Building on that, we then moved a bit more into innovation with our NHS Test Bed project called You and Type 2. This married up several different innovators and their offerings to plug a vast care and support planning hole in diabetes care. It has been going strong since 2018 with six boroughs involved, hundreds of health care professionals trained and thousands of care plans done. There is much more that we can do with it and as you can hopefully see, we are not ones to rest on our laurels. We are looking into better integration across primary and secondary care and remote monitoring.

I am really proud of everything the HIN has helped to do for diabetes care in south London and equally excited about the future. For those of you old enough to remember…the future is bright, the future is green. Or is that lime green? With a bit of blue and purple. Watch this space.

HIN Diabetes theme

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Modern telephony promises to transform the patient experience – but the marketplace is daunting for commissioners

Published on April 22, 2021 and last updated on April 22, 2021 by Simon Ellery

Clinician with mobile phone and computer

New telephony systems mean a revolution in the patient experience as part of the shift to ‘Total Triage’. But the wealth of systems on the market means GP surgeries face a daunting challenge identifying the right system, says Denis Duignan, the HIN’s Head of Digital Transformation & Technology.

Covid-19 has highlighted the inadequacies of traditional telephone systems in primary care. Patients waiting to get through on the phone, having to manually search for patient records and GP’s working remotely were all issues that have highlighted the shortcomings. But new systems help manage demand, enable remote working and improve the patient experience.

The promise of modern telephony is a transformed patient experience. However, with a multitude of systems on the market offering a range of different and complex packages, the decisions facing practices and Primary Care Networks (PCNs) keen to take advantage of new technology in this field are daunting.

The Health Innovation Network (HIN), working with Our Healthier South East London, has produced a ‘Commissioner’s Guide to Telephony’, which explores the primary care telephony market and aims to support better decision making for GP practices, federations, and primary care networks looking to upgrade or migrate their telephony solutions.

The inadequacies of traditional telephony

In 2019, poor telephone systems were identified as one of the key areas affecting patient experience and access to local primary care services within the London borough of Lambeth. The south east London Digital First Programme set out to improve primary care telephony through local healthcare, patient and industry stakeholder engagement which led to a workshop that stimulated many general practices to upgrade their systems. Whilst the learning from this was being consolidated, Covid-19 broke out across England. This very quickly highlighted the inadequacies of traditional telephone systems in facilitating an effective move to ‘Total Triage’ and remote working for clinical and non-clinical staff.
Many GP practices still use traditional phone systems, which consist of an on-site private branch exchange (PBX) which connects through fixed lines to the public switched telephone network (PSTN). This system has limited functionality and flexibility compared to more modern voice over internet protocol (VoIP) telephone systems.

What is Voice Over Internet Protocol?

Also called IP telephony, VoIP is defined as a method and group of technologies for the delivery of voice communications and multimedia sessions over Internet Protocol networks, such as the Internet. Some of the key areas where VoIP telephony has been seen to benefit primary care include:

Clinical system integration: The incoming caller’s patient record can be automatically ‘popped’ on screen, and calls can be made directly from the patient record using click-to-dial, streamlining the receptionist’s workflow.
Live call reporting and dashboards can enable practice managers to identify busy times and manage their workforce accordingly.
The ability to customise the phone system through an online portal giving practice managers control over auto-attendant/interactive voice response options so that they can route their calls in a way that suits their individual practice.
The flexibility of VoIP telephone systems enables them to be configured for different ways of working including central hub models and remote working using staff mobiles or telephony software on their laptops to receive and manage calls. The Commissioner’s Guide to Telephony provides further detail on the features and benefits of modern telephony systems.

The supplier market is large and complex

Another key area of guidance included in the report is in navigating the supplier market. The hosted telephony market in the UK is large and complex and comprises a diverse range of businesses from small family-run providers to large multi-national corporations, including both original equipment manufacturers and resellers. Understanding the capabilities of suppliers can be challenging for non-technical customers due to the number of acronyms, abbreviations, and jargon used and it is generally difficult to differentiate suppliers based on capabilities due to the range of add-on services a company can incorporate within their offer. In an effort to simplify the market for primary care, the guide includes a functional comparison of suppliers with primary care focussed products.

Practices that have adopted modern telephony systems have been overwhelmingly positive about the impact it has had on service delivery relative to their previous systems. This commissioning guide can assist other practices looking to update their telephony and realise the benefits of modern telephony.

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St George’s Hospital unveils dual electronic queue management and self check-in

Published on April 9, 2021 and last updated on April 9, 2021 by Simon Ellery

St George’s University Hospital Emergency Department unveils one of UK’s first dual queuing and self check-in system where patients see real time updates of their queue position on TV screens and smartphones.

HIN Innovation Grants supported project

St George’s installed the system after winning a HIN Innovation Grants award in 2019

St George’s University Hospital is one of the first Emergency Departments in the UK to introduce a dual queuing and self check-in.

Patients in the ED can map their queue position through real time updates on TV screens and smartphones.

In a move that reassures patients that they have not been missed or bypassed, the new system called “Patientcheck.in” helps free up emergency reception staff who handle a high volume of questions from patients about their wait and queue position. This has a knock-on delay in booking in new patients. Patientcheck.in – previously called “EDck.in” – also allows patients to complete a brief assessment questionnaire while they wait, using their own smartphone, which saves time during the assessment.

The technology aims to reduce patient anxiety around waiting times and improve efficiency.

Funded by the NHS’s Health Innovation Network, a joint Emergency Department and Transformation project team at St George’s was awarded £9,928 to design and build the software system and install TV monitors in the waiting areas.

Previously, a whiteboard behind the reception desk was used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This can lead to repeated queries to reception staff about the waiting time and occasionally result in aggressive and abusive behaviours which puts additional pressure on staff.

The second function – the assessment questionnaire – has three major benefits. It empowers patients to tell clinicians why they are in the ED, in their own words using a non-verbal communication channel; reduces clinical administration workload and creates better quality, standardised medical documentation.

Through its integration with Cerner, the hospitals’ electronic health record system, Patientcheck.in sends the questionnaire responses directly into the electronic clinical notes. This reduces note-typing time by around eight minutes per patient. Therefore, if just half of St George’s 400 ED daily attenders complete Patientcheck.in, this equates to a potential saving of more than 26 hours of clinical time every day.

The Health Innovation Network grant was used to develop and implement the system. Now live, the team hope that Patientcheck.in will be adopted by other NHS Emergency Departments. There is also an opportunity to use it in outpatient departments and development projects are underway.

Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust, said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.
“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.”Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust

Health Innovation Network Programme Director for Innovation Lesley Soden said:
“Hospital emergency departments can often be highly volatile as by their nature they have anxious patients waiting to be seen. Those patients often worry that they have been missed or passed over by other patients and this can lead to repeated questions to hard pressed reception staff, who are then preventing from getting on with their work to triage.
“This is a simple system using existing technology that can improve the patient experience, free up reception staff to focus on registering arriving patients and ultimately lead to faster care in hospital emergency departments.”

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St George's Patientcheck.in

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Sara Nelson named as new Deputy Chief Nursing Information Officer for NHSX

Published on January 14, 2021 and last updated on January 15, 2021 by Simon Ellery

DigitalHealth.London’s Sara Nelson, who leads the flagship Accelerator and Digital Pioneer Fellowship programmes, joins NHSX.

Sara Nelson has been announced as the new Deputy Chief Nursing Information Officer for NHSX.

Sara is a Registered General Nurse who has worked in the NHS for over 29 years. She has a wealth of experience in operational and digital nursing leadership having undertaken a number of roles including senior nurse for digital at Guy’s and St Thomas’ NHS Foundation Trust.

More recently Sara has undertaken leadership roles at DigitalHealth.London as an NHS Navigator, Programme Director of the Accelerator and most recently as the Deputy Programme Director of DigitalHealth.London leading the Digital Pioneer Fellowship.

The Digital Pioneer Fellowship supports 37 frontline NHS staff delivering transformation projects through digital innovation. Under Sara’s leadership, both the Digital Pioneer Fellowship and the Accelerator programme, achieved an increase in applications. The Accelerator also experienced an increase in applications from digital innovators identifying as BAME and was recognised as one of the top eight Accelerator programmes for women founders in Europe.

She has been widely recognised as a digital health leader speaking at conferences, writing thought leadership articles and above all building and supporting teams of NHS staff.

Sara has achieved her Post Graduate Diploma in Digital Healthcare Leadership through the NHS Digital Academy and is currently undertaking her MSc dissertation to identify the key factors for a successful CNIO.

Dr Natasha Phillips, Chief Nursing Information Officer at NHSX, said:

“Sara’s appointment by NHSX is another important milestone in the establishment of a strong nursing and midwifery digital leadership community – one which is vital to ensure a nursing and midwifery voice at all levels of digital transformation across the system. The breadth of experience and track record across digital innovation that Sara brings with her is outstanding and I am delighted to welcome her to the team”

“I feel privileged to take up this role working as part of NHSX with the CNIO Natasha Phillips and the CNO team to shape the future of nursing at this pivotal time.”Sara Nelson

Zoe Lelliott, Chief Executive at the Health Innovation Network, said:

“We’re delighted for Sara and know she’ll be brilliant in this well-deserved role.”

Sara Nelson, Deputy Chief Nursing Information Officer at NHSX, said:

“This new national Deputy CNIO role signifies the growing recognition of nursing and midwifery involvement in digital health. I feel privileged to take up this role working as part of NHSX with the CNIO Natasha Phillips and the CNO team to shape the future of nursing at this pivotal time.

“I am one of the many nurses and midwives who did not have computers or technology, as we now know it, when we started and I have seen real benefits to staff and patients, when technology is brought in correctly and is well designed with consideration of patients and staff. This has led me to move away from the traditional nursing leadership roles and towards increasing my understanding of technology and the commercial sectors – growing my knowledge of the barriers and opportunities we can elicit.

“I am looking forward to understanding how we can work together nationally, regionally and in our organisations to bring together that collective voice that listens and learns and is not afraid to speak up.”

Sara will take up her new role part time from 11 January and full time from March.

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Thousands of Londoners to benefit from digital urgent care plans

Published on December 17, 2020 and last updated on December 17, 2020 by Simon Ellery

Shared digital care records mean care home staff, paramedics and hospital emergency department staff know patients’ health and care wishes.

The stats

Over 115,000 Londoners already have a digital urgent care record

Thousands of Londoners will have a greater say over their care and treatment under a £200,000 drive to increase the use of a shared urgent digital care record for ambulances, emergency departments and other urgent care services.

The NHS’s Health Innovation Network (HIN) has won funding to roll out Coordinate My Care (CMC), which ensures health and social care professionals have access to patients’ urgent care plans. Covid-19 has brought into sharp focus the need for patients to set out how they want to be cared for with many preferring to stay at home rather than go into hospital.

Gloria Goldring created her own CMC care plan after a stressful end of life experience when her husband David was critically ill at a care home. He suffered from dementia and despite both agreeing that he did not wish to be resuscitated in a critical emergency, Gloria was told by paramedics that without paperwork to prove his end of life wishes, they would resuscitate David in the ambulance if needed.

“It was a big shock to me because this was something David and I had discussed many years ago and I just felt completely at a loss’, said Gloria Goldring.

Fortunately the trip to the hospital was just five minutes, David did not deteriorate and after Gloria explained to hospital staff that David had said he did not want to be resuscitated, this wish was accepted.

“So when CMC was introduced as a way to be able to flag this up I thought this was absolutely essential for people to understand. I think there is no doubt if we had a plan it would have been flagged up. This would have lessened the stress that I was under because I was in a very terrible state.”

Having already supported over 115,000 Londoners to date, a Coordinate My Care plan puts the patient at the heart of planning their future medical care. The care plan is designed to share the most important, up to date clinical information about the patient, including who to contact in an emergency. This information is then shared with all the health and social care professionals involved in treating them, such as 111, out-of-hours GPs, the London Ambulance Service and hospital emergency departments.

“Helping patients across London to better express their wishes about their care is very important at this time. We are extremely pleased to have this opportunity to work with Coordinate My Care and our NHS and care system colleagues to not only improve the quality of digital urgent care records but speed up the adoption and spread of this technology. ”Zoe Lelliott, Chief Executive of the HIN

The HIN will work closely with NHS and care system colleagues across London to identify a project in each of the five Sustainability and Transformation Partnerships (STP) areas to accelerate the adoption of CMC to match local priorities and address local opportunities. The scheme will fund local clinicians to focus on championing CMC with their peers and clinical colleagues and help to embed CMC in local care pathways and processes.

Zoe Lelliott, Chief Executive of the HIN, said:
”Helping patients across London to better express their wishes about their care is very important at this time. We are extremely pleased to have this opportunity to work with Coordinate My Care and our NHS and care system colleagues to not only improve the quality of digital urgent care records but speed up the adoption and spread of this technology.

“HIN seeks to speed up spread and adoption, so where innovations like digital urgent care records have been shown to be effective, we believe that it’s important to work with our NHS and care colleagues to adopt this technology to better meet patients’ needs.”

Professor Julia Riley, Founder and Clinical Lead for Coordinate My Care, said:
“As the coronavirus pandemic continues, we are hearing that many patients and families are talking about difficult futures, challenging decisions and appropriate treatments. This partnership with the Health Innovation Network means that health care services across the community will be supported to encourage increasing numbers of patients to have a digital CMC record, to ensure their wishes are recorded, to better their outcomes and to support the urgent care services.”

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2021 is the year to Think Diabetes in the Workplace

Published on December 8, 2020 and last updated on December 11, 2020 by Simon Ellery

Diabetes is one of our biggest health challenges so is it time to embed specialist education to combat this life-changing condition into the workplace? Rod Watson, Senior Project Manager for Cardiovascular Disease and Diabetes at the Health Innovation Network (HIN) sets out four easy steps to help Human Resources Directors and Occupational Health Managers, truly support employees with diabetes as we prepare for 2021.

Employers have an incentive to keep their staff safe and happy at work. As we know a healthy and happy workforce is a productive workforce. For workers living with a chronic health condition such as Type 1 or Type 2 diabetes, their condition is something they must manage daily and of course while at work. There are ways to support your staff to manage their diabetes and structured education programmes are part of the solution.

So how does structured education work? Diabetes structured education programmes aim to improve knowledge, skills and confidence for people with diabetes. It is proven to increase their ability to manage their condition and is recommended by the National Institute of Health and Care Excellence (NICE). This means structured education is clinically proven to help people with diabetes make positive changes to their diet and lifestyle.

There are several accredited providers of diabetes structured education in the UK and below are the ones that I have worked with and can recommend.

So how might you go about supporting your staff with diabetes to get access to structured education?
These four simple steps will show you how.

1. Be aware of the Equalities Act (2010) and be prepared to make reasonable adjustments for your employees
Diabetes is covered by the Equalities Act (2010) which means employers are obliged to make reasonable adjustments for staff. Reasonable adjustments can vary from one person and situation to another based on the individual’s needs and the those of the employer. An example of a reasonable adjustment could be allowing your staff with diabetes time away from work to attend a structured education programme.

2. Review your company’s relevant policies

I have worked with several organisations who updated key policies to make it easier for staff to attend structured education. Their case studies are detailed in this report entitled: Think Diabetes: Supporting a Cultural Shift in the Workplace. Does your organisation have a health and wellbeing strategy for staff? If so, you are ideally placed to adopt activities as suggested in the next steps.

3. Commission online and/or face-to-face diabetes structured education programmes via your workplace

There are several NHS approved providers of diabetes structured education I can highly recommend. For online programmes, Second Nature and Oviva are national leaders. Both providers have a strong and well-established relationship with the NHS. They offer programmes for people with Type 2 diabetes ranging between eight and twelve weeks.

Course sessions are delivered remotely via a coach with access to online advice, support and information. Participants use their phone, laptop or tablet to access the programmes remotely via the internet and via calls on a telephone at times convenient to them.
DESMOND is a national provider of face-to-face diabetes education. Trained facilitators can run sessions at your workplace which has the added advantage of peer support among staff within an organisation. A DESMOND session is usually one day or two half-days in length.

4. Support access to and encourage attendance at diabetes structured education programmes

How does all this look in practice? Following the steps above, Transport For London and the London Ambulance Service took part in an initiative supporting their staff with Type 2 diabetes accessing structured education.
The results were overwhelmingly positive. Not only did participating staff find it acceptable to be offered and to attend structured education at work, or via the workplace, they viewed their organisation’s support to help them to manage their diabetes very favourably indeed.

A full evaluation report of this initiative, including a range of recommendations for further action can be read here. A two page summary of this evaluation can be read here.

I strongly encourage you to download the Think Diabetes resources for more detail on these exciting initiatives. If you have any questions or comments about how you can further support your staff with diabetes in the workplace, please drop me a comment or message.

South London drive to detect and treat irregular heart rhythm helps prevent an estimated 100 deaths and 400 strokes

Published on November 26, 2020 and last updated on December 15, 2020 by Simon Ellery

Use of hand held devices to test for irregular heart rhythm in GP surgeries, care homes and religious settings is helping prevent strokes and saving lives.

The stats

Since the start of the programme, the number of additional people with AF receiving treatment each year has increased by almost 300,000 nationally.

New NHS figures reveal that a four year south London programme to improve the detection and management of an irregular heart rhythm known as Atrial Fibrillation (AF) is estimated to have helped prevent 400 strokes and saved 100 lives. These figures are based on modelling and a calculated reduction in risk.

In addition, the NHS’s Health Innovation Network in south London initiative over the last four years has reduced costs associated with strokes and deaths linked to AF by an estimated £5m and lowered social care costs by £4m.

AF is the most common type of irregular heart rhythm and is a major risk factor for stroke because it makes it more likely that blood clots will form in heart chambers and reach the brain, which contributes to 1 in 5 strokes and is associated with an increased rate of mortality. It is estimated that 1.4 million people in England have AF but nearly a third of these cases go undetected, and people with a diagnosis don’t always receive treatment, resulting in potentially avoidable strokes.

The programme consists of on-the-spot AF checks by clinicians in GP surgeries, care homes and ‘virtual clinics’ in community settings such as churches, mosques and Hindu temples using handheld devices.

Shan, aged 57 from Wimbledon and a worshipper at the Shree Ghanapathy Temple in south London, had his heart rhythm checked as part of a ‘mass screening’ earlier this year. He said:
“Today I had my blood pressure and heart rate checked. Everything is normal so I’m glad to hear that. This is a good thing so you can reduce the risk. We don’t have regular health check-ups but today we were able to see if we have anything wrong.
“My family back home and relatives have had heart attacks and diabetes. So this is also good for our peace of mind.”

AF is the most common type of irregular heart rhythm and can increase risk of stroke, leaving survivors with disabling consequences. Around 200,000 people in the UK develop AF each year. Detecting AF early and making sure people are given optimal treatment – usually blood-thinning medication to prevent clots (anticoagulants) reduces the risk of stroke by two thirds. It’s estimated that the impact of newly treating 70 high risk AF patients is up to three strokes prevented, saving the health system £37,000 in the first year.

This is part of an NHS programme, delivered by the AHSN Network in England. Nationally, this is estimated to have saved the NHS £158m and £105m in social care costs.

Since the start of the programme, the number of additional people with AF receiving treatment each year has increased by almost 300,000 nationally.

“A stroke can be devastating both physically and psychologically for patients and their families.”Oliver Brady, Programme Director for Diabetes and Mental Health at the Health Innovation Network

Oliver Brady, Programme Director for Diabetes and Mental Health at the Health Innovation Network in south London, said: “A stroke can be devastating both physically and psychologically for patients and their families. Yet with the new digital tools available we are able to detect and manage AF and ensure that fewer lives are lost and people with the condition can continue to live normal lives.
“The HIN will continue working with its local partners to proactively go into high impact settings to carry out these vital health checks.”

