Enough of being digitally ‘done-to’

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Enough of being digitally ‘done-to’: 2020 is the year of the nurse, let it also be the year of digital nursing

Recently, Health Innovation Network (HIN) hosted a roundtable discussion with senior nurses involved in digital from across south London. The event was chaired by Breid O’Brien, Director: Digital Transformation at Health Innovation Network with special guest speaker Natasha Phillips, Chief Nursing Informatics Officer: University College London Hospitals NHS Foundation Trust (UCLH) and Digital Health’s CNIO of 2019. Breid and Natasha share some of the discussion highlights and why they are evidence that if 2020 is to be the year of the nurse, then nursing needs to be made a central part of the digital discussion in 2020.

We have a combined 62 years of nursing and healthcare experience and have seen an incredible amount of change in our profession during our careers, but the most significant has probably been the transformation of the time nurses spend with patients. Based on our experience and what we observe happening now, and depending on which studies you read, nurses currently spend approximately 20 – 25 per cent of their time on medication administration. In addition, data from Safer Nursing Care Tool (SNCT) observations shows nurses spend 10 per cent of their time acting as the glue in the system by communicating and raising issues. Seven per cent of time is spent on documenting care away from the patient (i.e. excluding documentation that happens by the bedside). At best, this means 37 per cent of nursing time is not spent on direct care.

This calculation started a lively discussion at our recent roundtable for senior nurses involved in digital across south London, prompting some to suggest that, in their personal experience, it is much closer to just one third of their time that is spent with patients. Additionally, data from “Productive Ward: Releasing time to Care” shows another third is lost to looking for things and duplicating work.

For many nurses, time spent on direct patient care is where the joy of work resides, and this is the time our patients’ value most. The group concluded this imbalance between time spent on tasks and time to care needs to change. We need to release time to care.

How technology could help

It’s undoubtedly true that technology is a huge part of the answer, but, as a profession, nursing is not yet reaping the benefits. We are often digitally ‘done-to’. We often have systems that are designed by others, such as patient flow systems, which, although fulfilling an important need, were designed to meet the needs of the organisation with little understanding of the increased workload for nurses. Attendees gave examples of innovative new systems implemented in their practices, which have led to the need for nurses to duplicate their notes. Under these systems, if nurses see 14 patients, they end up writing 28 sets of notes, as they have to create a physical and a digital copy.

Nurses are not routinely involved in the design of new systems, and other countries like the US are much further ahead in recognising nursing informatics as a profession. The group identified a lack of education for nurses in undergraduate and post-graduate environments when it comes to using digital tools in care delivery, though the group recognised HEE is working to change this.

Nurses are in a prime position to lead transformative change, with a depth of experience and a very rounded view of the system. Sometimes, we underestimate the role that nurses can and should be playing right now in system design. Technology can be overwhelming, the volume of data alone. But let’s remember – nurses have been using data for years, and effectively. If someone cannot explain a new technical system clearly to a nurse, then we argue that they need to get better at explaining it.

Imagine a world where digital is at the heart of our practice, the heart of our education and the heart of our leadership. This is happening in patches and where it does, the results show the great potential. It’s happening where change is clinically-led, where nurses sit on advisory committees and where nurses are embracing the opportunity to change their practice, not just digitise what is already happening.

Technology will not always save time, but it will make our practice safer, and it does have the power to improve our approach to tasks.

Year of the nurse

If 2020 is to be the year of the nurse, let’s make 2020 the year that nursing and nurses are put at the heart of digital transformation, and where these examples become the norm. Let’s make 2020 the year that we stop walking back and forth to computers and put the power in our pockets, the year we embrace audio and voice recognition. Let’s create a culture where newly trained nurses come in with bright ideas, and we create the right opportunities for them. Technology will not always save time, but it will make our practice safer, and it does have the power to improve our approach to tasks.

To do this, we need to stop the feast and famine approach to technology spending and projects. Bursts of capital funding won’t do the trick – expensive, capital-funded roll-outs are just the beginning. Successive governments have proclaimed innovation is a panacea and announced new policies, CQINs and mandates, as though they are the answer to a problem rather than the first step in a long journey of change. Privately, most will admit that they understand that change takes time. Let 2020 be the year that this is publicly recognised, and the slow, painstaking work of ongoing training and optimisation of systems is sustainably funded.

Nurses are close to their patients. Let 2020 be the year we use this to drive real change. What could we be asking our patients to do with technology to help us? Entering their own health information, accessing information, monitoring their own health trends? Too often there is still a fear of putting people in charge of their own care – hunger from patients to change the system will help encourage people to take risks, never with patient safety, but with innovative approaches to care delivery.

2020 is the year of the nurse – let it also be the year of change. If that sounds optimistic, that’s because it is. But after spending time in conversation with fellow senior nurses discussing these issues, we were left inspired and hopeful. Rather than battling organisational hierarchy and tradition alone, we vowed to do it together. To share and learn from each other and to create a new community of digital nurses. No more digitally done-to. The opportunity is there for us to work as a community. Let’s let 2020 be the year we take it.

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We know we need genuine public involvement in healthcare. Why are we still getting it wrong?

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We know we need genuine public involvement in healthcare. Why are we still getting it wrong?

Andrew Walker, Deputy Clinical Director MSK and Evaluation Lead, Health Innovation Network reflects on a recent patient and public involvement and engagement process and the need for a relentless focus on true engagement.