Professor Gary Ford, Chief Executive of Oxford Academic Health Science Network and Consultant Stroke Physician said: “Identifying people who have AF and ensuring they are provided with the most appropriate anticoagulant therapy can significantly reduce their risk of having a stroke.

“The work we have undertaken with our partners in primary care, alongside others in both the NHS and charity sector, has prevented thousands of people having a stroke. The latest data also shows that these measures have resulted in significant cost saving to the NHS and social care, with £158 million and £105 million saved respectively”

Between April and December 2018, Guy’s and St Thomas’ carried out a total of 590 pulse rhythm checks in its community podiatry clinics using Kardia devices.
GSTT community podiatrist Monica Fisk said:
“We detected 27 people with possible AF, these patients were referred on to their GP for a 12-lead ECG to confirm the diagnoses and to initiate anticoagulation treatment where indicated. The prevalence rate in our community podiatry clinics was 4.6 per cent or 1 in 22 people tested. This is higher than what is found in the general population as we tend to treat patients at higher risk of the disease. I therefore feel podiatry clinics are good settings for identifying undiagnosed AF and this opportunistic testing was well received by our patients.”

One GSTT patient said: “I never expected to attend the podiatry clinic for a foot problem and be identified as having possible AF. If it wasn’t for that appointment I don’t know what could have happened. My GP has now placed me on anticoagulation therapy and I am ever grateful to the podiatry service for going above and beyond.”

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Keep moving to manage pain

Published on November 16, 2020 and last updated on November 16, 2020 by Simon Ellery

Clinician working with woman with back pain

Post Title

Musculoskeletal (MSK) conditions such as osteoarthritis and chronic low back pain affect over 18 million people across the UK. These conditions can cause pain and functional limitations, as well as impact on our mental health, which can make ordinary, everyday activities a struggle and prevent us from being able to work or remain independent. Sally Irwin, a Project Manager for the Joint Pain Advice service in the Health Innovation Network, considers the benefits of simple self-management strategies, such as being active, in preventing and managing what can be a life-changing condition.

People often have the view that they can’t do much about the symptoms of osteoarthritis and chronic low back pain. However, there are tools and techniques that people can use to help manage pain and reduce the impact that these conditions can have, and resources available on how to do this. Keeping moving, a healthy lifestyle and self-management strategies such as learning how to pace yourself by planning and prioritising activities are all helpful.

Those with osteoarthritis and chronic back pain often worry being active will increase their pain and may cause more damage. Conversely, keeping moving can help to manage pain, improve mobility and strengthen muscles and bones. Remaining active can bring many benefits, but we know that putting this into practice and changing our habits and behaviours is not easy. It takes time and effort to do and maintain.

Unfortunately, the current Covid -19 pandemic means many people have less opportunity to be active and socialise as they spend more time at home. Similarly, changes to work environments, such as working from home, may be affecting MSK health.

Many MSK organisations have provided useful web-based information and support, including helplines, online groups and peer support. But for some, all of this information can be overwhelming. It can be difficult to know where to start, how to navigate the options available and how to make them relevant to their lives and what matters to them.

One option to support individuals experiencing hip or knee osteoarthritis or chronic low back pain is Joint Pain Advice (JPA). JPA is a service that provides people with an opportunity to have a conversation about their experience and how it impacts them, as well as relevant self-management options.

The Joint Pain Advice (JPA) model of care was developed by the Health Innovation Network as a result of an identified need for accessible, personalised and understandable information, and practical advice and support about how to self-manage the impact of chronic knee and hip pain (often labelled osteoarthritis) and chronic low back pain.

JPA supports individuals to understand and better self-manage their chronic knee and hip and low back pain.

It puts the National Institute for Health and Care Excellence (NICE) guidelines for the management of osteoarthritis and low back pain into practice, using education and self-management strategies for a patient-centred, holistic approach and focusing on increased physical activity and managing weight where appropriate.

The model can easily be incorporated into existing services with minimal disruption and adapted to local contexts. Its flexibility means it can be delivered by a wide range of healthcare and non-healthcare professionals, and it sits comfortably within community, clinical and workplace settings.

The HIN co-ordinates and delivers training for professionals wanting to deliver Joint Pain Advice, which is offered nationally but with a focus on south London. This evaluation shows improvements in pain, physical function, physical activity and mental wellbeing through JPA. Whilst this is based on face-to-face appointments, the approach can easily be delivered virtually where this is not possible.

JPA is a simple and effective way to support individuals experiencing knee and hip osteoarthritis and chronic low back pain to manage the impact that the condition can have on their lives.

If you are interested in finding out more information about Joint Pain Advice, please email hin.jointpainadvice@nhs.net. The JPA training is delivered free of charge to south London organisations.

Sally Irwin is a Project Manager for the Joint Pain Advice service in the Health Innovation Network.

TfL and London Ambulance Service trial workplace diabetes education to improve staff health

Published on November 13, 2020 and last updated on December 22, 2020 by Simon Ellery

Image of map of London with diabetes cases

Two major London employers embedded clinically-proven Structured Education for Type 1 diabetes to tackle one of London’s biggest health challenges.

The stats

671K Londoners live with diabetes and employers in the capital lose an average £250K due to ill health each year.

An initiative with two major London employers has shown that face to face and virtual diabetes education can be successfully embedded into the workplace to improve the health of staff with Type 2 diabetes.

This comes as the NHS faces increased pressure due to the condition with over 671,000 Londoners living with diabetes and employers in the capital losing an average £250,000 due to ill health each year.

An evaluation of a project by the NHS’s Health Innovation Network with the London Ambulance Service and Transport for London (TfL) has found significant behaviour change in staff toward healthier lifestyle and eating.

Over 60 staff members from the employers attended either online or face to face structured education courses, which is recommended as a vital part of care for people with Type 2 diabetes by the NHS’s clinical standards guardian National Institute for Health and Care Excellence (NICE).

Structured Education (SE) is clinically proven to help people living with diabetes to make changes to their diet and lifestyle that help them to self-manage their condition. It also offers peer support after being diagnosed with the life-changing condition.

Staff were offered a choice to attend a course delivered remotely either by Second Nature or Oviva, which both offer programmes for people with Type 2 diabetes ranging between eight and 12 weeks. Course sessions were delivered through a trained coach with access to online advice, support and information which participants could access through their phones, tablet or computer.

An in-house session to improve self-management was delivered by trained diabetes education experts from Kingston Hospital NHS Foundation Trust. They delivered face-to-face group education using the DESMOND Type 2 Management Module, used widely across the NHS, for up to 14 people in a one-day session and a variety of resource materials were provided to participants at the session.

Twenty five staff members completed the Oviva programme and clocked up an average weight loss after eight weeks of 2.3kg, with evidence showing that participant weight loss continues up to 12 months after the programme.
For the 37 staff who completed the Second Nature programme, the average weight loss after three months was 5.7kg.

Staff taking part in this evaluation overwhelmingly welcomed the offer, and to attend, SE courses at their workplace. There was also very high approval of the three programmes from participants. Those completing either the in-house DESMOND programme or one of the remote programmes said their diabetes education needs had been met.

TfL staff who made use of the programmes said: “I think it’s a good thing that TfL are actively promoting this sort of thing. It’s a positive thing in terms of awareness around health and the impact of different health conditions. It’s good that workplaces are doing more to make people aware [of people with different health needs].”
“It’s a powerful message to send to the employee: we’re not just interested in your productivity, but also your health and how to look after yourself.”

TfL was due to start another round of the programme in September 2020 but brought it forward to May. TfL’s Health and Wellbeing Improvement Programme Manager Fernanda Siusta said:
“It was great to be involved in this work which has had such a positive effect on so many participants’ lives. While the pandemic led us to bringing the work forward, we know that for some this has been key to ensuring they stay on track if they had to shield or if they were unable to see their usual medical teams while the NHS handled the response to coronavirus.”

Head of Healthy Workforce at London Ambulance Service Gill Heuchan said:

“As someone with type 2 diabetes I know how difficult it can be when you are first diagnosed and have to attend diabetes education courses. We started the initiative at London Ambulance Service because we are very aware that we have staff whose lives do not fit the norm. Call handlers, medics and support staff are often working busy 12-hour shifts and during unsociable hours, so they can find it even harder to attend courses on learning how to manage their diabetes.

“It has been a fantastic opportunity for staff to have flexible support, not just about diabetes, but about lifestyle choices and general health on a tablet device, which they can utilise easily to fit their lifestyle. Staff who have signed up have fed back positively and many have been able to achieve personal goals because of the support they have received. This initiative has also helped form part of our ‘Wellbeing at Work’ support package for staff which aims to help them manage their own health and wellbeing in and outside of work.”

“We started the initiative at London Ambulance Service because we are very aware that we have staff whose lives do not fit the norm. Call handlers, medics and support staff are often working busy 12-hour shifts and during unsociable hours, so they can find it even harder to attend courses on learning how to manage their diabetes ”Head of Healthy Workforce at London Ambulance Service Gill Heuchan

Health Innovation Network Diabetes Programme Manager Rod Watson said:

”Diabetes is one of our biggest health challenges. Not only is it a leading cause of premature mortality with over 22,000 additional deaths each year, but it doubles an individual’s risk of cardiovascular disease and costs over £10 billion every year to manage.

“The HIN has successfully sped up the spread and adoption of a range of evidence-based programmes both face to face and digital to help prevent and treat the condition.
“We spend a third of our time at work so it makes sense for us to work with employers to help embed programmes directly into the workplace. This project shows that this is possible and I would urge all employers to read through our findings.”

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Hundreds of young people with eating disorders to benefit from ‘gold standard’ NHS treatment

Published on November 6, 2020 and last updated on December 22, 2020 by Simon Ellery

Rapid eating disorder intervention for young people developed in south London to be rolled out nationally.

The problem

Between 600,000 and 725,000 people in the United Kingdom have one or more eating disorders.

SOURCE: National Institute for Health and Care Excellence, 2015

Young people with eating disorders such as anorexia and bulimia are to get rapid access to specialist NHS treatment across England.

The NHS has announced that it will scale up an early intervention service developed by Health Innovation Network (HIN) members King’s College London and South London and Maudsley NHS Trust (SLaM).

The model supports young people in the early stages of eating disorders.

The new service to be rolled out in 18 sites across the country builds on a successful scheme shown to help 16-25 year olds in London, with one patient describing it as ‘the gold standard’ of care.

With eating disorders causing serious physical and mental health problems which can last decades, the expanded service will target care to those who have been living with a condition for fewer than three years, to tackle problems before they escalate.

Teens or young adults coming forward who would benefit from treatment can be contacted within 48 hours and with treatment beginning as soon as two weeks later.

The approach is based on a successful model developed and trialled at King’s College London and the South London and Maudsley NHS Foundation Trust, with support from the Health Foundation. It reduces wait times and improves patients’ outcomes.

The investment in the early intervention – First Episode Rapid Early Intervention for Eating Disorders (FREED) – service is part of the NHS Long Term Plan commitment to provide an additional £1 billion a year by 2023/24 to expand and improve community mental health care so adults, including those with an eating disorder, can get earlier access to care, as close to home as possible.

Professor Tim Kendall, NHS England’s National Clinical Director for Mental Health, said:

“Young people who are struggling with an eating disorder stand to benefit significantly with the roll out of this new NHS service which will provide access to early intervention, treatment and support.

“These services have already proven to be effective and the expansion in care we have announced today will support our ambition to meet the rising demand for support to tackle young people’s ill health.

“And although we are in the throes of a pandemic, the NHS continues to offer face-to-face appointments and inpatient care for patients with eating disorders when needed, while providing the option of phone and video consultations and online support where appropriate.”

Amanda Risino, Chief Operating Officer for Health Innovation Manchester and Academic Health Science Network Early Intervention in Eating Disorder National Programme Chair, said:

“We are delighted to see 18 new services across England receive funding to implement this NHS service for young people aged 16-25 years. Early intervention in eating disorders is shown to lead to substantial improvements in clinical outcomes at a critical time of transition and development, and is highly acceptable to both patients and families.

“The AHSN Network, through our National Early Intervention in Eating Disorders Programme will be supporting implementation at these 18 new sites, in addition to our work with all Eating Disorder services across England interested in adopting an early intervention model of care for this age group.”

Ulrike Schmidt, Professor of Eating Disorders at King’s College London and Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust, said:

“Eating disorders are disabling and potentially deadly, and early treatment is essential.

“We are absolutely thrilled with this much needed investment and we hope that rolling out this NHS new service to 18 specialist eating disorder teams in England, will create the momentum needed to make early intervention a reality for all young people with eating disorders.”

“The new NHS service is highly recommended by patients and families and has helped many people including George and Sue.”

George moved to London when she was 21 and her eating disorder worsened as she moved to the capital on her own.

After persuasion from her family, George visited the GP who referred her to an eating disorders service delivering the NHS service. Within two weeks, she was meeting with a psychologist for a Cognitive Behavioural Therapy (CBT) session.

George was with the service for 18 months and recognises the service not only supported her to manage her eating disorder but also with other challenges she had to face including having surgery, changing jobs, moving homes and acclimatising to the new city.

George said: “My treatment was completely tailored to me and my lifestyle. After my treatment was finished, I left the programme so optimistic and grateful for everything they had given me.”

The service has also helped Sue support her 18-year-old daughter who was the first person outside of London to use it in her local eating disorder programme.

Sue says her daughter was a bit apprehensive at first, but she built a genuine bond with her psychotherapist. Sue witnessed how the service caused a positive change to her daughter’s approach to food and exercise. From the dedication from her support worker to the involvement of a dietitian, Sue watched her daughter’s life and eating disorder improve.

She said: “I totally trusted the professionals involved in my daughter’s care and that’s what helped me help her. Without any question this NHS service should be seen as the gold standard of eating disorders care.”

“Eating disorders are disabling and potentially deadly, and early treatment is essential.”
Ulrike Schmidt, Professor of Eating Disorders at King's College London and Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust.

The new and expanding community-based mental health care will provide treatment and support for 370,000 adults, including those with eating disorders as part of the NHS Long Term Plan, and for anyone experiencing poor mental health, the NHS message remains the same: please help us help you, and come forward for the care you need.

The Academic Health Science Network (AHSN) is supporting the national adoption of evidenced based models including the NHS FREED expansion for the early identification of eating disorders in people aged 16 – 25.

A 2015 National Institute for Health and Care Excellence report estimated that between 600,000 and 725,000 people in the United Kingdom have one or more eating disorders.

Find out more about FREED

Find out more about FREED by clicking on the button below.

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Joint pain programme ESCAPE-pain and young people’s Type 1 diabetes initiative win awards

Published on October 21, 2020 and last updated on December 22, 2020 by Simon Ellery

A national programme to tackle chronic joint pain and a local initiative supporting young people with Type 1 Diabetes have won at the prestigious Health Service Journal Value Awards.

Chronic joint pain programme ESCAPE-pain and the Youth Empowerment Service (YES) that supports 14-19 year olds with Type 1 diabetes, have won prizes at the Health Service Journal Value Awards.

ESCAPE-pain won the MSK Care Initiative of the Year. Since being on the programme , Ann, 68, is no longer in constant pain. She said: “Osteoarthritis was really impacting on my daily life as I had to ask for help to do everyday tasks around the home. My life has significantly changed since I completed the course and I’ve continued to do the exercises and now I no longer have any pain and I live a very active life.”

ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) is a national programme offering face-to-face and online exercises to help people suffering from chronic joint pain. Driven by the NHS’s Health Innovation Network, in south London, and backed by Sport England and in association with Versus Arthritis, roll-out of the programme has been supported by the national Academic Health Science Network. Prior to Covid-19, the programme was running in 295 sites and has helped 19,300 participants since it started.

ESCAPE-pain programme originator Professor Mike Hurley said:

“The judges were clearly impressed with the general ethos of the programme about self-management, its effectiveness and benefits that it brings to individuals and the healthcare system as a whole. We hope the award gives a boost to ESCAPE-pain that we believe can make a major contribution to the post-Covid-19 NHS ‘reset’.

Guy’s and St Thomas’ Youth Empowerment Skills (YES) programme, which is supported by the HIN, runs vital programmes for 14-19 years-olds with Type 1 Diabetes. It won the HSJ Diabetes Care Initiative of the Year.

YES programme Lead Dr Dulmini Kariyawasam, consultant at Guy’s and St.Thomas’ Foundation Trust , said:

“We are absolutely delighted to have been named as the winners in the Diabetes Care Initiative of the Year 2020! The positive impact of this award will help to create a long-lasting legacy and bolster our efforts to expand the YES programme across London giving every young person living with Type 1 diabetes in London access to the programme.”

“The HIN seeks to speed up the spread and adoption of evidence-based innovation in health and care so both these award-winning projects highlight the value of our work to improve lives. A huge well done to both teams. ”Health Innovation Network Chief Executive Zoe Lelliott

The Health Innovation Network’s Diabetes team Project Manager, Ellen Pirie, said:

“Young people suffering with Type 1 Diabetes face many challenges and the YES programme offers them practical support on issues such as food, sexual health and handling a diabetic seizure. There are also opportunities to go on social outings and try out new skills such as driving and rock-climbing and it’s this peer support network building that I know participants really benefit from.”

HIN backs Londoners’ decisions over use of their data to save lives and improve care

Published on July 2, 2020 and last updated on December 22, 2020 by Simon Ellery

OneLondon Citizen's Summit members discuss how their health and care data is used

Londoners have set out how they expect their health and care data to be used to improve care. A diverse mix of 100 Londoners strongly endorsed joined up data sharing by NHS and care services under clear conditions.

Commenting on the findings from the HIN-supported OneLondon Citizen’s Summit Public deliberation in the use of health and care data report, Denis Duignan, Head of Digital at Health Innovation Network, said:

“We welcome this report as for the first time it sets out how Londoner’s want their health and care data to be used. This is vital because patient confidentiality is such a delicate issue and sharing data between healthcare providers has huge benefits in directly caring for patients, and also for wider research, proactive and personalised care.

“This is compounded by the fact that the data captured and shared by the public through a plethora of digital tools and devices will soon provide additional information and capabilities to improve how we care for patients and ourselves as citizens.”

Read the story here and download the report here.

Watch the NHS’s video setting out the potential for data in health and care here.

“Sharing data between healthcare providers has such huge benefits in directly caring for patients, and also for wider research, proactive and personalised care. ”Denis Duignan, Head of Digital at Health Innovation Network

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Londoners set out their expectations for appropriate use of their health and care data

Published on June 30, 2020 and last updated on December 22, 2020 by Simon Ellery

Londoners have set out how they expect their health and care data to be used, as part of a London-wide Citizens’ Summit. There was strong endorsement for joining-up information held by the NHS and care services to improve care for individuals and for the population, as long as certain conditions are in place.

In receiving these detailed recommendations, local health and care leaders confirmed that these public expectations will be used to shape policy for London, ensuring that Londoners can have confidence in how their health and care data is used.

The OneLondon Citizens’ Summit was a large scale and in-depth public deliberation on uses of health and care data. It involved 100 Londoners in a four-day process of detailed discussion and debate. Participants reflected London’s diverse population, came from all 32 boroughs, and had a mix of attitudes towards data sharing. They were provided with technical information by experts and practitioners. The work was overseen by an independent advisory group.

This Citizens’ Summit is a new and innovative way to involve the public in policymaking. As a result, Londoners have had more opportunity than ever before to be informed about the issues and trade-offs, and to set out their expectations about the uses of their health and care information by the health and care system.

The Citizens’ Summit was commissioned by London’s five health and care partnerships via the OneLondon Local Health and Care Record Exemplar (LHCRE) programme, and delivered by Ipsos MORI and The King’s Fund. Through public deliberation, London is leading the way in understanding how citizens weigh-up the benefits and potential concerns of data use, to reach an informed set of public expectations that will now shape the development of policy across the capital.

How do Londoners expect their health and care data to be used?

• Access and control in health and care data
At the end of the process, after four days of deliberation, there was almost unanimous agreement (97 per cent of those who attended on the day)* that all health and care organisations in London should join up identifiable data to support the provision of care to individuals. An expectation was set that health and care professionals would only have access to information relevant to their roles through a means of role-based access control. Strict conditions were set out by Summit participants, taking into account the level of urgency of a patient’s condition, safeguarding of information and accountability.

• Use of de-personalised data for health and care planning and improvement
Participants recommended that de-personalised data must be used by relevant organisations to plan and improve services and demonstrably benefit the health of the population, with conditions set out to ensure security of data, transparency of access, and an individual’s choice to opt out of this use if they wish.

• Use of de-personalised data for research and development
Conditions for using de-personalised data to support research and development included who should have access (including commercial organisations) and how they should be charged for this access, with a tiered pricing model being suggested. Participants also set conditions around how information should be safeguarded and accessed in a safe and secure setting, and how benefits – financial and otherwise – should be realised and distributed across the NHS.

• Governance and oversight
There was a strong expectation set that citizens are involved in ongoing policy and decision-making around the uses of health and care data as part of a continuing diverse citizens’ advisory group, with a request for those in elected positions, for example, the London Assembly, to play an oversight and scrutiny role.

• Consistency across London
After four days of deliberation, nearly all of the participants (98 per cent of those who attended on the day)* stated an expectation that all health and care organisations in London must join up de-personalised information, as part of a population dataset, to support proactive care, planning, improvement, research and development in line with the recommendations and conditions they set out.

What does this mean for London’s health and care system?

Data collected about a person’s health and care offers a range of benefits – from helping NHS and care staff to provide safe, quality care, to planning and improving services, to supporting research and discovery of new treatments. The public health emergency of the Covid-19 pandemic has highlighted more than ever the need for a joined-up approach in using data, both now and into the future. This is an expectation shared by Londoners, and the recommendations formed by participants through the Citizens’ Summit provide a clear directive to the health and care system.

One participant involved in the Citizens’ Summit, said:

“I consider my healthcare information to be very personal and it’s important that it is discussed openly as to whether we want that to be shared, or the extent to which it’s shared. It’s very democratic to be part of this process. We can often feel, politically, quite impotent as individuals, so being able to feel like the opinions I’m expressing are going to be helping to shape policy… it’s really good to be a part of it.”

A second participant commented:

“Certain expectations that I had of the NHS and our data were completely blown out of the park. Connections I thought might be there – or hoped were there – weren’t. So it’s been very informative. I came in initially with the view that, ‘the data is mine, no one should have access to it’, so I’ve done a big flip. It’s been a journey because I’ve kept flipping to and fro.”

Dr Vin Diwakar, Regional Medical Director for the NHS in London, commented:

“Having listened to Londoners about how they expect their personal health information to be used, it is clear they want those treating patients to have access to all the health and care information for those individuals, to optimise care. They also strongly support using data for research and the clear benefit of improving the city’s health and social care. Privacy and other safeguards must be in place. We are grateful for the involvement of all those who took part and will continue to work closely with Londoners as we look to develop an agreed set of principles for how we safely and securely use Londoners’ data, based on their recommendations.”

London’s Chief Digital Officer, Theo Blackwell, said:

“There is huge potential to harness health and care data in a safe and secure way, in order to improve Londoners’ wellbeing while protecting their privacy. The Mayor and I are clear that Londoners must be at the heart of shaping how their data is used and by whom. The OneLondon Citizens’ Summit has empowered Londoners to make recommendations on this important issue, to ensure the system can develop policy in a trustworthy way.”

Recommendations and findings from the OneLondon Citizens’ Summit are detailed in a new report. Download Public deliberation in the use of health and care data here.

For more information visit One London website.

“Having listened to Londoners about how they expect their personal health information to be used, it is clear they want those treating patients to have access to all the health and care information for those individuals, to optimise care. “Dr Vin Diwakar, Regional Medical Director for the NHS in London

Time to Talk – mental health and the role of digital

Published on February 7, 2019 and last updated on May 31, 2020 by Simon Ellery

It’s time to talk about mental health

Mental health problems affect one in four of us, yet people are still afraid to talk about it. Time to Talk day encourages everyone to talk about mental health and at the HIN we’re bringing digital innovators and clinicians together to identify solutions, says Amy Semple.

Time to Talk day is about encouraging everyone to talk about mental health. Last week, the Health Innovation Network started the conversation early with the sometimes contentious topic of digital. In our experience working with both NHS stakeholders and digital companies, there remains some scepticism and reticence amongst both groups on how they can work together to benefit the 1 in 4 of the population who are currently experiencing mental health issues. So what better way to open up the channels of communication than to invite 100 key decision makers and innovators to spend the day discussing the opportunities and challenges of maximising digital opportunities in mental health, together.

The NHS Long Term Plan

The stars (at least on paper) have recently aligned in terms of national strategy, with the NHS Long Term Plan having digital at its core and a strong focus on mental health. I believe that success in both areas will be mutually dependent. To date, most digital companies, in my experience, have targeted primary care and the acute sector as this has often been the easiest way to prove their concept. Digital interventions available in the NHS are associated with benefits such as improved access to services, online self-help and therapies, prevention and organisational efficiencies.
When speaking to some companies prior to the event I felt that mental health was perhaps outside their comfort zone, seemed too large and unwieldly to take on, or wasn’t acknowledged as a viable space for their product. This is understandable. Stigma surrounding mental health means that many people believe that people with a mental health condition are unable to self-manage and will struggle to maintain the consistency needed to use some technologies. These viewpoints only sustain the inequalities we continue to see in terms of people with mental health conditions gaining equal access to services and support with physical health conditions. Mental health services can be equally cautious of digital solutions, often concerned about the ethical implications of removing the human face to face element in mental health care without putting people at risk.

Maximising digital opportunities

With our Maximising Digital in Mental Health event we created a space to encourage a healthy debate to air these concerns. To get the people who could really effect change talking to each other. We invited national and local leaders to set out their digital strategies, we presented real life examples where digital companies are already working successfully within mental health and we showcased digital companies not yet working in mental health whose products have relevance to the sector in terms of patient care or organisational efficiencies. The result; a two-way conversation where both sides could speak openly and honestly about their fears as well as their excitement at the potential to radicalise mental health care with digital technology. Honest dialogue, open conversations and exploration of the solutions were met with a real appetite for adoption and lateral thinking.

Reducing the inequality in mental health

Yes, there were challenges highlighted, barriers questioned and a little bit of scepticism still; but overwhelmingly there was positivity and real desire to work together. We know that people with serious mental illness are likely to die on average 15-20 years earlier than other people and two thirds of these deaths are from avoidable physical illnesses. It’s time to talk; to find a safe and cost-effective way for users of mental health services to benefit from digital solutions and reduce this inequality. As Liz Ashall-Payne from ORCHA eloquently phrased it, “the conversation [in the room] has moved from not if, but when.”

Time to keep talking

From the dialogue on the day, I believe there are three key next steps to the conversation:

1. Get the decision makers on board. Talking to the right people who are influential in ensuring digital is part of mental health strategy and decision making process, such as Innovation Teams, CCGs, Strategy Teams, Board Members, Systems and Information Teams will ensure digital stays on the agenda.
2. Engage with front line staff. Unless you engage the people who will be using digital technologies, they simply won’t get used. Asking them what solutions they need, what their preferences are working in true partnership with staff and users will secure the buy-in needed to test ideas.
3. Consider the system implications. Interoperability is a huge challenge and needs to be overcome with commitment and responsibility from both organisations and digital companies to make this happen. Put simply, we need to ensure that the systems being able to talk to each other is also part of the conversation.

Enjoy this blog? Then we think you’d also like:
Maximising Digital Opportunities in Mental Health: programme and slide pack
Digital is helping us tackle healthcare inequalities, but the real issues are deeper and run system-wide
Digital is a valuable tool for prevention – and so rightly it’s at the heart of the long term plan

For more information on the Health Innovation Network’s Mental Health theme, click here.

NHS Trust first in the country to translate ‘ESCAPE-pain’ chronic joint pain programme into Gujarati

Published on February 1, 2019 and last updated on May 30, 2020 by Simon Ellery

NHS Trust first in the country to translate ‘ESCAPE-pain’ chronic joint pain programme into Gujarati

Rapidly expanding ESCAPE-pain programme, born in south London, has now been translated into Gujarati. Hear all about it in this exclusive video produced by our AHSN colleagues at Imperial College Health Partners.

Physiotherapists at London North West University Healthcare NHS Trust have successfully translated a rehabilitation programme for patients with chronic knee and hip pain into Gujarati for the first time.

Previously only available in English, ESCAPE-pain is a programme for people with chronic knee and hip pain that runs over six weeks combining educational self-management and coping strategies with an exercise regimen for each patient.

The physiotherapy team at Northwick Park Hospital (NPH) identified that a significant proportion of their local community were missing out on attending the programme because one of the criteria is for participants to have a good level of English.

Through truly living their Trust’s HEART value of Equality, the team used their expertise to overcome these language barriers. Karsh Patel and Arti Inamadar translated the sessions, allowing members of the local Gujarati community to take part and benefit from ESCAPE-pain. Further sessions are planned in Northwick Park Hospital and have the potential to be used in other locations across the country.

Tanya Aptowitzer, Musculoskeletal Therapy Lead from NPH, said: “We’re immensely proud of our ethnically diverse workforce and our physios who have gone above and beyond to meet the needs of our local Gujarati speaking population. Through their initiative and the support of the Trust we have been able to help patients that would have otherwise been excluded.”

A local patient Aruna on completing the course said: “Having this translated in Gujarati has helped us to properly understand as our English isn’t that good. ESCAPE-pain has given us knowledge about what we should do to reduce pain and in a group we can all do it together.”

ESCAPE-pain is one of the seven programmes developed regionally which have been selected for national adoption and spread across the Academic Health Science Network (AHSN) 2018-2020. Imperial College Health Partners (ICHP), as North West London’s AHSN, have been supporting local NHS Trusts and CCGs in this work.

Piers Milner, Innovation Advisor from ICHP, said: “For innovation in the NHS to thrive it needs to be shaped and its adoption supported by local communities. The team, through translating ESCAPE-pain into Gujarati, have shown the key role that frontline staff have in shaping innovative programmes to meet the needs for their local patients.”

Professor Mike Hurley, originator of the ESCAPE-pain programme, said: “It’s really great to see our programme translated into other languages so that as many people as possible benefit. The pain caused by arthritis has no language barriers, so interventions that can help shouldn’t be hindered by language either. It is wonderful to see that the local physiotherapists have responded to the needs of their local community and taken the time to translate the programme into Gujarati. We know getting to non-English speaking populations is difficult and I’m sure this will encourage more people to take part and benefit from the programme.”

NHS Long Term Plan; a welcome focus on digital, prevention and tech

Published on January 28, 2019 and last updated on May 30, 2020 by Simon Ellery

NHS Long Term Plan; a welcome focus on digital, prevention and tech

With its focus on digital, prevention and out of hospital care, the NHS Long Term Plan matches key work stream priorities of both the AHSN Network and the Health Innovation Network, says Acting Chief Executive Zoe Lelliott.

We very much welcome the NHS Long Term Plan (LTP), published on 7 January, recognising its strong focus on areas of current priority for the HIN. These include service innovation, digital transformation as well as prevention and out of hospital care.

The AHSNs have been asked to consider how they best support their local sustainability and transformation partnership and emergent integrated care systems, as they shape local implementation plans over the coming weeks. We believe that we can do this in a number of ways:

Through specific expertise and experience (e.g. digital health, diabetes transformation, medicines optimisation, care homes and prevention)
Through practical support for the implementation of innovations which improve patient care and efficiency
By connecting the system, through our extensive, cross-sector networks and relationships (health and care, third sector, academia and industry)

As a network, we have been reflecting on what the Long Term Plan means for some of our collective themes in this series of blogs.

Innovation and research for better health: five key opportunities
UCL Partners Managing Director Dr Charlie Davie thinks we need to focus on five key areas and sets them out.

Ten years from now: What to expect from the NHS Long Term Plan

In this joint blog, Yinka Makinde, Programme Director for DigitalHealth.London and Jenny Thomas, Programme Director for DigitalHealth.London Accelerator explore how technology will play a central role in realising the Long Term Plan.

Good news for prevention of stroke in the Long Term Plan

Dr Liz Mear, Chief Executive of the Innovation Agency and a trustee of the Stroke Association, focuses on the plan’s emphasis on stroke prevention.

2019 sees focus on investment in life sciences and economic growth

Mike Hannay, Managing Director of East Midlands Academic Health Science Network, examines investment in life sciences.

Achieving goals of Long Term Plan will only come through innovation

Oxford Academic Health Science Network Chief Executive Gary Ford emphasised the need for innovation.

Artificial intelligence – is the future here?

Big data and computing power is at the heart of this blog by Kent Surrey Sussex AHSN Network Managing Director Guy Boersma.

Digital is a valuable tool for prevention – and so rightly it’s at the heart of the long term plan

Tara Donnelly, HIN Accountable Officer and interim NHS England Chief Digital Officer, blogs on the emphasis on digital to enable the shift to prevention.

For the AHSN Network’s response to the long term plan, click here

Evaluation into ‘Red Bag’ Hospital Transfer Pathway

Published on January 24, 2019 and last updated on May 30, 2020 by Simon Ellery

Key learnings for Red Bag emergency transfer pathway revealed in report

The ‘Red Bag’ Hospital Transfer Pathway, which was highlighted in the recent NHS Long Term Plan, is now running across south London. But how effective is it? The HIN has produced this evaluation report which explores the impact and stakeholder experiences of implementing the pathway within three south London boroughs.

A new evaluation report has found that vital communication between paramedic crews, care home staff and hospital clinicians has been improved by the Red Bag Pathway when all measures were adhered to, but there are still a series of barriers to best practice to overcome.

The study, which included survey responses, interviews with hospital clinicians and paramedics, and a focus group with care home managers, found that the majority of care homes are using the Red Bag as intended. Conducted by the Health Innovation Network, the report said that improvements need to be made at both ends of the pathway to ensure it is adhered to and the benefits are fully realised.

Pioneered by Sutton Homes of Care Vanguard, the pathway ensures vital medical information, such as current medical condition and medicines regime, travels with the care home resident in a specially-designed red bag when they make emergency hospital visits.

Over two-thirds of the 90 survey responses from care homes, ambulance crews and hospital clinicians in Kingston, Richmond and Lambeth, stated that the Red Bag had improved communication between care homes and hospitals and made the handover to ambulance crews smoother.

Over half of care home managers believed the pathway had improved the transfer process for residents and both ambulance and hospital staff stated that the two forms most helpful in the Red Bag documentation were the ‘Do Not Attempt Resuscitation’ form, for older people making decisions about what happens towards the end of their life and the Alzheimer’s Society’s ‘This Is Me’ form to help healthcare professionals know more about people living with dementia.

As well as highlighting some of the positive effects the pathway has had on emergency hospitals for care home residents, the study also flags some of the challenges faced in implementing the transfer pathway. These included finding that, on some occasions, standardised patient information was either missing or incomplete when residents were transferred to hospital, that medical discharge information was not always sent with the patient and that locating and retrieving bags that had become lost in hospital transfers was particularly difficult.

Responses also indicated that both care homes and hospitals faced challenges with successfully promoting the pathway in the face of high turnover of staff and during the busy winter period. The report found that when the pathway was not adhered to – either in the care home or hospital setting – this caused practical difficulties and could result in despondency and frustration amongst professionals

The challenges highlighted have led to some wider learnings for practitioners. Don Shenker, who led the Red Bag project for the HIN, believes there are five key tips that can be taken away from the study:
1. When preparing the Red Bag in the care home, double check all the documentation is filled in properly
2. When receiving the Red Bag in the ambulance or hospital, read through the documentation
3. When transferring patients to different wards in hospital, check the Red Bag and documentation is with the patient
4. When discharging the resident back to the care home, make sure the Red Bag and discharge documentation accompanies the resident
5. When receiving the resident back in the home, update the care plan records.

Effective implementation of the Red Bag Pathway will contribute toward the Enhanced Health in Care Homes (EHCH) model as set out in the recent NHS Long Term Plan.

The report launched at a HIN sharing event, attended by staff from all parts of the Pathway, designed to ensure the complexities of implementing the pathway and opportunities for improvement are discussed more widely so all parties can work together to keep improving the use of the Red Bag.

Zoe Lelliott, Deputy Chief Executive for the Health Innovation Network, said:
“Our work is all about promoting innovation in the NHS and across the whole care system. The Red Bag is a successful innovation born in Sutton and recently extended across the whole of south London, but this study shows that there are still challenges and a focus on careful implementation is needed to maximise the benefits.
“True joined up work with our members and partners in south London is making a real difference to people’s lives and I want to thank all the health and care staff who have worked so hard to adopt the Red Bag Pathway in their areas.”

Berenice Constable, Head of Nursing for Kingston Hospital NHS Foundation Trust, said:
“Frail care home residents are at their most vulnerable when transferred in an emergency to hospital. It’s vital that the latest state of their health is communicated to all clinicians from ambulance crews to hospital staff so quicker decisions can be made over their care.
“It’s also a moment when they might lose important personal possessions from hearing aids to glasses, so the Red Bag Pathway is a simple innovation that, when followed fully, ensures the safest possible transfer as well as the fastest discharge.”
“This report shows that the Red Bag is really making a difference and improving the care of some of our most vulnerable residents.”

Evaluation of the Hospital Transfer ‘Red Bag’ Pathway in South London

Download the report here.

Digital is a valuable tool for prevention

Published on January 16, 2019 and last updated on May 30, 2020 by Simon Ellery

Digital is a valuable tool for prevention – and so rightly it’s at the heart of the long term plan

Digital is at the core of the NHS Long Term Plan. Quite right too, argues Tara Donnelly, as it can be the means of moving to prevention as a priority, something that will benefit the health service and patients alike. This blog was first published here by DigitalHealth.net.

Alex Lang, AF Project Manager checks for irregular heart rhythm on our very own Medical Director, Natasha Curran, using the new range of mobile devices linked to a smartphone. This is part of the drive to prevent strokes.

The 10-year blueprint for the NHS was, I think, worth the wait. Published last week, the Long Term Plan promises a major shift to prevention and supporting people stay healthy, unlocked by the power of digital. In fact, the word digital features 117 times in the 136-page document.

I’ve worked in the NHS for 30 years and am a realist. I completely get how hard it can be to imagine the bold commitments taking shape when days are so busy clinically and operationally. But it is only by thinking about the longer term and investing bravely that we can make the nearer term much better for staff and patients alike.

Long term conditions are a good example of the pressing need for action. They account for at least 70% of the NHS’s time and budget. Diabetes alone costs the NHS £1.5 million an hour, that’s £14 billion a year.

The problem is that this spend is not currently on preventative care that will reap future benefits, or in supporting patients with great, evidence-based digital tools to enable effective self-management and keep them out of hospital. Instead, it’s almost entirely on dealing with the distressing complications of advanced disease.

Being smart with devices

The plan promises to redress this balance, and to really start unlocking the power of digital. “The connecting of home-based and wearable monitoring equipment will increasingly enable the NHS to predict and prevent events that would otherwise have led to a hospital admission,” it states.

Examples of devices include digital scales to monitor the weight of someone post-surgery, a location tracker to provide freedom with security for someone with dementia, and home testing equipment for someone taking blood thinning drugs.

Connecting clinicians directly with patients through smart devices promises to deliver powerful benefits such as weight loss, blood glucose stability and better medicines management.

The new tech will allow reminders and alerts to be sent direct to patients. This truly is remote monitoring and we know there are a good number of great digital health start-ups, many of them British, with solutions that can help in each of these areas.

The next stage is the expansion of digital services for particular conditions. For example, the NHS will develop and expand the successful diabetes prevention programme to offer digital access this year.

People newly diagnosed with diabetes will be supported through expanded pilots of digitally-delivered education. Increased use of digital in mental health is also promised: “By 2020, we aim to endorse a number of technologies that deliver digitally-enabled models of therapy for depression and anxiety disorders for use in IAPT (Improving Access to Psychological Therapies) services across the NHS.”

The expectation is this will be expanded to include therapies for children and young people and other modes of delivery, such as virtual and augmented reality – said to already be demonstrating success through the mental health GDE programme.

Providing the option for digital outpatient care is another big commitment. Having a third of outpatients services offered this way will make a huge difference for patients in terms of convenience, travel and time off work.

If this sounds impossibly futuristic, bear in mind in the highly respected and huge Kaiser Permanente health care group in California already provide over 50% of their consultations remotely. The plan says this will allow for longer and ‘richer’ face-to-face consultations with clinicians where patients want or need it, and this offers benefits.

It will take time, but progress has already been made

We need to recognise, however, that this will be a major piece of work, and we need clinicians and patients at the heart to design these new services more effectively. Kaiser took several years to reach this and invested markedly in supporting their staff transform services in this way and make the most of the digital opportunity.

Parts of the country are ahead of the curve and beginning to offer these sorts of services already. The Academic Health Sciences Network (AHSN Network) worked with NHS Improvement last year to run a series of “digital outpatients” events in Birmingham, Reading, Manchester, Leeds and London. These brought together trusts working on digital outpatients with some of the best evidenced solutions available and sharing the learning.

As Digital Health.London we also ran a collaborative in London last spring to support trusts exploring new ways of undertaking consultations including video, phone and email. Great solutions already exist to book and change appointments via smartphones too, but these need to quickly become the default not the exception.

Digital will also boost the effectiveness of community staff and ambulance crew. I’m particularly glad that the Long Term Plan envisages that community clinicians will have access to mobile digital services, including the patient’s care record and plan. Paramedics will have the tools to help them reduce avoidable and costly hospital transfers.

NHS staff include some of the most mobile staff groups and we need to properly equip them so they can provide great care and enjoy their work, spending as much time with patients as possible and as little on administrative tasks and travel as they can. Mobility solutions do this and are much loved in organisations that have taken this on; in south London, Oxleas NHS Foundation Trust has done this in an exemplary way.

Digital first option on offer

Over the next 10 years, the NHS will offer a ‘digital first’ option for most citizens according to the plan. A key milestone in this drive is the current national rollout of the NHS App. This features a simple triage offer, connection to local services, GP records, the ability to book appointments, all from a computer or smartphone.

On top of this, increasingly, automated systems and AI will make these services smarter. The plan says that, over the next five years, every patient will be able to access a GP digitally and where appropriate, opt for a ‘virtual’ outpatient appointment.

But to achieve these digital advances, the plan sets out a need to create the right environment and infrastructure. These include creating a secure and capable digitally literate workforce, requiring NHS technology suppliers to comply with published open standards, and making solutions commisioned and developed by the NHS open source to the developer community.

There is, of course, much to do to make these ambitions a reality, but the momentum is right for this digital healthcare revolution. That’s because so many now think that digital and smart devices may well be the tools to deliver the required shift to prevention that the NHS so badly needs. This NHS Long Term Plan should be welcomed as the blueprint that sets out this brave new world.

Find out how #AHSNs are paving the way for a simpler innovation system within in the NHS, supporting innovations get to patients faster than ever before. Read the AHSN Networks response to the NHS Long Term Plan here.

NB: This post was updated to show that the word digital is used 117 times, which includes the number of times in the references section.

Digital is helping us tackle healthcare inequalities, but the real issues are deeper and run system-wide

Published on November 16, 2018 and last updated on May 30, 2020 by Simon Ellery

Digital is helping us tackle healthcare inequalities, but the real issues are deeper and run system-wide

Alex Lang describes the benefits of mobile ECG devices for people with serious mental health conditions and their potential to help tackle health inequalities.

It is a sobering fact that people with a serious mental illness have a life expectancy 15-20 years less than the general population.

The reasons vary, but the higher rates of cardiovascular disease experienced by this part of our population are a large part of the problem. According to Public Health England data, people with a serious mental illness aged 15-74 are nearly twice as likely to suffer a stroke as the general population. Part of the reason is that hypertension, diabetes, smoking and alcohol use are key risk factors for stroke and are all greater in those with a serious mental illness.

The medications used to treat serious mental illness complicate the picture further. Some can cause weight gain and obesity, which further increases risk of stroke. Others are associated with electrocardiogram (ECG) changes, and it is possible that certain drugs are causally linked to serious ventricular arrhythmias and sudden cardiac death.

When we started rolling out mobile digital devices to help detect stroke risk, the stark inequality made it was obvious that we needed to prioritise working with our mental health colleagues across south London. In a mental health setting, mobile ECGs can help not only by detecting atrial fibrillation, an irregular heart rhythm associated with stroke, and helping to diagnose and treat people at higher stroke risk. They can also make it easier to offer people ECGs before they start medications when needed.

The mobile ECG we are rolling out, called Kardia Mobile, is a credit card sized, single lead rhythm strip linked to an app on tablet or smart phone, that works by the user placing their fingers on it for 30 seconds. Compare this to a 12 lead ECG: it’s invasive for patients and harder for staff. Traditional 12 lead ECGs aren’t always easy to access either, particularly if a patient is acutely unwell or housebound. This is a serious issue – as patients could start medication that increases their cardiac risk without the appropriate monitoring in place.

These digital devices are starting to make a real difference. One of our partners, Oxleas NHS Trust, a mental health trust in southeast London, is already using Kardia Mobile ECG devices in clinical practice. Already, this is allowing staff to increase the numbers of opportunistic pulse rhythm checks they perform to identify service users with undiagnosed atrial fibrillation. These checks enable timely detection, diagnosis for AF, and treatment with anticoagulants which can reduce risk of stroke by two thirds.

Oxleas is also using the Kardia mobile ECG device for service users where a 12 lead ECG is declined or not practically possible. Kardia is designed to indicate whether AF is present, but by using an on-line calculator, clinicians can calculate the QTc reading from the trace, so that medication can be prescribed safely. This can then be followed up with a 12 lead ECG once practically possible.

This is just one example where digital devices and innovations can make a real difference in mental health care. There are countless others, and we’ll be exploring the potential of digital innovation and its potential to help prevention, self-management and efficient and safer care at our upcoming event in January.

We’re focusing on the potential of digital in mental health because too often, mental health provision has lagged behind, while physical health care has received the lion’s share of attention and funding. This is changing, but it’s crucial that mental health settings reap just as many of the benefits of digital innovation as other healthcare settings.

Digital devices alone won’t change the shocking discrepancy in life expectancy. To really close this health inequality gap, the entire health and care system must make a much greater cultural shift. But we believe that innovation has a role to play in that shift and we’re committed to working with our partners to use innovation to improve care for people with serious mental illness, and to reduce wider health inequalities.

To find out more, please contact Alex Lang, Project Manager in Stroke Prevention alexlang@nhs.net or visit our website here

Think Diabetes for World Diabetes Day

Published on November 13, 2018 and last updated on May 30, 2020 by Simon Ellery

Think Diabetes for Diabetes Day

HR managers are working in partnership to revolutionize the workplace in a move which could improve employees’ health, save money for the NHS and boost productivity, argues Health Innovation Network Senior Project Manager Linda Briant (pictured below) who is driving forward Think Diabetes.

Employees with a diagnosis of both Type 1 and Type 2 diabetes (and carers of people with diabetes) will be supported and encouraged to take time off work to learn about their diabetes. The insight and knowledge gained at these Structured Education sessions will empower individuals to self-manage their condition and improve their long-term health outcomes.

How big a problem is diabetes?
Diabetes costs the NHS more than £10 billion per year and this constitutes roughly 10 per cent of the entire budget. We know that Structured Education is part of the solution. People with diabetes benefit from being able to self-manage their condition and make changes to diet and lifestyle. Structured Education helps them to do this and is clinically proven. It also provides much needed peer support after being diagnosed with a life changing condition. What’s more, it is recommended as a basic and crucial part of care for an individual with diabetes by the National Institute for Health and Care Excellence (NICE), the NHS’s guidance on clinical standards.

Despite this, uptake rates of diabetes education are low and one of the reasons commonly cited is that it is difficult to take time off work. Diabetes is covered by the Equality Act 2010 as a long term condition that has significant impact on individuals’ lives. Employers are therefore obliged to make reasonable adjustments, although these adjustments are not defined. The case for employers adjusting their policies and supporting individuals to attend structured education is overwhelming.

What must change?
The working population in Britain spends roughly a third of their life at work. Yet all too often, the role of employers in creating and maintaining healthy workplaces, or supporting their staff to be healthy, is overlooked.
The workplace is a great setting for reaching people with messages that promote and encourage healthy lifestyles and many businesses are already taking action by promoting healthy initiatives. The benefits to them are higher staff morale and lower rates of sickness absence.
Evidence shows that employers that invest in appropriate workplace health initiatives to support the health and wellbeing of their employees have the potential to see a significant return on investment (1) A review of academic studies shows that the return on investment for some workplace health initiatives can range from £2 for every £1 spent (1:2) to £34 for every £1 spent (1:34) (2).

How is the Health Innovation Network influencing change?
Human resource (HR) professionals, alongside people living with diabetes have worked with the Health Innovation Network to develop and test strategies that could easily be adopted by organisations to support people living with diabetes attend structured education. These include:
1. HR policy and strategy changes to facilitate taking leave to attend courses
2. Structured education delivered in the workplace
3. Healthy lifestyles awareness-raising sessions at work with a focus on diabetes prevention

The learning from this feasibility study is being incorporated into a ‘how to’ guide, which provides examples of good practice, along with recommendations for undertaking this initiative in your workplace.

This guide will be published and available in January 2019.
How can you make change happen for your workforce?
• Sign up to receive a free copy of the ‘how to guide’ for supporting people living with diabetes in the workplace
• Implement the recommendations
• Tell us about the impact
• Grow the UK’s healthy workplace community
If you are an HR professional interested in receiving more information, contact me on linda.briant@nhs.net.
Citing the evidence

Evidence informs us that working age adults and younger people with diabetes are less likely to complete Structured Education, which can result in poor health outcomes.
The All Party Parliamentary Group for Diabetes’ report: Taking control: Supporting people to self-manage their diabetes (March 2015) highlighted that many structured education courses require substantial time off work during the week; and that this is a major disincentive to attendance as people often do not wish to use annual leave for this purpose.
A recommendation from the report states: “The clear benefits to people’s health of attending education courses mean that the Government should give people a legal right to time off work to attend education courses about their diabetes that their healthcare team believe are appropriate to their needs.” (3) NICE recommends that well-designed and well-implemented structured education programmes are likely to be cost-effective for people with diabetes and should be offered to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review.
References:
1 Healthy Work – Evidence into Action 2010 page 46
2 BUPA, Workplace Health – A Worthwhile Investment, 2010
3 Taking Control: Supporting people to self-manage their diabetes, page 20 – APPG Diabetes Report

Innovation Awards support next generation of improvements in health & care in south London

Published on October 12, 2018 and last updated on May 30, 2020 by Simon Ellery

Innovation Awards support next generation of improvements in health & care in south London

From group consultations for chronic health management in urban deprived populations to tackling falls by older residents with dementia, Small Grants kickstarts innovative projects in south London..

Twelve projects, including schemes to meet the needs of women with perinatal mental health problems, group consultations for chronic health management and training for volunteers to hold challenging conversations about end of life care, have won funding under South London Small Grants 2018.

The awards were made by the Health Innovation Network working in partnership with Health Education England (HEE). In all there were 120 applications across 45 different organisations that applied for funding.

The aim of the grants is to support innovative practice that can be spread and adopted across the health and social care landscape. The funding also aims to encourage cross-boundary working in areas of research, education and improvement in healthcare services.

In previous years, the Small Grants have enabled people across London to access funding for research and innovation to kickstart novel ideas, using the grant as a springboard to support their potential. This forms a key aspect of the Health Innovations Network’s role as an Innovation Exchange, helping innovators through signposting and supporting the adoption of innovations.

The 12 projects that will receive funding are:
• Kim Nurse, Darzi Fellow, (Kingston Hospital NHS Foundation Trust): A collaborative project with the University of Creative Arts to create a campaign to educate patients, their relatives and staff regarding the risks of deconditioning in hospital

• Emily Symington, GP, (Amersham Vale Training Practice): Group consultations for chronic health management in urban deprived populations in GP practices

• Manasvi Upadhyaya, Consultant Paediatric Surgeon, (Evelina Children’s Hospital): Development of a gastrostomy care package – a quality improvement project

• Vicky Shaw, Clinical Lead, (Lewisham and Greenwich NHS Trust): A integrated and collaborative approach to Falls (the term that describes older people falling over) training to address high levels of falls amongst residents with dementia in Lewisham Care Homes

• Katherine Bristowe, Herbert Dunhill Lecturer, (King’s College London): ACCESSCare-e: reducing inequalities for LGBT people facing advanced illness and bereavement – an evidence based self-paced online intervention

• Hind Khalifeh, Honorary Consultant Perinatal Psychiatrist, (SLAM/KCL): Meeting the needs of women with perinatal mental health problems through partnerships between NHS perinatal mental health services and voluntary sector organisations Home Start and Cocoon

• Ursula Bowerman, Operational Director/Lead Facilitator, (Project Dare/SLAM): The LGBTQ+ Dare Sessions

• Estelle Malcolm, Clinical Psychologist, (NAAAPS/SLAM): Using an appreciative inquiry approach to increase the voice of adults with an autism spectrum condition in shaping psychological therapy services

• Kate Heaps, CEO, (Greenwich & Bexley Hospice): Young Ward Volunteers Scheme

• Michael Brady, Consultant in Sexual Health and HIV, (Kings College Hospital NHS Foundation Trust): Delivering and evaluating a Sexual Health and Well-being service for Trans communities in SE London

• Liz Bryan, Director of Education and Training, (St Christopher’s Hospice): Challenging Conversations: training volunteers to support the frail elderly and those with long-term conditions in the community who want to talk about end of life issues

• Sophie Butler, Higher Trainee in General Adult Psychiatry, (SLAM): Extreme Psychiatry 2.0

Health Innovation Network Chief Executive Tara Donnelly said:
“Great ideas are at the centre of innovation in healthcare but sometimes they need a small amount of money to help them develop. The South London Small Grants have shown to be a great springboard to success with one of our previously supported projects ‘HaMpton’, an app that allows high blood pressure monitoring during pregnancy at home, now on the NHS Innovation Accelerator.
“These 12 winning projects look like being important innovations that could really make a difference to the lives of people in south London and hopefully beyond.”

HEE’s South London Local Director Aurea Jones said:
“South London Small Grants is all about helping develop innovations where there is a funding gap. We had a record number of applications this year and I was really impressed by the quality of these. I’m confident that the winning 12 projects will make a real difference to the lives of patients and their families.

“I look forward to following the progress of these initiatives closely and seeing how they deliver real health improvements.”

Ends
For more information contact the press office on 0207 188 7756
Notes to editors:
• Health Innovation Network is the Academic Health Science Network (AHSN) for south London, one of 15 AHSNs across England. We work across a huge range of health and care services through each of our clinical and innovation themes, to transform care in diabetes, musculoskeletal disease and healthy ageing, to accelerate digital health uptake into the NHS, and we’re passionate about education. The Health Innovation Network acts as a catalyst of change – identifying, adopting and spreading innovation across the health and care system in south London.
• Health Education England (HEE) exists for one reason only: to support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place.

Innovation Awards support next generation of improvements in health & care in south London

Published on October 10, 2018 and last updated on May 30, 2020 by Simon Ellery

Innovation Awards support next generation of improvements in health & care in south London

From group consultations for chronic health management in urban deprived populations to tackling falls by older residents with dementia, Small Grants kickstarts innovative projects in south London.

• Emily Symington, GP, (Amersham Vale Training Practice): Group consultations for chronic health management in urban deprived populations in GP practices

• Manasvi Upadhyaya, Consultant Paediatric Surgeon, (Evelina Children’s Hospital): Development of a gastrostomy care package – a quality improvement project

• Ursula Bowerman, Operational Director/Lead Facilitator, (Project Dare/SLAM): The LGBTQ+ Dare Sessions

• Kate Heaps, CEO, (Greenwich & Bexley Hospice): Young Ward Volunteers Scheme

• Sophie Butler, Higher Trainee in General Adult Psychiatry, (SLAM): Extreme Psychiatry 2.0

“I look forward to following the progress of these initiatives closely and seeing how they deliver real health improvements.”

Thousands of care home residents across south London to benefit from safer emergency hospital visits and faster discharge as novel ‘Red Bag’ scheme expands

Published on October 1, 2018 and last updated on May 30, 2020 by Simon Ellery

Thousands of care home residents across south London to benefit from safer emergency hospital visits as novel ‘Red Bag’ scheme expands

Novel ‘Red Bag’ ensures thousands care home residents across south London will have safer emergency hospital visits and faster discharge

The ‘Red Bag’ keeps vital medical info and personal belongings safe during emergency hospital visits

Thousands of care home residents will benefit from an innovation designed to make emergency hospital visits safer and speed up discharge after health and care chiefs agreed to extend the innovative Red Bag scheme across the whole of south London.

The news comes on the United Nation’s International Day of Older Persons (1st October) and means older residents enjoy a more personal and seamless health and care service.

Started three years ago Sutton Vanguard’s Hospital Transfer Pathway ‘Red Bag’ ensures key info such as existing medical conditions and other clinical information is communicated and helps ensure residents return to their care home as promptly as possible once hospital treatment is completed.

Developed by NHS and care home staff, the Red Bag has already been adopted across 11 London boroughs and is expected to go live in south London borough Croydon in November. NHS England unveiled a Red Bag scheme toolkit in June to encourage all areas of the country to adopt the scheme.

Care homes across south London, holding more than 13,000 care home beds between them, have committed to taking part in the Red Bag – a simple innovation which ensures records and personal belongings are kept safe when a care home resident is transferred into hospital.

Under the scheme, when a patient is taken into hospital in an emergency they have a Red Bag to take with them. The Red Bag contains:

General health information, including on any existing medical conditions
Medication information so ambulance and hospital staff know immediately what medication they are taking
Personal belongings (such as clothes for day of discharge, glasses, hearing aid, dentures or other items)

The Red Bag also clearly identifies a patient as being a care home resident and provides hospital staff with the information they need to speed up clinical decisions. This means patients can often be discharged sooner which is better both for the residents and for the NHS, as it means individuals are out of hospital more quickly and money is saved. Extended hospital time can be particularly problematic for those with dementia who can deteriorate more rapidly when away from their usual settings.

The bag stays with the patient whilst they are in hospital. When patients are ready to go home, a copy of their discharge summary (which details every aspect of the care they received in hospital) will be placed in the Red Bag so that care home staff have access to this important information when their residents arrive back home.

The Red Bag has been used with care home residents 2,000 times in south London since April 2017 and length of stay in hospital has reduced by on average 2.4 bed days per Red Bag used.

The Red Bag initiative was created by Sutton CCG hosted Sutton Homes of Care, which was a national Vanguard programme to improve care in residential and nursing homes, in partnership with clinicians from Epsom and St Helier University hospitals, Sutton and Merton Community Services, London Ambulance Service and representatives of the care homes.

Since its introduction in Sutton, the Red Bag has also stopped patients losing personal items such as dentures, glasses and hearing aids worth £290,000 in a year.

There are half a million more people aged over 75 than there were in 2010 – and there will be two million more in ten years’ time. They are also spending more years in ill-health than ever before.

Caroline Dinenage, Care Minister, said:

“The Red Bag is a great innovation that helps link up health and care services for older people, so it’s fantastic news that the whole of south London is now committed to using it. Not only is this more efficient – saving valuable resources – but it leads to a much better experience for patients leaving hospital when their treatment has finished. It’s encouraging to see the scheme being rolled out even further across the country as we move towards our ambition of joined up care that is centred around the individual.”

Aditee Naik, Peartree Care Home Manager, said: “Care home residents are at their most vulnerable when they travel in an emergency into hospital. This is why the Red Bag is so important because it ensures all key paperwork, medication and personal items like glasses, slippers and dentures, are handed to ambulance crews by carers and travel with patients to hospital where they are then handed to the doctor.

“Sometimes it’s the personal touch that makes a big difference to patients, especially if they’re elderly, and the Red Bag helps people feel reassured and more at home. It’s great that on United Nations International Day of Older Persons, here across the whole of South London we are celebrating the fact that the Red Bag is helping ensure our older residents and patients have the very best care.”

Jason Morris, London Ambulance Service Clinical Team Leader, who helped develop the Red Bag at Sutton CCG during its national Vanguard status, said:

“The Red Bag standardises the process of handover from a care home and means we can get all the essential information in one go, no matter which home in they’re in.

“We’re delighted this scheme has led to such a wide range of benefits for us, our colleagues in hospitals as well as care home staff. But most importantly, it’s seen improvements in the care of these patients who can go to the hospital with everything they need. We’re even seeing them returning back to the care home quicker.”

Stephanie Watts, NHS Greenwich CCG Commissioning Manager, said: “The Red Bag pathway is a true example of collaboration between health and care agencies. It works well because all the agencies involved in patient transfers from care homes are invested in it.

“Use of the Red Bags has a number of proven benefits which we are already beginning to see, even though it’s only been a few months, including things like increased communication between hospital teams and Care Home staff, shorter stays in hospital and improved quality of information provided to Care Homes when their residents are discharged.”

Chris Terrahe, Deputy Director of Nursing at Croydon Health Services NHS Trust, said: “We are delighted to be working alongside our partners in Croydon CCG and local care homes as part of the new Red Bag scheme in the borough. For care home residents arriving at or leaving hospital, it should make things much more efficient because all the vital information about their health will be in one place.”

Dr Agnelo Fernandes, Clinical Chair of NHS Croydon CCG and local GP said: “I’m delighted that the Red Bag is being rolled out in Croydon. We’ve seen that it can really reduce hospital stays for care home residents, ultimately improving their quality of life.”

Sarah Blow, Senior Responsible Officer for South West London Health and Care Partnership, said: “We’re incredibly proud of the work being done to improve the health of older people in Sutton by bringing together health and social care providers. Having seen the benefits to patients, we have already rolled out the red bag scheme in other boroughs in south west London, so we’re delighted that this will become a national scheme.”

Tara Donnelly, Chief Executive of the Health Innovation Network, said: “Our hospitals provide great care, but no one wants to spend any longer there than they need to and being transferred from a care home to hospital in an emergency can feel traumatic. That’s why the Red Bag is a great example of a simple idea with a big impact.”

NHS England has launched the call for applications for next year’s ITP programme

Published on September 11, 2018 and last updated on May 30, 2020 by Simon Ellery

Second round unveiled for applications for next year’s Innovation and Technology Payment

Launched at Expo 2018, NHS England has developed the Innovation and Technology Payment (ITP) 2019-20.

Delivered with the support of the Academic Health Science Networks (AHSNs), the ITP aims to deliver on the commitment detailed within the Five Year Forward View – supporting the NHS to adopt innovative market-ready medical devices, diagnostics, digital platforms and technologies which have demonstrated improvement to the quality and efficiency of patient care, by removing financial or procurement barriers to uptake.

The Innovation and Technology Payment (ITP) 2019/20 builds on the Innovation and Technology Tariff (ITT) and ITP 2018/19. It aims to support the NHS in adopting innovation by removing some of the financial or procurement barriers which can inhibit uptake at scale.

It is a competitive process designed to scale up adoption of innovations and technologies that have already proved their clinical effectiveness and are ready for nationwide spread.

The ITP is looking to support medical devices, digital platforms and technologies. The programme is not suitable for pharmaceutical products or research projects.

We aim to select a range of cost effective innovations within our budgetary confines in order to have a wide-reaching impact on patient care, and maximise learning from the programme while fostering culture change.

The ITP programme forms part of a wider set of activities to support innovation in the NHS, led by NHS England with the Academic Health Science Networks (AHSNs).

The programme will be delivered with the support of the AHSNs.

The ITP is specifically focused on low cost innovations which can deliver significant patient outcomes and savings to the NHS.

Applicants can be from healthcare, academia, commercial or voluntary sectors.

The implementation of any agreed payment mechanism or procurement will be operational from April 2019.

Day-to-day support and reporting will be via NHS England’s Innovation and Research Unit.

Read the application guidance here.

Access the application form here.

Digital Outpatients Online Resource launched

Published on September 7, 2018 and last updated on May 30, 2020 by Simon Ellery

Digital Outpatients Online Resource launched

With more than 100 million outpatient appointments every year, the NHS has a major opportunity to introduce more efficient and patient-focused digital outpatient service. The HIN has worked with DigitalHealth.London and members to take advantage.

Photo above: The Hillingdon digital outpatients team

The Health Innovation Networks new digital outpatients online resource is now available on the DigitalHealth.London website.

This follows our successful digital outpatients collaborative work, with sixteen Trusts using digital technology for virtual consultations and new ways to reduce non-attendance.

Project lead Jess Parsons said: “I’m really pleased we’ve had such great feedback about the Digital Outpatients Collaborative. We worked really hard to support the Trusts and we’ve seen some impressive results which we should continue to build on in the future.”

Help shape the next 10 years of the NHS

Published on September 3, 2018 and last updated on May 30, 2020 by Simon Ellery

Help shape the next 10 years of the NHS

National conversation unveiled to help shape the next 10 years of the NHS.

NHS England has launched a national conversation to help shape the next 10 years of the NHS.

Feedback, comments and suggestions are being invited by 30 September on a series of themes that will form the new ‘Long Term Plan’.

NHS staff, people working across social care and public health, healthcare companies, patients and carers are all encouraged to submit their views.

The plan will seek to ensure the NHS continues to innovate and adapt to the needs of all patients, focusing on three key areas:

Mothers & children – improving maternity services, care for ill and disabled children and addressing issues such as obesity and mental health
Staying healthy – helping people live longer and healthier lives
Ageing well – making the right choices and reducing unnecessary hospital stays

The Plan is being developed by a series of sub-groups and the HIN together with the AHSN Network is supporting the Research and Innovation workstream – it is inviting comments on a series of questions about how the NHS can harness the potential for innovation to transform services and empower staff and patients:

How can we increase opportunities for patients and carers to collaborate with the NHS to inform research, and encourage and use of innovations (for example new approaches to providing care, new medical technologies, use of genomics in healthcare and new medicines)?
What transformative actions could we take to enable innovations to be developed, and to support their use by staff in the NHS?
How can we encourage more people to participate in research in the NHS and do so in a way that reflects the diversity of our population and differing health and care needs
What should our priorities be to ensure that we continue to lead the world in genomic medicine?

The deadline for feedback is 30 September – to take part visit the NHS England website to access the questionnaire, or for more background contact england.ltp@nhs.net

Following this initial feedback during September, there will be further opportunities to shape the Long Term Plan throughout the autumn.

Health Innovation Network’s Stroke Prevention and MSK themes demo new tech at TEDxNHS 2018

Published on August 31, 2018 and last updated on May 30, 2020 by Simon Ellery

Health Innovation Network’s Stroke Prevention and MSK themes demo new tech at TEDxNHS 2018

High profile conference delegates hear about tech developments under Health Innovation Network and AHSN national programmes for ESCAPE-pain and stroke prevention.

The latest TEDxNHS event in London, which has grown to a record 500 delegates, featured talks around the theme of ‘Shaping our Legacy’ to celebrate 70 years of the NHS.

Held at the British Film Institute IMAX, speakers shared untold stories, infectious ideas and tales of evolution that may shape the future of our NHS.

Photos and videos of the talks will be available shortly on the TEDxNHS website for all NHS staff. All you need to do to gain access to three years of TEDxNHS talks is sign-up to our website.

The MSK theme demonstrated the various digital ways to complement the face to face ESCAPE-pain programme while Stroke Prevention was able to instruct people in the use of various AF test devices and update them as to the national drive to increase detention rates.

MSKs Isabel Rodrigues de Abreu and Stroke Prevention’s Alex Lang met Sir Bruce Keogh, former National Medical Director for NHS England, who heard about the progress of the two high profile national programmes.

Both digital ESCAPE-pain support tools are available free of charge – the ESCAPE-pain app can be downloaded onto iOS and Android devices and the recently launched ESCAPE-pain Online, our web-based version of the app, is designed to be accessed from a computer.

Stroke Prevention is continuing its work distributing AF detection devices across south London and has so far distributed more than 250 out of a total of 400 with the rest due to go out by the end of October. The team is targeting high risk population areas.

Award-winning ESCAPE-pain programme now online

Published on August 10, 2018 and last updated on May 30, 2020 by Simon Ellery

Press Release: Award-winning ESCAPE-pain programme now online

The award-winning ESCAPE-pain programme for the management of chronic joint pain is now available online to help ease the suffering of thousands of people across the country.

Chronic joint pain, or osteoarthritis, affects over 8.75 million people in the UK, including half the population over the age of 75, and one in five of the population over 45. A small proportion proceeds to surgical intervention while the vast majority are managed in the community with painkillers.

GPs typically spend around a day a week on appointments related to joint pain; by helping those people with joint pain undertake regular exercises evidenced to improve mobility and reduce pain, a large number of GP appointments can be freed for other people to be seen more quickly.

The new online version of ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain through Exercise), is a digital version of the well-established, face-to-face group programme that is now delivered in over 80 sites across the UK and is already being used to improve the lives of over 7,000 people with chronic joint pain.

Under the new digital programme, people can choose from 16 high-quality exercise videos to help improve joint pain including engaging animations and education videos to learn to manage their condition better. They can feel more in control of their pain through this free NHS resource developed by the South London-based Health Innovation Network which works to innovate health and care in the NHS.

Professor Mike Hurley, originator of the ESCAPE-pain programme, said:
“Thanks to ESCAPE-pain Online anybody with chronic knee or hip pain can now access the ESCAPE-pain programme regardless of where they live. ESCAPE-pain Online isn’t a replacement for attending the face-to-face programme, as that’s the most effective way to experience its benefits but it will support people to exercise safely and regularly in their own homes. People who are unable to attend a face-to-face programme or those who don’t have access to a smartphone can use ESCAPE-pain Online.”

Health Innovation Network Chief Executive Tara Donnelly said:
“ESCAPE-pain is a proven rehabilitation programme with a strong evidence base approved by NICE that is helping thousands of people who have been suffering in pain. By making use of digital technology and extending the programme through offering videos online, we are rolling out the potential benefit of this programme to many more people experiencing chronic joint pain; currently affecting one in five of the population over 45.”

ESCAPE-pain has been recognised with awards from both the Royal Society for Public Health (RSPH) and the British Society for Rheumatology, and is cited in the NICE clinical guidelines for osteoarthritis. More recently, ESCAPE-pain has been recommended as a preferred intervention for musculoskeletal conditions by Public Health England, which showed a positive Return on Investment of £5.20 for every £1 spent.

ESCAPE-pain Online is a free resource produced in the NHS by the Health Innovation Network and Salaso Solution Ltd. It is best viewed on a computer and is accessed via the ESCAPE-pain website homepage. For more information please visit escape-pain.org or email hello@escape-pain.org. Watch a film about ESCAPE-pain here.

The NHS 70th Birthday celebrations at Westminster Abbey

Published on July 13, 2018 and last updated on May 30, 2020 by Simon Ellery

The NHS’s 70th birthday celebrations at Westminster Abbey

This week NHS’s 70th birthday celebrations were held at Westminster Abbey. The Abbey was packed with NHS staff and patients with stories to tell and the ceremony was full of pride while Simon Stevens had strong messages for all, says the HIN’s Faye Edwards, who is part fo the team leading the national AF programme.

Photo above: A selfie in the Abbey with Tara.

Take a moment to consider how often in your lifetime the NHS has been there for you and your family when you have needed it the most. Free at the point of access, it is founded on a fundamental belief that no one should be denied health care regardless of their ability to pay. Whether it’s the birth of a child, a medical emergency or the passing of a loved one it is the care, dedication and support we receive in these profound moments is the reason we all hold the National Health Service so dear and why so many of us took pride in celebrating this momentous occasion.

On its 70th Anniversary last week I was privileged to attend a service of celebration for the NHS at Westminster Abbey. Such a beautiful setting usually associated with royal occasions it was wonderful to see the abbey packed to the rafters with NHS staff and patients, all with a story to tell and bursting with pride for this great British institution.

The service was conducted by Dean of Westminster and was attended by the Countess of Wessex. Sitting near to high alter I felt honoured to be so close to all the action and tried so hard to soak up the atmosphere. The choir sang beautifully and the congregation did their best when it was their turn! The readings and lessons from a wide variety of individuals captured the mood of the day exquisitely. Freya Lewis a teenage girl who was injured in the Manchester Arena attack in 2017 bravely delivered a moving, heartfelt speech in which she thanked the paediatric critical care team at Royal Manchester Children’s Hospital for the love and care shown to her and her family since the attack. Having undergone such a life changing ordeal she reflected on the positives. How she has gained a lifelong friendship with the nursing staff and her dedication, not only to her recovery, but in raising thousands of pounds for the hospital to say thank you for the care she continues to receive, and the pleasure she now has from seeing that money put to good use.

Simon Stevens delivered the address, reflecting on the skill, compassion and bravery of health and social care workers who support the dignity of individual life. He gave earnest thanks to staff from all levels of the service and spoke of the NHS as a unifying ideal, to those of all faiths, and of none, across this nation, and down the generations, a health service that belongs to us all.

In doing so he acknowledged it would be foolish to be blind to the imperfections of the NHS, saying ‘we must be honest about its achievements and hold ourselves accountable to an ever higher standard’. He quoted Aneurin Bevan in saying “the NHS must always be changing, growing and evolving” so that “it must always appear to be inadequate”.
Therefore ‘in order to continue to succeed in the future, the NHS must always be impatient with the present’. A paradox perhaps that is at the heart of the establishment of the AHSNs and the reason why we at HIN are striving to ‘speed up the best in healthcare’.

He spoke of the many innovations and advances in healthcare over the years and the benefits to humanity that this country has given to the world, such as antibiotics, vaccines, IVF and CT Scanners. And the radical shifts in public attitudes to disability, sexuality and patient power over the years acknowledging there is still more to be achieved.

He finished by laying down a challenge to the brilliant and idealistic staff embarking on their NHS career today. ‘You’ve made a fantastic career choice’ he said. ’

Despite the pressures and sometimes, yes, the frustrations, there is no more worthwhile, or important contribution you can make to our nation for the years ahead. The NHS of the future is largely in your hands.’

It was a thoughtful and humble address, which looked to the future whilst being mindful of the lessons from the heritage of the NHS. It was uplifting also, celebrating the great people and skill within our health service, with a definite optimism of a bright future ahead.

Once the hymns had been sung and prayers delivered the bells of the abbey were rung, it was as if they were projecting all the gratitude and thanks that had filled the abbey during the service.

Announcing to the world the national pride in the NHS and the enthusiasm with which we look forward to its 100th birthday!

Follow all the action on the day at #NHS70 on Twitter

Identifying the gaps for innovation

Published on July 12, 2018 and last updated on May 30, 2020 by Simon Ellery

Identifying the gaps for innovation

Identifying gaps in the health and care system is key to success with South London Small Grants, says Sandra Parish (pictured below) of the South London and Maudsley Foundation NHS Trust, who is running a project that for the first time provides training for staff that have often challenging conversations around dementia.

Colleagues at the Psychological Medicine and Older Adults (PMOA) at South London and Maudsley NHS Foundation Trust had been reviewing their training provision for dementia care. It was found that there was very little, if any, specific training for staff working with carers and those living with dementia which looked at having conversations around diagnosis and advance care planning. These were often quite challenging conversations for both parties which needed skill and compassion when delivering.

Spotting the gap

Maudsley Simulation and PMOA End of Life Group came together to submit a bid that looked at the gaps in training and proposed an innovative simulation training day to meet the needs of staff working across the dementia care pathway.

A literature search and consultation of all local and national policies were initiated to inform the bid and the training. The service user and carer group (SUCAG) linked to PMOA were also advocating for this type of training, to address what they thought was required to support service users’ and carers.

The project was a totally collaborative effort and was driven on both sides by passionate individuals with tasks allocated to make it a success. Service user’s thoughts and ideas were consulted throughout the process and they were also invited to observe one of the training days remotely and provide feedback. The project was delivered on time and within budget.

Identifying potential threats to the project

The project would only succeed if the potential participants, including external stakeholders, were identified early, given the learning objectives, information and time to attend. Keeping tabs on who was attending was a full-time job in the lead up to the training days. We were thankful that a member of the team took on the additional task of coordinating this.

The training was hosted and facilitated by Maudsley Simulation on each of the four training days. Senior clinicians from PMOA were there to support the running of the day and provide clinical leadership as needed. A patient story video was included to frame the morning and afternoon sessions and the carers generously gave their own time to support the project by telling their stories to camera.

Taking time to evaluate

The evaluation sheets were used to review the course after each day to make on-going improvements. The training was evaluated using qualitative and quantitative measures that were prepared as the course was designed. The results showed a statistically significant improvement in confidence and knowledge of the subject. Qualitative data gave us a good indication of how the training would be put into practice.

The training day is part of a wider remit to improve the provision of advance care planning and specialist end of life care across our Dementia Care pathway. Getting key staff involved in the training days has kick-started the conversation.

Starting the Conversation - Maudsley Simulation final report

Community health trainers are tackling high cost of chronic joint pain in innovative new programme

Published on July 5, 2018 and last updated on May 30, 2020 by Simon Ellery

New study shows community health trainers are tackling high cost of chronic joint pain

New study shows NICE approved new chronic joint pain intervention could be rolled out across the country through community health trainers.

An intervention that relieves chronic joint pain, called Joint Pain Advisor, has been successfully piloted with community health trainers in south London in a project that reduces pressure on GPs and has the potential to improve the lives of millions of people living in pain.

Musculoskeletal (MSK) pain, which includes chronic knee, hip and back pain, has a major impact on individuals and society. It is the second most common reason for GP visits, accounts for around 25% of all GP consultations and is estimated that 9.3 million working days are lost in the UK to MSK problems.

The Joint Pain Advisor model of care is a safe and cost effective alternative to GP consultations. Involving a series of face-to-face consultations, advisors work collaboratively with people with hip and/or knee osteoarthritis and/or back pain, focusing on supporting self-management. This model has been previously delivered by physiotherapists as Advisors but this new, small-scale study trained health trainers to deliver the advice in the community.

The study has shown that using community health trainers to deliver the Joint Pain Advisor model is effective. Many participants of the study said that their pain was dramatically reduced and movement had returned. They reported taking fewer pain-killers as well as increased mobility and weight loss.

The finding is significant because extending the model to community health trainers could result in much faster growth and mean that many more people can benefit from the service. There are around 3,000 community health trainers at present, who currently provide lifestyle advice on issues such as smoking cessation, weight management and healthy eating. Extending the programme to these trainers could mean that thousands more people are able to live in less pain.

Health Innovation Network Clinical Director Professor Mike Hurley said:
“The Joint Pain Advisor approach allows many more people with joint pain to benefit from NICE advice. Our service enables patients to help themselves live better lives – in less pain, able to do more, with a better quality of life.
This new study is small scale but extremely promising. Not only do we know that the Joint Pain Advisor service works to empower people to manage their pain, but through using the thousands of community health trainers up and down the country we can spread this innovation rapidly and help many more people.

With GPs under so much pressure and the countless working days lost to chronic joint pain, our programme could provide both economic and health and care benefits to the NHS.”

To date over 500 patients have used the service with physiotherapists in a previous pilot in Lewisham, south London, and they reported less pain, better function and higher activity levels. A high satisfaction rate was achieved which included reduced BMI, body weight and waist circumference and has led to fewer GP consultations, investigations and onward referrals. For every £1 spent on the programme there is a saving to the health and social care system of up to £4, according a Social Return on Investment (SROI) analysis.
The programme consists of up to four 30-minute face-to-face consultations between the advisors and people with hip or knee osteoarthritis (OA) or back pain. Patients attend an assessment where they discuss their lifestyle, challenges and personal goals and then jointly develop a personalised care plan that gives tailored advice and support based on National Institute for Health and Care Excellence (NICE) guidelines for the management of OA. They are then invited to attend reviews after three weeks, six weeks and six months to access further tailored support and advice.

Patients involved in the pilot said:
“Before I came, I used to have a lot of pain. Now I can do more walking. It’s helped me.”
“The pains eased, because I’ve strengthened my knees.”
“I’ve stopped taking painkillers because my hip has stopped hurting.”

In the latest study, 10 health trainers were trained as Joint Pain Advisors (JPAs) by the Health Innovation Network and offered the service across six community sites across Greenwich. It involved 85 participants between March 2017 and January this year.

Joint Pain Advisors are currently available in Shropshire and Merton, with plans for Croydon, Bromley and Cornwall to launch Summer 2018.

Download full report Joint Pain Advisor – Greenwich

A new funding settlement needs to put the NHS in everyone’s pocket

Published on June 15, 2018 and last updated on May 30, 2020 by Simon Ellery

A new funding settlement needs to put the NHS in everyone’s pocket

Smart use of funding can help people to benefit from digital innovations in health and care, writes Tara Donnelly

Talk of a new financial settlement for the NHS has reached fever pitch. The alluring symbolism of additional money as a “birthday present” will be difficult for politicians to resist. For staff working flat out, additional money couldn’t come sooner.

But the most important question isn’t how much, it’s what we do with it. Spending to sustain an increasingly archaic way of working must be swept swiftly off the negotiating table. New money must be used to unleash digital change. When we bank, travel, order food – we do it digitally.

When we interact with the NHS, we rarely do. The innovations set to disrupt the NHS exist, many of them created by clinical staff who could clearly see a better way. We just don’t yet use them at scale.

Care for long term conditions is a great example of the potential for change, with the NHS spending 70 per cent of its budget here. On diabetes alone, the NHS spends £14 billion a year, £1.5 million every hour. The vast majority of this is not on preventative care that will reap future benefits, it is spent mopping up the complications of uncontrolled illness.

There are strong preventative digital solutions and many that support better self-care. Systematically implementing those with the strongest evidence base, even just across five conditions where the most mature solutions exist – diabetes, prediabetes, COPD, cardiac rehab and asthma – would have a phenomenal impact.

There are also brilliant, cheap devices now that combine with smartphones to enable sophisticated home self-care and remote monitoring: blood pressure cuffs, mobile ECGs, home urine testing, peak flows, smart inhalers. These and other digital therapeutics work best when there is a partnership between the patient, their GP and where necessary a team of specialist clinicians or coaches supervising results, coaching and encouraging.

The results are powerful – weight loss, blood glucose stability, increased activity, better adherence to medicine, improved self-care, and savings in the longer term to the NHS, thanks to fewer complications.

Trusts tell us they don’t want to just digitise their outpatient processes – they want to transform them. Academic Health Science Networks are supporting a number of trusts to introduce video, phone and email consultations, make services one-stop to avoid unnecessary visits and communicate results in new ways. Their take on the barriers is fascinating. Patients aren’t the problem, they’re often keen and demanding new models.

It’s not clinician resistance either; busy clinicians can see that the digital solutions they use in their daily lives will free up time to care for patients who need them most. It’s money.

Both the perverse disincentives to digital, with examples of trusts being paid £27 instead of around £200 for a visit, and the lack of funding available for staff to take the time to implement something new. Great solutions exist to book and change appointments via smartphones too, these need to quickly become the default not the exception.

Not all parts of the population can access digital solutions, but that’s not the same as saying that they couldn’t benefit if access was improved

Not all parts of the population can access digital solutions. But that’s not the same as saying that they couldn’t benefit, if access was improved. There’s good evidence that digitally excluded groups, including the homeless and parts of the prison population, could radically improve their health with a smartphone or telemedicine.

Charities like Pathway are already giving cheap smartphones with £10 credit to homeless patients on discharge from hospital and using the devices to support with mental health and addiction through remote cognitive behavioural therapy. The success rate is impressive.

Consider that homeless people’s NHS care is typically eight times the cost of that of homed people a year (£1.5 billion a year according to the Centre for Equity Studies) and maths is clear.

We know that putting the NHS in people’s pocket works. How can we use additional funding to make it a reality?

Scale up digital therapeutics where the evidence is strongest and commit to truly digital outpatients. Create a digital innovation fund to give NHS organisations the investment they need to look beyond the day-to-day and make this a reality. Remove perverse barriers and the disruptive power of new technologies will help with the rest.

Be bolder with devices to make sure those who need it most can also benefit from a real digital health revolution. Explore offering these through personal health budgets, or partnering with the private sector to give these out as an inspired NHS birthday present.

Revolutionise the recycling of smartphones so that they end up in the hands of the homeless and other digitally excluded groups.

Unlock real patient power. The sooner we can get securely held patient records and results into the hands of activated patients the better.

Create a digital innovation fund to give NHS organisations the investment they need to look beyond the day-to-day and make this a reality

Invest more in projects that make use of artificial intelligence, now. There have been considerable advances in cognitive medical imaging and AI research but we are yet to see any real world application with patients in the English NHS. The fund could support those trusts who have a very specific use case.

We must be mindful, too, as we go on this journey that the gap between the best and the rest narrows, rather than increases. This means support for parts of the system that are struggling with digital, as well as the incentives we have for exemplar sites.

Across the NHS we have great, innovative staff. Across the country we have people who could benefit from the best digital innovations in health and care. The solutions are out there. Smart use of new funding can make it happen.

New tech drive to solve key London challenges including dementia

Published on June 13, 2018 and last updated on May 30, 2020 by Simon Ellery

Mayor unveils new tech drive to solve pressing London challenges

The Mayor has launched a major city-wide initiative to harness London’s tech talent during London Tech Week (11-17 June). Health Innovation Network is a challenge partner working to help the Mayor identify digital solutions.

Commenting on the launch this week (11 June) of the Mayor of London’s Civic Innovation Challenge to use tech and data to tackle key challenges, Health Innovation Network Commercial Director Anna King said:

“We’re proud to support the Mayor of London for the first year of the Civic Innovation Challenge. It’s an opportunity for innovative start ups and SMEs to help solve some of London’s pressing challenges, including on health and inequalities. We’re particularly pleased to see the focus on improving dementia treatment and support services for underrepresented communities in London, to help people have more healthy years of life.

“We work with small companies with big ideas every day to help solve problems facing the NHS, so we’ve no doubt that there are fantastic ideas out there to meet the challenges the Mayor has announced. We’d encourage companies to get involved and help us develop new solutions for Londoners.”

The Civic Innovation Challenge is a key initiative within the Mayor of London’s Smarter London Together roadmap published this week. The aim of the challenge is to match tech startups with leading companies and public bodies to tackle some of London’s most pressing problems, including inequality, climate change and London’s ageing population.

Health Innovation Network is working with Our Healthier South East London STP to connect start-ups and SMEs to bid for £15k grants to identify digital solutions to dementia amongst Black Asian and Minority Ethnic communities across south London.

Interested innovators should apply here.

#KnowYourPulse during Heart Rhythm Week

Published on June 4, 2018 and last updated on May 30, 2020 by Simon Ellery

#KnowYourPulse during Heart Rhythm Week

Official figures show that more than 420,000 people across England have undiagnosed irregular heart rhythm, which can cause a stroke if not detected and treated. This week south Londoners can have a free, 30-second pulse rhythm check at selected locations.

A fresh drive has been launched to identify cases of undiagnosed Atrial Fibrillation across south London as part of Arrhythmia Alliance’s Heart Rhythm Week.
Several Health Innovation Network partners are putting on events where the public can attend to have their pulse rhythm checked.

Arrhythmia Alliance World Heart Rhythm Week is taking place this week 4 – 10 June 2018. Health Innovation Network partners are putting on events where the public can attend to have their pulse rhythm checked in an attempt to detect AF in south London.

So far, these are the following events:

Monday 4/6/18

1300-1600 Main reception, Bracton Centre, Bracton Lane, DA2 7AF

Tuesday 5/6/18

1000-1200 + 1330-1600 Bracton Centre, main reception, Bracton Lane, DA2 7AF

0800-1300 Coin Street Family and Children’s Centre, 108 Stamford Street, SE1 9NH

1000-1400 Gracefield Gardens Health and Social Centre, 2-8 Gracefield Gardens, SW16 2ST

Wednesday 6/6/18

1330-1600 Main reception, Memorial Hospital, Shooters Hill, SE183RG

09.30-1700 Lewisham Pharmacy, 334 Lee High Road, SE13 5PJ

1000-1600 Wimbledon Library, 35 Wimbledon Hill Road, SW19 7NB

Thursday 7/6/18

1000-1200 + 1300-1600 Main reception, Bracton Centre, Bracton Lane, DA2 7AF

09.30-1700 Lewisham Pharmacy, 334 Lee High Road, SE13 5PJ

Friday 8/6/18

1330-1600 Main reception, Bracton Centre, Bracton Lane, DA2 7AF

09.30-1700 Lewisham Pharmacy, 334 Lee High Road, SE13 5PJ

1400-18.30 Ethnic Minority Centre, Vestry Hall, 336 London Road, CR4 3UD

Saturday 9/6/18

09.30-1700 Lewisham Pharmacy, 334 Lee High Road, SE13 5PJ

1000-1600 Downham Festival, 7-9 Moorside Road, BR1 5EP

Sunday 10/6/18

0930-1700 Lewisham Pharmacy, 334 Lee High Road, SE13 5PJ

London-wide initiative to tackle chronic joint pain could reduce use of strong painkillers

Published on March 20, 2018 and last updated on May 30, 2020 by Simon Ellery

London-wide initiative to tackle chronic joint pain could reduce use of strong painkillers

Leading NHS health innovator and physiotherapist speaks out after London newspaper The Evening Standard’s ‘The Opioid Timebomb: Special Evening Standard investigation into the overuse of prescription painkillers‘.

ESCAPE-pain Participant Interviews from Health Innovation Network on Vimeo.

Video: The video above provides patient testimony of the effectiveness of the ESCAPE-pain programme.

A leading London physiotherapist and healthcare innovator has joined calls to reduce the use of opioids for chronic joint pain. Commenting on an Evening Standard investigation that has revealed a sharp increase in opioid painkiller prescribing for chronic pain with experts warning of “a public health disaster hidden in plain sight”, a leading physiotherapist who pioneered the award-winning ESCAPE-pain programme Professor Mike Hurley has urged GPs to adopt other methods to tackle chronic joint pain.

New figures published by the London paper show that 23.8 million prescriptions were dispensed for opioids such as tramadol in England last year, one for every two adults. This is an 80 per cent rise on the 2007 figure.

Prof Hurley invented the ESCAPE-pain rehabilitation self-management programme which is shown to reduce pain, improve physical function and reduces healthcare costs for people with chronic pain. The number of sites running the programme has increased rapidly with 12 running across London helping 600 patients aged over 45 each year. He said:

‘Chronic pain is devastating – over the years I’ve seen too many people caught in a cycle of physical pain, leading to mental health problems, and in the worst cases ending up with addiction. We simply can’t continue to care for patients like this. I understand that for many GPs, who have tight 10-minute appointments which often overrun, prescribing medication may seem appropriate. But with patients suffering from poor outcomes and osteoarthritis affecting nearly 10 million people, taking up substantial GP resources, this can’t go on.

‘These painkillers haven’t been proven to work in the long term. The reality is that a combination of exercise and education does more for patients than a prescription. In London, the NHS has already proven that there’s a better way and is already pioneering an alternative approach that doesn’t involve opioids. We hope that more and more places across the country will also change their approach.’

ESCAPE-pain changed Arlene Rowe’s life. She was in terrible pain because of Osteoarthritis before taking up the six-week programme. She says:

‘Since being on the ESCAPE-pain programme, my life has changed massively. My first goal was just to stand straight. Now, I’m not hunched over, and I’m beginning to walk properly.

‘I’m still stiff, I’ve still got arthritis, but what I don’t have is the pain. Occasionally I get twinges, but nothing that makes me miserable. Being able to sleep at night is wonderful. I’m not afraid to go out, I’m not afraid to cross the road, I can get on and off the bus okay, and I can get on the train.’

Ends

For more information contact the Health Innovation Network media team on 077537 60124

The Opioid Timebomb: Special Evening Standard investigation into the overuse of prescription painkillers:
https://www.standard.co.uk/news/uk/the-opioid-timebomb-special-evening-standard-investigation-into-the-overuse-of-prescription-a3791051.html

Case study
For more details on Arlene’s story see: https://nhsaccelerator.com/story-enabling-self-management-coping-arthritic-pain/

About ESCAPE-pain
ESCAPE-pain is a group-based, six-week rehabilitation programme which combines exercise and education in an innovative way. Patients who take part in the programme say they experience less pain, have increased mobility and are better able to undertake activity in their daily life, such as gardening and caring for grandchildren. In addition, mental health improves with results for anxiety and depression improving following the programme. Recent independent evaluations have reinforced how much money the NHS saves, showing that every £1 invested returns over £5 in wider health and social value. For more information on ESCAPE-pain go to: http://www.escape-pain.org/

NHS support
ESCAPE-pain is one of 37 high impact, evidence-based innovations on the NHS Innovation Accelerator (NIA); a national initiative delivered by the 15 AHSNs and NHS England.

About Professor Mike Hurley
Finding a way to improve the practical support for people experiencing chronic pain has dominated Mike’s 25-year career as a clinical researcher. In 2017 he joined the NHS Innovation Accelerator as an Innovation Fellow: https://nhsaccelerator.com/innovation/escape-pain/
Mike qualified as a physiotherapist in 1985 and obtained his PhD in 1992. Between 1990 and 2009 he held the posts of Lecturer, Reader and Professor of physiotherapy at Kings College London before joining St George’s University of London and Kingston University as Professor of Rehabilitation Sciences. Since September 2013 he has been Clinical Director of the Musculoskeletal Programme at the Health Innovation Network, the AHSN for south London.

NHS rolls out new tech to prevent 3,650 strokes, save 900 lives and £81 million annually

Published on February 14, 2018 and last updated on May 30, 2020 by Simon Ellery

NHS rolls out new tech to prevent 3,650 strokes, save 900 lives and £81 million annually

Thousands of patients to benefit from increased diagnosis of irregular heart rhythms

Innovative technology is being rolled out across the country to prevent strokes in a national campaign.

More than 6,000 devices including mobile electrocardiogram (ECG) units are being distributed to GP practices, pharmacies and NHS community clinics across England during National Heart Month this February. The range of tech being rolled out can detect irregular heart rhythm quickly and easily, enabling NHS staff to refer any patients with irregular heart rhythms for follow up as they could be at risk of severe stroke.

Official figures show that more than 420,000 people across England have undiagnosed irregular heart rhythm, which can cause a stroke if not detected and treated appropriately, usually through blood-thinning medication to prevent clots that lead to stroke.

The range of technology includes a smartphone-linked device that works via an app and a new blood pressure cuff that also detects heart rhythms. Small and easy-to-use, NHS staff can also take the devices on home visits and allow more staff in more settings to quickly and easily conduct pulse checks.

The devices pictured, which are being distributed by NHS England and the AHSN Network, can accurately and quickly detect atrial fibrillation. Clockwise from top right: Watch BP blood pressure cuff, imPulse, Kardia Mobile, MyDiagnostic & RhythmPad

The mobile devices provide a far more sensitive and specific pulse check than a manual check and this reduces costly and unnecessary 12 lead ECGs to confirm diagnosis. As a result, the project aims to identify 130,000 new cases of irregular heart rhythms (known as Atrial Fibrillation) over two years, which could prevent at least 3,650 strokes and save £81 million in associated health and costs annually.

The devices are being rolled out by the 15 NHS and care innovation bodies, known as Academic Health Science Networks, in the first six months of this year as part of an NHS England-funded project.

Professor Gary Ford, Stroke Physician and lead on the project for the Academic Health Science Networks, said:

“More than 420,000 people throughout England are unaware they have irregular heart rhythms and of the dangers that this can pose to their health. We have highly effective treatments that can prevent these strokes, but early detection is key. Using cost-effective technology, the NHS will now be able to identify people with irregular heart rhythms quickly and easily. This will save lives.

“As the NHS approaches its 70th birthday this year, this is also a great reminder of the way that healthcare is continually evolving and innovating. Taking advantage of digital health solutions will be even more important for the next 70 years. Today’s new devices are just one example of the way that low-cost tech has the potential to make a huge difference.”

Professor Stephen Powis, Medical Director of NHS England, said:

“Cardiovascular disease kills more people in this country than anything else, but there are steps we can all take to prevent it. These innovations have enormous potential to prevent thousands of strokes each year, which is why NHS England has committed to funding the rollout of 6,000 mobile ECG devices to help identify cases of atrial fibrillation so behaviours can be changed and treatment started before strokes occur.

“We are also encouraging people, during National Heart Month, to learn how to check their own pulse so we can catch even more cases.”

One million people in the UK are known to be affected by AF and an additional 422,600 people are undiagnosed. As the most common type of irregular heart rhythm, it is responsible for approximately 20% of all strokes. Survivors must live with the disabling consequences and treating the condition costs the NHS over £2.2 billion each year.

The rollout is being unveiled during National Heart Month, which raises awareness of heart conditions and encourages everyone to make small changes towards a healthier lifestyle. This year the British Heart Foundation is encouraging everyone to make small changes towards a healthier lifestyle. See more here.

The public are being encouraged to spread the word about irregular heart rhythm and urge friends and family – particularly those aged over 65 – to check their pulse and see a GP if it is irregular. Pulse checks can be done manually (a British Heart Foundation video and guide shows how here) or through new technology, with irregular rhythms investigated further by healthcare professionals.

REAL STORIES

Ian Clark, 62, North West London

I was visiting a client in 2012 and suddenly thought I was having a heart attack. The client called 999 for an ambulance. When the ambulance arrived, they took me to see a registrar in A&E who said that I had atrial fibrillation. I was in complete shock because I didn’t know what it was. She told me it’s an irregular heartbeat, lots of people have it and you will get attacks from time to time.
I felt dreadful. Really, really bad as it felt like I could die at any point. I was living in fear. The ongoing feeling was of complete and utter exhaustion and being totally drained. It’s far worse than the worst jetlag. You do not have the energy to do anything at all.
To know that there is something dreadfully wrong with your heart is awful and all you want to do is collapse into a corner.
Three days after being in A&E I went to my GP. The nurse there gave me a ECG and while doing it she ran out and came back with the doctor and they thought I was having a heart attack! It turned out I wasn’t but they booked me to see a cardiac specialist at the Harefield Hospital in North West London, who was amazing. She put me on anti-coagulants to treat my condition.
During this whole period, I constantly thought I was going to die and that was massively draining and stressful. I had 37 medical appointments in three months.
Six years on after the diagnosis, the reality is that I am living a normal life. Two years ago, I even went white water rafting in Costa Rica!

Above: Chris (4th from left) white-water rafting in Costa Rica six years after an atrial fibrillation diagnosis

Wendy Westoby, 77, Tyldesley in Wigan

After suffering from an AF-related stroke, Wendy Westoby is the first to encourage people to get their pulses tested.
77-year-old Wendy, from Tyldesley in Wigan had been suffering from an irregular heart rate since 2000. She first noticed an atrial flutter after her 60th birthday but put it down to “over indulgence!”
Wendy suffered a stroke in 2009 and but despite many consultations with cardiologists, her symptoms “wouldn’t appear to order” so she wasn’t diagnosed with AF until 2011.
Wendy has received a catheter ablation but her symptoms reappeared in 2017 and Wendy is scheduled for further surgery this weekend at Liverpool Heart and Chest Hospital.
Now Wendy has become an AF Ambassadors – using the latest AliveCor technology to test people’s pulses in her community – she also finds it useful for emailing her own ECGs to her consultant’s secretary.
She said: “The experience has shown me is that it’s even more important to pick cases up early.”
And for those who may be nervous after being tested, she advised: “Go ahead – very simple – initial treatment should be non- traumatic and may avoid long term problems after a stroke.”

Local innovations set for national spread

Published on December 18, 2017 and last updated on July 8, 2020 by Simon Ellery

Innovations born in south London are now being spread nationally

Better care for people with pain, eating disorders and high blood-pressure in pregnancy, thanks to local innovations set for national spread, says Anna King, who is Commercial Director of the Health Innovation Network.

With the papers full of snowstorms and Brexit, you may have missed the quiet revolution that is south London innovations dominating this year’s NHS Innovation Accelerator.

Day-by-day, step-by-step, our members and their staff are using innovation to improve outcomes for their patients. This fantastic endorsement means that more patients nationally will benefit from these home-grown innovations.

We know that good ideas do not often spread themselves. That’s why programmes like the NHS Innovation Accelerator (NIA) can make such a difference. The NIA is an initiative delivered in partnership between NHS England and the 15 Academic Health Science Networks (AHSNs). It supports and accelerates the uptake of high impact innovations so that patients can benefit from new products and services.

Each year it takes on a number of ‘fellows’ – people who are passionate about scaling their evidence-based innovation to benefit a wider population, with a commitment to share their learnings from their own work.

This year’s cohort was announced recently, and includes an impressive line-up of innovations that we in south London know well.

There are three locally developed innovative service models:
• ESCAPE-pain – a six-week group programme delivered to people aged 55+ with osteoarthritis (OA). Developed by the Health Innovation Network’s own Prof Mike Hurley, ESCAPE-pain is known to generate a return of £8 for every £1 spent.
• The FREED ‘first episode rapid early intervention service for eating disorders’ was developed by the South London and Maudsley NHS Foundation Trust model and provides a rapid early response intervention for young people aged 16 to 25 years.
• The home monitoring of hypertension in pregnancy (HaMpton) new care pathway, developed locally by St George’s, uses an app for monitoring high blood pressure at home, empowering expectant mothers to be involved in their own care.

The line-up also includes current and former DigitalHealth.London accelerator companies: Oviva, Transforming Systems and My Diabetes My Way. These innovations are varied – from apps that help patients decide on urgent care depending on the size of the queue to new ways of self-managing diabetes.

With tight budgets, maintaining and spreading these initiatives is more important than ever. These examples from south London are far from isolated or unique – AHSNs across the country are supporting a wide variety of innovative service models and technologies, that are not only improving outcomes, they are saving vital funds for NHS services.

It is difficult for staff to improve services through innovations whilst coping with increased demand and complex patient needs. In this context, it’s important that we recognise, celebrate, support and spread the innovative work of NHS staff, and their dedication to making life better for their patients.

The Health Innovation Network is keen to support any of its members who are looking to adopt innovations from the NHS Innovation Accelerator, so if you are interested in any of the areas mentioned please get in touch info@digitalhealth.london

Why SBRI matters

Published on December 13, 2017 and last updated on May 30, 2020 by Simon Ellery

Why SBRI matters

The SBRI programme provides vital funding to get innovations off the ground – its successes are clear, says Health Innovation Network Chief Executive Tara Donnelly.

Whenever I hear that a health innovation is being adopted across the country to improve patient safety and save the NHS money, I’m reminded of the power of innovation and the role that Academic Health Science Networks have to play in spreading it across the health and care system.

Recently, an independent review by David Connell of Small Business Research Initiative (SBRI) Healthcare, the NHS England funded programme, recognised the critical role to the success of the programme played by the 15 Academic Health Science Networks (AHSNs). See SBRI story

The SBRI programme provides vital funding to get innovations off the ground in two phases. The first is for feasibility testing up to £100,000 and the second is to develop a prototype and is worth up to £1 million.

Since launching in 2009, £69 million has been awarded to over 150 companies developing solutions for major NHS challenges such as cancer detection, dementia care, mental health in young people and self-management of long-term conditions. These funds provide crucial support to early stage health care ideas and help convert them into products with evidence that can help patients and the NHS.

But why does this latest report matter? Most importantly it matters because this is public money and money that has been earmarked to improve our NHS through innovation. The fact is, I regularly hear about how innovations that the AHSN Network is spreading are saving the NHS money, improving the patient experience and indeed saving lives.

For example, we know that the London Ambulance Service has adopted Perfect Kit Prep, which cuts paperwork in medicines management and is a vital audit tool, across all its ambulance stations. See Perfect Ward

At the same time North West London CCGs have successfully trialled digital tools to encourage self-care as part of important initiatives to reduce weight, improve fitness and tackle Type 2 diabetes across their populations. The products used include Oviva, OurPath and Changing Health who we have supported through our London-wide Digital Health Accelerator.

But it’s not all about using smartphone apps. Working with BBC Choices, we also this year produced a video that helps parents and clinicians spot the signs of sepsis – a condition that kills around 44,000 each year which if spotted earlier could be prevented.

The video has been viewed more than 1.7 million times and has saved at least one life with a mother telling us on Facebook how the video helped her save her daughter. Numbers are important in equating the success of innovations but when a mother says a video helped her save her daughter’s life, that makes it all worthwhile. The film is here and if you can share it with more people, we’d be delighted.

But in terms of the significance of the SBRI review, this report underlines the important role that AHSNs play in spreading innovation into our NHS at pace and scale. It’s vital that we tap into clinical and commercial expertise to deliver solutions to health challenges identified in our communities and hospitals so that we can improve the patient experience.

Up and down the country, AHSNs are using their local knowledge to work closely with the SBRI to ensure funding is aimed at innovative companies solving healthcare problems.

For example, 11 Health’s ostom-i wireless ostomy pouch alert system, which lets patients know when to empty their stoma pouch, received critical financial support from SBRI Healthcare as well as support from the Digital Accelerator mentioned above. This is helping the roll-out of the product and improving the lives of users of ostomy pouches in London.

Mr Connell identifies the SBRI as “the best role model” and recommends the programme led by the AHSNs be developed and built upon. This is exactly what we are doing in as dynamic and innovative way as we possibly can.

London NHS digital chief crowned Top 50 female leader in UK healthcare

Published on November 2, 2017 and last updated on May 30, 2020 by Simon Ellery

London NHS digital chief crowned Top 50 female leader in UK healthcare

Award follows significant growth in digital innovation in London’s NHS.

The 50 top leaders in the UK’s growing healthcare sector have been unveiled and the list features a leading champion driving digital innovation in London’s NHS.

Tara Donnelly, the Chief Executive of the Health Innovation Network (HIN), features in the annual BioBeat top 50 for the first time for her commitment and leadership in spreading innovation across the NHS in south London.

As one of the founding partners of DigitalHealth.London, Tara has helped innovative tech companies to spread their work across the NHS, saving the NHS money and improving patient care. DigitalHealth.London’s work includes supporting innovations such as DrDoctor, which has reduced missed appointments at Guy’s and St Thomas’ NHS Trust by 40 per cent and has saved hospitals up to £3 million a year.

Other examples of innovations DigitalHealth.London has helped to roll out across the NHS include iPad apps, Perfect Ward and Perfect Kit Prep, which eliminate paperwork and improve auditing and have now been adopted across 70 London Ambulance Service stations. With 5,000 staff serving 8 million people, these innovations are helping ambulance staff to save crucial time and resources.

Produced by BioBeat, the report 50 Movers and Shakers in BioBusiness 2017 emphasises how diversity of thinking is critical to the success of the sector in the UK. The report also celebrates how women are driving innovation in healthcare. It comes within weeks of the Government announcing that, by 2023, the UK should be in the top quartile of comparator countries for the speed of adoption and the overall uptake of innovative medicines, devices and digital products.

Health Innovation Network Chief Executive Tara Donnelly said:

“I’m honoured to join this top 50 list of key players in UK healthcare at such an exciting time. We achieve these results by working with others so I’m delighted to see Academic Health Science Networks recognised, with my colleague Karen Livingstone from Eastern Academic Health Science Network in today’s list, as well as Elin Haf Davies, chief executive at Aparito, one of the digital health companies we are currently supporting.

“Our reports are a crucial source of information for health organisations and reveal just how fast innovation is happening across London to improve services for patients and save the NHS much needed cash. Whether it’s the London Ambulance service or hospitals such as King’s College and Guy’s & St Thomas’ innovating through smartphone apps, or wearable 3G and Bluetooth devices helping patients at Chelsea and Westminster and North West London CCGs, we are helping the NHS begin to make the most of digital technologies, and that is very satisfying.”

GSK Senior Vice President, UK & Ireland Pharmaceuticals, Nikki Yates, commented:

“Diversity of talent is critical to life sciences and it is great to see the contribution these women are making. 50 Movers and Shakers in BioBusiness 2017 celebrates leaders whose dedication is about innovation in the healthcare business. It is fantastic to see that these are female leaders, and that they are recognised for the progress they have made over the past year.”

Based in South London, Tara also plays a role on the national stage within the AHSN Network, which represents the 15 Academic Health Science Network organisations covering the population of England, speeding up innovation in health and care.

For copies of the report contact Ol Anscombe T: 01223 828 200 & for info on Tara Donnelly and the Health Innovation Network see healthinnovationnetwork.com

About BioBeat’s 50 Movers and Shakers in BioBusiness: The 50 Movers and Shakers in BioBusiness report has been released by BioBeat every autumn since 2014. The full report for 2017 is available to download

Read more examples of innovative care in DigitalHealth.London’s latest report: Digital Leadership in London’s NHS

DigitalHealth.London is a programme aiming to speed up the development and scaling of digital innovations across health and care, and pioneer their adoption by the NHS. DigitalHealth.London was established by London’s three Academic Health Science Networks – UCLPartners and Imperial College Health Partners as well as Health Innovation Network, with MedCity.
The DigitalHealth.London Accelerator is the first programme of DigitalHealth.London and is part-funded by the European Regional Development Fund.
For more info on DigitalHealth.London see its website DigitalHealth.London

Video and audio feature in all new interactive and digital Network 12

Published on October 27, 2017 and last updated on May 30, 2020 by Simon Ellery

Video and audio feature in all new interactive and digital Network 12

Interactivity is at the centre of our new look Network 12 digital magazine which features links to our top stories.

Watch, listen and read the latest exciting news about the digital revolution in the NHS as revealed in our redesigned and interactive digital magazine Network 12.

The redesigned Network 12 features links to our top stories including the sepsis video that clocked up 1.6 million views, audio from a lively Spectator magazine debate on digital tech as well as our key events and vital new resources.

In her Network 12 introduction, Health Innovation Chief Executive Tara Donnelly says:

“We are witnessing a revolution in the way that digital technologies, from smartphone apps to Bluetooth, are impacting healthcare.

“Earlier this year we revealed the extent to which NHS leaders in London have adopted new tech to improve services to patients and save millions of pounds, with south London examples including the six South West London CCGs, Kings College Hospital & Guy’s & St Thomas’.

In September we celebrated the first anniversary of DigitalHealth.London’s Accelerator programme and the NHS England board committed to relicense England’s 15 AHSNs for a new five year period. Other updates include our ESCAPE-pain programme scooping Sport England funding to expand.

“Listen to the Spectator magazine debate I took part in on the digital health revolution, watch the “Spotting the Signs of Sepsis” video with CBeebies Dr Ranj that has clocked up more than 1.6 million views to raise awareness of the symptoms of sepsis and the short video we made after winning the FT/VitalityHealth healthy workplace prize.

“Finally, please take a moment to browse our new website which better reflects our agile and modern approach to innovation in health, and perhaps ‘like’ our Facebook page which aims to take a more social and fun look at our day to day work.

“I hope you enjoy the new Network 12 and if you do please like and share it on social media.”

ESCAPE-pain awarded Sport England funding to help older adults get active

Published on October 12, 2017 and last updated on May 30, 2020 by Simon Ellery

ESCAPE-pain awarded Sport England funding to help older adults get active

Coleen, 84, is a retired nurse, who has suffered knee pain for many years. Through ESCAPE-pain she has been able to cope and is determined to continue the programme.

Award-winning programme for people with chronic joint pain ESCAPE-pain has been given £392,000 of National Lottery funding from Sport England to help reduce the number of inactive older adults.

ESCAPE-pain is a rehabilitation programme for people with chronic joint pain, that integrates educational self-management and coping strategies with an exercise regimen individualised for each participant. It helps people understand their condition, teaches them simple things they can help themselves with, and takes them through a progressive exercise programme so they learn how to cope with pain better.

Currently there are 36 active sites running the ESCAPE-pain programme across six AHSN patches in England; Health Innovation Network (South London), UCLP(North London), Kent, Surrey & Sussex, West of England, Oxford AHSN and North East & North Cumbria. The programme also runs in Wales and the Republic of Ireland.

The Escape Pain app was launched in February and has been downloaded more than 1,800 times.

Sport England has put tackling inactivity at the heart of its strategy Towards An Active Nation, and launched the Active Ageing fund to tackle inactivity in the over 55s.

Sport England research shows:

There are roughly 5.8 million inactive people over 55 in England and the number of inactive people is growing as people are living longer.

Inactivity among over 55s is responsible for as many deaths as smoking

36% of over 55s are inactive compared to 26% of the population as a whole

Age 55-64 (28% inactive), 65-74 (31% inactive) 75-84 year olds (49% inactive), 85+ (72% inactive)

Mike Diaper, Executive Director at Sport England, said: “Being active is one of the most important things people can do to maintain health and wellbeing as they age. We’re delighted to be supporting ESCAPE-pain with National Lottery funding to help get older adults lead happier and heathier lives. We’ll be sharing learnings so successful approaches can be scaled-up or replicated across the country.”

Professor Mike Hurley, originator of the ESCAPE-pain Programme, said: ”We’re delighted to have been selected to work with Sport England, in partnership with Arthritis Research UK, to help older people increase their physical activity levels.

“We know that for millions of older people, chronic knee or hip pain is seen as a barrier that prevents them from being active. The ESCAPE-pain programme has already shown 3000 people in England that they can become more physically active and manage their pain.”

The Health Innovation Network will be looking for more leisure organisations and other partners to run the ESCAPE-pain programme in community locations. For more information please see www.escape-pain.org or email hello@escape-pain.org

ESCAPE-pain featured in Daily Telegraph Arthritis Awareness

Published on October 12, 2017 and last updated on April 9, 2019 by Simon Ellery

Daily Telegraph Arthritis Supplement

Award-winning chronic pain programme ESCAPE-pain and Joint Pain Adviser are featured in a Daily Telegraph supplement called Arthritis Awareness. Under a feature headlined ‘The MSK Revolution underway at a GP near you’, the pathway approach is illustrated using a case study.

Strap in – it’s time to channel-shift

Published on October 9, 2017 and last updated on May 30, 2020 by Simon Ellery

Strap in – it’s time to channel shift

SMS text messaging, telemonitoring, vdeo consultation – these are all contenders in the race to deliver improved care and reduce costs. But what works and where should providers and commissioners prioritise local investment? The Health Innovation Network’s Tim Burdsey shares some insights from a recent review of the evidence base.

Much has been written in recent years about opportunities for new technologies to enable so-called “channel-shift” in the provision of health and care services. But what does the available evidence tell us about which technology solutions are most effective, and about where providers and commissioners should prioritise local investment? Tim Burdsey from the Health Innovation Network (HIN) AHSN shares some insights from a recent review of the evidence base.

To provide services that meet local needs and expectations and that address anticipated demand, we need to think differently about how we deliver care. New technologies are an important part of the answer; however, service providers and commissioners often don’t know which technology solutions are best placed to realise particular kinds of benefit.

In December 2016, NHS England’s New Care Models programme approached the HIN to review the evidence for technology-enabled care services (TECS) to provide colleagues with information to make effective decisions about TECS to support the development of new models of care. The programme was established in 2015 in response to the NHS Five Year Forward View. It aims to build sustainable health and care models which respond to the ‘triple gap’ – health and wellbeing, quality and care, and cost. The programme is built on four guiding principles of clinical engagement, patient involvement, local ownership and national support.
From the start, we were cautioned that the review would be a tricky undertaking. “The evidence just isn’t there…”, people warned us. “There’s plenty of great stuff, but it’s not in peer-reviewed journals…”. To some extent, this has proven true. However, we wanted to find some useful insights that would assist planning and decision-making, and so decided to adopt a pragmatic approach to the evidence review and press on as best we could.

The first challenge we faced is that the concept of TECS is very broad. It covers everything from assistive equipment in the patient’s home (‘telecare’), to remote diagnostic equipment (‘telehealth’), to the provision of psychological therapies ‘at a distance’ (‘telecoaching’), to digital health apps on smartphones or tablets. To make matters more complicated, we found that, sometimes, some of the concepts above are used interchangeably, or a term that relates to a specific type of technology is used as an umbrella term to refer to the field of TECS as a whole. This required us to exercise due rigour when devising the search strategy that would inform our interrogation of the evidence.

The second challenge we faced was the sheer size of the evidence base. An initial search yielded >10,000 primary studies, which meant that it was not going to be possible for us to analyse everything within the scope of the project. We therefore decided to focus on systematic reviews and other meta-analyses listed in the Cochrane and DARE databases, of which there were 411—which made our analytic endeavour manageable.

So, what did the evidence reveal?

There is limited evidence of the effectiveness of TECS, and information on cost-effectiveness is particularly scant
The studies covered in a single systematic review can be diverse, which can make it difficult for the authors to draw firm, cohesive conclusions. On the occasions when we drilled down into the detail of primary studies, we found issues with poor study design, lack of relevance, or simply findings that were equivocal. We hope this will be addressed as new, more rigorous studies are developed and published in this area.

The evidence base hasn’t yet caught up with the pace of technology innovation
Many new and emerging technologies are felt to have the potential to revolutionise healthcare delivery: virtual/augmented reality (VR/AR), robotics, artificial intelligence (AI), ‘Big Data’-based analytics, the Internet of Things (IoT), to name but a few. Whilst compelling, these are at the preliminary stages of spread and adoption—indeed some are at an even earlier stage in the innovation pathway than that. As a result, such technologies are conspicuously absent from the evidence base. It will be for future reviews to explore their impacts, and to make recommendations about whether they are worthy of consideration and investment at that stage.

Whilst stakeholders were generally aware of, and excited by, some of these developments, their attention was focused on understanding the potential impact of more ‘mainstream’, currently available technologies. SMS text messaging, for example, is so ubiquitous that most would consider it unremarkable—and its applications well-understood. However, there is a sense that we haven’t fully appreciated its potential to support health-related behaviour change, and so stakeholders were keen that we examined the evidence for its effectiveness.

Stakeholders indicated five areas of technology delivery that they are interested in. The evidence of effectiveness for each of these areas is as follows:

• SMS text messaging: Helpful in supporting adherence to medication; enabling smoking cessation (at least in the short-term) and substance misuse interventions; and encouraging glycaemic control in diabetes management. However, must be tailored for the individual, and is most effective when it is delivered in the context of a proven behaviour change framework.
• Telemonitoring: Effective for people with diabetes or heart failure. Telemonitoring is frequently undertaken in conjunction with educational interventions and in the context of enhanced relationships with medical professionals. It is unclear precisely which of these aspects is responsible for the impacts observed.
• Video consultation: Felt to be at least as effective as face-to-face interventions. Effective in treating mental illness through consultation, short-term support, and counselling.
• Web-based interventions: Effective in reducing anxiety symptoms. Again, personalisation and interactivity are important, as is the need to combine online interventions within other support measures.
• Mobile digital health apps: we found only one study covering smartphone apps—a situation that will surely improve in future. Apps can increase adherence to diet monitoring, and enhance compliance with treatment instructions among patients undergoing routine cardiac procedures.

Findings have informed the development of a benefits realisation model, produced by mHabitat and the York Health Economics Consortium. This will provide practical assistance to those seeking to understand the benefits of a particular TECS intervention.

For more information and to view or download the final report from the project, and to provide feedback on the recommendations, please visit https://healthinnovationnetwork.com/projects/tecs/.

Powerful new film launched as part of training package to tackle alcohol stigma

Published on September 18, 2017 and last updated on May 30, 2020 by Simon Ellery

Powerful film aims to tackle stigma that patients with alcohol problems face

A powerful new film to support an e-learning package has been unveiled to reduce the stigma that patients with alcohol problems face.

Using emotional and thought-provoking real stories voiced by patients alongside a practical package of training materials including facilitator’s notes, the e-learning programme is a valuable resource for frontline professionals.

Health Education England e-Learning for Healthcare (HEE e-LfH) has worked with the Health Innovation Network South London, the South London and Maudsley NHS Foundation Trust and King’s College London to develop the package for for NHS healthcare professionals.

Having a better understanding of alcohol dependency may help healthcare professionals to improve longer-term outcomes for patients with alcohol dependency and reduce re-attendance.

This e-learning programme will be of interest to health and social care staff who come in to contact with patients with alcohol problems, whether that is in hospital, primary care or community settings.

Sometimes people with alcohol problems can be stereotyped, and judged to be less worthy of excellent treatment and care. Such stigma can be a barrier to help-seeking. It also impacts on treatment outcomes and diminishes patients’ feelings of empowerment.

Frontline health and social care staff regularly come into contact with patients with alcohol problems. While a small group of healthcare professionals are specifically trained in addictions or alcohol, many frontline staff will have received little or no specialist training in this area. The new national NHS Commissioning for Quality and Innovation (CQUINs) payments framework for 2017-19 incentivises certain secondary healthcare clinicians to enquire about patients’ alcohol use, leading to possible brief intervention or referral to appropriate care.

The e-learning programme includes a mix of resources including a thought-provoking film reflecting on some service user experiences, facilitator’s notes for group or face to face delivery of the training (recommended) and also a shorter online version for individuals keen to learn about this, who do not have access to the group training.

To access the free Alcohol Stigma e-learning programme and to view the film please click here.

Health innovation body in south London scoops Financial Times/VitalityHealth healthiest workplace prize

Published on September 14, 2017 and last updated on May 30, 2020 by Simon Ellery

Health innovation body in south London scoops Financial Times/VitalityHealth healthiest workplace prize

HIN has been recognised as one of Britain’s Healthiest Workplaces in the prestigious Financial Times/VitalityHealth Britain’s Healthiest Workplace competition.

Health Innovation Network wins healthy workplace award in prestigious Financial Times/VitalityHealth competition from Health Innovation Network on Vimeo.

A south London organisation that promotes the spread of health and care innovations into the NHS is the healthiest small new entrant in the prestigious Financial Times Britain’s Healthiest Workplace survey.

The Health Innovation Network in south London, which employs 70 staff including nurses and paramedics, offers free yoga and mindfulness classes as well as ‘standing up’ desks, showers for running and cycling clubs. It also promotes a book club and discourages staff from engaging with emails after 7pm or at weekends.

“We want to make sure people switch off, so we have a curfew to help our staff recharge. You need to be with your family and friends in your free time,” says chief executive Tara Donnelly. Tara switched off digitally on holiday in August for two weeks.

“I’m delighted that we have won such a prestigious award and against such tough opposition. We take pride in promoting healthier living for all of our staff and encouraging colleagues in the NHS to do the same. Given we are in the business of innovating in health care and helping people take healthy decisions it is only right that we seek to do the same as an organisation.

“We are very proud of our staff at the Health Innovation Network. We need to look after them and keep them. It makes sense morally and it makes business sense,” she added.

Britain’s Healthiest Workplace was developed by VitalityHealth and is delivered in partnership with the Financial Times, RAND Europe, University of Cambridge and Mercer

Britain’s Healthiest Workplace aims to celebrate organisations that have an outstanding approach to their employees’ health and wellbeing and is one of the UK’s largest and most comprehensive surveys into employee health.

£114k awarded to drive NHS innovations across south London

Published on September 8, 2017 and last updated on May 30, 2020 by Simon Ellery

£114k awarded to drive NHS innovations across South London

Money directed at local projects will deliver innovations in health for patients across south London.

Twelve projects including schemes to improve the care of depression in older people, a new way to deliver medication to housebound patients and digital diabetes education have won funding under South London Small Grants 2017.

The awards were made by the Health Innovation Network working in partnership with Health Education England. In all there were 75 applications across 42 different organisations that bid for funding.

The aim of the grants is to encourage innovations that address the gaps highlighted in the NHS Five Year Forward View and support the ambitions of the Sustainability and Transformation Partnerships within south London. The funding also aims to encourage cross-boundary working in areas of research, education and improvement in healthcare services.

In previous years, the Small Grants have enabled people across London to access small pockets of funding for research and innovation to try out their ideas, using the grant as a springboard to support their potential.

Picture above: One of last year’s award winners delivered Project Growth where researchers from University of Roehampton’s Sport and Exercise Science Research Centre collaborated with the NHS to give patients the opportunity to participate in a newly developed falls prevention gardening programme. Read the blog on this link: http://bit.ly/2ja0rLb

The 12 Projects that will receive funding are:

Jane Berg, Deputy Director Skills, Knowledge and Research, (Princess Alice Hospice): Development of a faculty of Hospice Evaluation Champions (HEC)

Catherine Gamble, Head of Nursing Education, Practice and Research, (South West London and St Georges Mental Health Trust): To improve the management and treatment of depression in older people residing in care homes- A Quality Improvement Project

Dr Cheryl Gillett, Head of Biobanking, (Guys and St Thomas’ NHS Foundation Trust): Using Volunteers to Seek Consent for Research Biobanking

Jignesh I. Sangani, Practice Pharmacist, (Brockwell Park Surgery): A new approach to medication delivery for housebound patients that aims to identify and manage medication issues, wellbeing, living and safety concerns

Emma Evans, Consultant Anaesthetist, (St George’s University Hospital Foundation Trust): Proposal to train staff to apply patient-centred quality improvement methods to improve the experience of women having operative deliveries, and their families

Sandra Parish, Simulation Nurse Tutor, (Lambeth Hospital): Starting the Conversation – ADVANCE Care Planning and End of Life Care Skills Training in Dementia Care

Clare Elliot, Planned Care Projects & SWL Lead for Diabetes, (Wandsworth CCG): Digital Diabetes Education

Dr Stephanie Lamb, GP, (Evelina Children’s Hospital): Feasibility study for assessing the effectiveness and impact of using a bio-psychosocial assessment tool to encourage holistic conversations with young people for Youth Workers

Ann Ozsivadjian, Principal Clinical Psychologist, (Guys and St Thomas’ NHS Foundation Trust): Meeting the mental health needs of children and young people with autism spectrum disorder – a collaboration between health and education

Kath Howes, Lead Pharmacist, (University Hospital Lewisham): Validation Of A Tool That Assesses The Impact Of A Medicines Optimisation Service

Professor Matthew Hotopf, Director of NiHR Biomedical Research Centre, (King’s Health Partners): IMPARTS MOOC – Integrating Mental & Physical Health: Depression & Anxiety

Felicity Reed, Practice Lead, (Southwark Council): Incredible Women

Health Innovation Network Chief Executive Tara Donnelly said:

“Great ideas are at the centre of innovation in healthcare but sometimes they need a small amount of money to help them develop. The NHS faces real financial challenges and innovation is vital in order to improve patient care and reduce costs so South London Small Grants play a key role in all of our healthcare.

“These 12 winning projects look like being important innovations that could really make a difference.”

Health Education England South London Local Director Aurea Jones said:

“South London Small Grants is all about helping develop innovations that have a funding gap to make sure they happen. We had a record number of applications and it was very difficult to shortlist but the winning 12 are excellent projects that should make a real difference to people’s lives.

“I look forward to following the progress of these initiatives closely and seeing how they deliver real healthcare improvements.”

What are we doing to prevent strokes?

Published on July 15, 2017 and last updated on May 30, 2020 by Simon Ellery

A new online tool will help prevent strokes and save lives

An estimated 68,000 people in London are living with undetected AF and at risk of blood clots, stroke, heart failure and other heart-related complications. The Health Innovation Network’s Fay Edwards talks about the launch of an important new tool.

This week together with our partners we launched the Pan-London Atrial Fibrillation (AF) toolkit. The online toolkit is the culmination of a collaboration between the three London Academic Health Science Networks (AHSNs) and the London Clinical Network (LCN).

Visualised in 2016, it is targeted at commissioners and providers who want to find more people with AF (Detect), Treat more people with AF (Protect) and improve the outcomes of those people receiving treatment (Perfect). The toolkit focuses on each of these three areas and is laid out in a logical order, first setting the scene with an introduction from Tony Rudd (National Clinical Director for Stroke, NHS England) and Matt Kearney (National Clinical director for Cardiovascular Disease Prevention, NHS England) highlighting the unmet need for appropriate anticoagulation and improved detection of AF.

Within each of the three domains there are three “opportunities for improvement” designed to stimulate ideas and focus efforts. These contain case studies, resources and best practice examples which provide guidance on how to replicate. With all quality improvement it is vital for teams to understand their ‘current state’ before embarking on the future. The AF improvement cycle (on page 7) encourages teams to consider the quality and performance of their service compared to national standards and highlights the need for them to understand and interpret their own service level data. The AF improvement cycle is a complete and concise methodology which has been developed through the understanding of the critical success factors needed to undertake AF improvement work. It can be applied to any of the three domains and opportunities for improvement.

Complementing the AF improvement cycle is a series of infographics for each London CCG which clearly and pictorially presents data on prevalence, anticoagulation rates, those known to be at risk of stroke and those who have had a stroke in the past year. These have already proved very powerful in engaging interest and understanding a starting point. For those teams outside of London, or for data more focused on each domain (Detect, Protect and Correct) there is a useful table of data sources laid out within each of these.

Supporting all of this is the AF business case model. Designed by Public Health England and the AHSNs this tool uses publically reported data of AF to help organisations identify areas for improvement in the identification management of AF. It will also quantify the cost and savings associated with addressing these opportunities.

Detect

Within detect there is a focus on AF Awareness campaigns, the importance of manual pulse rhythm checks and AF detection devices. This includes the Health Innovation Network’s AF detection device review, a detailed report which defines the current technology and software designs available to enhance AF detection. It contains examples of how to use these devices and improve actual prevalence in a variety of settings.

Protect

Within protect there is focus on how to improve anticoagulation, Initiating anticoagulation in community settings, correcting heart rhythm and rate where necessary.

Perfect

Perfect encourages high quality anticoagulation services which provide patient education, a range of treatment options and support of self-monitoring. It contains the ‘Excellence in Anticoagulation Care’ document from the London Clinical Network – a guide for commissioners and service providers to help deliver high quality anticoagulation services.

A pathway for service review is contained in this section including a checklist to assist commissioners in benchmarking their anticoagulation service or create a service specification.

There are also educational resources for patients and staff n to support self-management and self-monitoring of International Normalisation Ratio (INR) for those prescribed Warfarin.

Mythbusters

Designed to dispel the common myths and misconceptions encountered when prescribing anticoagulation, by providing an evidenced based explanation.

I hope the toolkit will inform clinicians and commissioners in the design of local services to deliver the best patient care and optimum outcomes.

Download the toolkit here.

New Atrial Fibrillation toolkit helps prevent strokes and saves lives

Published on July 12, 2017 and last updated on February 13, 2023 by Simon Ellery

New Atrial Fibrillation toolkit helps prevent strokes and saves lives

Health professionals across London today have access to a brand new, online Atrial Fibrillation (AF) Toolkit, improving the detection and treatment for the estimated 68,000 people in the capital at risk of an AF-related stroke.

The Atrial Fibrillation Toolkit has been designed by a team of experts, including the Health Innovation Network, to help address one of the biggest burdens on the NHS and the health of the population. It brings together the latest clinical guidance, performance data, case studies and support for clinicians and commissioners.

Tackling the risk
Atrial Fibrillation (AF) is the most common cardiac arrhythmia and is a major risk factor for stroke; contributing to 1 in 5 strokes and associated with a 20% increased likelihood of mortality. An estimated 68,000 people in London are living with undetected AF and at risk of blood clots, stroke, heart failure and other heart-related complications. The risk of a stroke for people with AF can be substantially reduced by detecting and diagnosing the condition, and providing effective anticoagulation to prevent the formation of clots in the heart. Despite this, up to 25% of known people diagnosed with AF are not appropriately anticoagulated. Aside from the clinical risks, it is estimated that stroke care costs the NHS £2.8 billion in direct care each year.

What’s included
A London-wide partnership of the three London Academic Health Science Networks, the London Clinical Networks and AF charities is working to tackle these issues through better detection and treatment using evidence-based interventions. This includes the creation of the Atrial Fibrillation Toolkit; an online interactive resource, which includes examples of best practice under the three themes: DETECT, PROTECT and PERFECT. Containing case studies and exclusive resources, the toolkit includes:
• An extensive review of mobile detection technology, including single lead ECGs
• The AF improvement cycle – developed to provide clinicians and commissioners with a clear process to follow when deciding on and developing improvements in AF care
• Clear, concise infographics for each London Clinical Commissioning Group outlining its latest performance data under the themes of DETECT, PROTECT and PERFECT
• Nine opportunity areas for improving the detection, treatment and ongoing management of AF, supported by case studies and practical tools
• Anticoagulation myth busters
• Anticoagulation adherence support for patients.

Tony Rudd, National Clinical Director for Stroke at NHS England, said: “This toolkit provides information and support for those commissioning services for and treating people with AF. With so many Londoners estimated to have undiagnosed AF, the toolkit will enable commissioners and clinicians to lead the way, showing that correct management of AF is simple to deliver and prevents a huge amount of suffering for individuals and their families, avoiding an unnecessary burden on our health service.”

Working in partnership
Partner organisations in London are working with colleagues through the AHSN Network to make the Atrial Fibrillation Toolkit available to healthcare professionals, commissioners and clinical networks across the county. It can be downloaded here http://bit.ly/london-af.

The toolkit has been a collaboration of the three London Academic Health Science Networks (Health Innovation Network, Imperial College Health Partners and UCLPartners), the London Clinical Networks and charities. The partnership seeks to avoid the debilitating effect of strokes by detecting AF and treating people using evidence-based innovations, whilst also making savings within the NHS and social care.

For further information, please contact Faye Edwards 0207 188 9805

Update: The toolkit has now been replaced by the national AF toolkit website.

Smartphones among digital tech transforming London’s NHS

Published on June 30, 2017 and last updated on September 6, 2018 by Simon Ellery

Smartphones among digital tech transforming London’s NHS

Digital technologies – from smartphone apps that help people successfully manage their diabetes, avoid “no shows” at hospitals, to tools that save time for nurses and paramedics – are beginning to transform London’s NHS services.

For the first time, NHS providers in London have revealed the extent to which smartphones, the Internet and Bluetooth are improving patient care and look set to save the capital’s NHS millions each year.

Guy’s and St Thomas’ NHS Foundation Trust expects to save £2.5 million each year by reducing missed appointments through an app called DrDoctor which gives patients much more say in selecting a date and time of their choice, resulting in “no show” rates falling by 40%.

Health chiefs are also using smartphones to tackle a looming health crisis with London boroughs tackling type-2 diabetes.

Programmes run by the North West London Collaboration of Clinical Commissioning Groups, covering eight boroughs, are successfully tackling diabetes through digital technology. OurPath links an app to a fitness wristband and 3G connected weighing scales to provide clients with realtime updates that help tackle type-2 diabetes, and in studies has achieved an average 5.3kg weight loss, while Oviva has seen more than 200 people complete the online programme with an impressive 90 per cent completion rate.

Dr Tom Willis, diabetes clinical lead for the Collaboration, said: “GPS are by nature very busy, naturally sceptical and want evidence.”

The London Ambulance Service, which was praised for its speedy and high quality care to the victims of the recent London Bridge terrorist attacks, is a key adopter having helped adapt the Perfect Ward audit tool specifically for its ambulance stations. The city-wide service has also developed Perfect Kit Prep and cuts out medicines paperwork for faster ambulance care, these are being implemented across over 70 ambulance stations in the capital.

In Chelsea and Westminster another tool links a stoma bag, used to collect faeces and urine for more than 13,000 people who undergo surgery each year nationally, through Bluetooth to users’ smartphones. A discrete device called ostom-i Alert Sensor, developed by a patient innovator, provides alerts when the bag is full so users have more control over their daily life and, importantly, greater dignity.

A new report ‘Digital Leadership in London’s NHS’ reveals that within eight months the 31 start-ups and digital companies backed by an organisation called DigitalHealth.London have achieved strong uptake within the capital.

Download the report here

Catheter Care Awareness Week returns and widens its reach

Published on June 29, 2017 and last updated on July 19, 2017 by Simon Ellery

Catheter Care Awareness Week Returns and widens its reach

This year’s Catheter Care Awareness Week (19-23 June 2017) built on the successful campaign from 2016, empowering more patients and professionals to practice the safer use of urinary catheters.

A significant proportion of urinary catheter use is not justified by clinical need, and long-term catheterisation carries the risk of catheter-associated urinary tract infections (CAUTIs), complications (haemorrhage, blockage, trauma) and has detrimental effects on continence status and dependency level. CAUTIs also contribute to recurrent Emergency Department admissions, prolonged hospitalistion, re-admissions and increased mortality.

Last year, the Health Innovation Network’s Catheter Care Awareness Campaign contributed to a 30 per cent reduction in CAUTI in south London. This year saw more engagement from around the UK, with Aneurin Bevan University Health Board in south Wales holding a week long set of seminars and stalls. The Health Board were first made aware of our Catheter Care work because of the 2016 Catheter Care Awareness Week Campaign on Twitter. Hospitals in Surrey and Bath also contributed, sharing valuable resources and training materials, and Charlie Adler, Darzi Fellow at Kent Surrey & Sussex AHSN, shared an eleven episode mini-series, ‘The Secret Life of Catheters’. Victoria Coghlan, Urology Nurse Specialist for Aneurin Bevan University Health Board Continence Service said: “Thank you for all your support with the awareness week. As a team we thoroughly enjoyed taking time to promote better catheter care for our patients. We hope to continue this inspirational work that you started.”

The week was also fully embraced by our south London partners. Across our membership, 21 events, study days and workshops were attended by over 1800 healthcare professionals and 800 patients, and supported by 13 urology industry partners.

Lewisham Nurses with their Catheter Care Pledges and Passports

To find any of the discussions and resources that have been shared, please search for #cathetercare on Twitter, or email hin.southlondon@nhs.net.

For more information about the HIN’s catheter care work and how you can be involved, please email eric.barrett@nhs.net

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