Healthcare in the NHS has come a long way from the paternalistic, prescriptive model and principles upon which it was founded in post-war Britain.

The aspiration for greater and better patient and public involvement and engagement (PPIE) is at the heart of today’s NHS. There are multiple, high profile policy documents that reiterate its importance and the need to continue to focus on increasing patients’ voice to improve care. We now have lay member representation on the boards of NHS trusts and clinical commission groups and embedded into how research is prioritised (such as James Lind Alliance), designed and approved (such as INVOLVE and NHS Research Ethics Committees). There is also an increasing wealth of resources and guides from organisations such as INVOLVE and The King’s Fund to help us do PPIE well and in a meaningful way.

There are many examples of when PPIE has been done well, but there are still many occasions when we still fall short. Recently, I was involved in a PPIE process and I wanted to share my experience of how we fell short, despite best intentions.

Background to the process

In 2017, NHS England and NIHR published ‘12 actions to support and apply research in the NHS’, which tasked AHSNs to set out local NHS research and innovation priorities. Collectively, the AHSN Network, NIHR and NHS England commissioned ComRes to undertake a Local Survey of Innovation and Research Needs by engaging with key senior stakeholders nationally and locally. Published in June 2019, the report identified a number of priorities across workforce, mental health, digital technology and more. As part of an on-going engagement to explore and refine local priorities, the Health Innovation Network and CLAHRC south London jointly held a Patient Public Engagement event on with service users from across south London.

There were 10 participants with a mix of gender, ethnicity, age and physical/mental conditions. Dr Jane Stafford (South London ARC Associate Director of Operations) and I presented the background to the Survey, AHSNs and CLAHRC/ARCs. The session was facilitated by a PPI expert.

PPI perspectives on the priorities

In terms of the contents of the report, participants felt it was a useful start and broadly concurred with the priorities. However, they felt that some priorities did not resonate with them as patients (e.g. workforce) and illustrated the disconnect between what professionals working within the system perceived as local priorities and service users’ needs. The group wanted a greater focus on research and innovation that addresses the health inequalities and health needs of underrepresented service users. Participants were passionate in expressing a need to implement and deliver interventions and services that meet the needs of people from different ethnic backgrounds (e.g. Southwark has the largest African diaspora of all London boroughs) and excluded/marginalised groups (such as those experiencing homelessness). Participants also felt there was not enough focus within the priorities about improving patient experience, patient choice or personal budgets.

A feeling of ‘rubber stamping’

What I had not expected was the group’s strong criticisms about the process that had been used to identify local priorities. I had seen the session with PPI members as a step in the process of engagement. Whereas, they perceived it more as ‘rubber stamping’ a report that had already defined the local priorities. Specifically, they questioned why there hadn’t been public/patient involvement from the outset. Rightly, participants felt this would have improved the balance of priorities and made the survey more inclusive and comprehensive, and their involvement more meaningful. As I listened, the penny dropped and I thought ‘you’re right, we did it again!’

We highlighted that the survey report provided a sample of stakeholder perspectives and was a starting point for discussion and their input as valid and important as what was in the report. However, the group’s perception was that the timing and scale of PPI in the process gave greater status to stakeholders’ priorities. It also meant that whilst they broadly agreed with the priorities, they felt disconnected with some and couldn’t always see themselves or things that were important to them in the survey.

Being bolder and getting it right

For me, this process was a valuable reminder of the power words gain when committed to paper and how we can always improve our engagement with service users. The experience has renewed my personal commitment to this and to support others to do the same.

We need to be bolder in challenging colleagues and ourselves when we see PPIE is not being done appropriately or a process could be improved. For me, it comes back to the INVOLVE core principles for PPI of respect, transparency and responsiveness. If we can’t clearly demonstrate we’re addressing these principles – no matter the pressure – we need to stop and re-think our approach.

Health and social care are complex, dynamic systems where not one person or group can understand the whole system. It’s only by engaging with people from across the system (public and professionals) and by sharing our perspectives and knowledge that we can bring about system change.

This calls for a more radical shift where we cede power to patients and start to co-design and co-produce health and social care. But to get it right, this approach must also be backed up a commitment to provide adequate time, resources and political will and leadership – across the whole system.

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ESCAPE-pain trains 1000 trainers

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ESCAPE-pain trains 1000 facilitators to help people living with osteoarthritis in boost to out-of-hospital care

By Professor Mike Hurley, Clinical Director MSK Programme, Health Innovation Network and creator of ESCAPE-pain.

If we are serious about achieving the goals of the NHS’ Long Term Plan, physical activity should be prescribe-able on the NHS and we need to facilitate its delivery through leisure centre and community halls.

It is well documented that people in our communities are now living far longer but they are more likely to live with multiple long-term conditions. Osteoarthritis (chronic knee/hip pain) is a major cause of suffering, physical and mental ill-health in people in our country. It is estimated that in England 4.11 million people (18.2 percent of people aged over 45 years) have osteoarthritis of the knee and 2.46 million people (10.9 percent of people aged over 45 years) have osteoarthritis of the hip.

Typically, these patients are managed in primary care. Despite the risk of side effects and high costs, treatment for osteoarthritis is all too often the prescription of painkillers, typically non-steroidal anti-inflammatory drugs, with little to no practical support. Many people with these conditions mistakenly believe that physical activity will make their condition worse, when it can actually benefit them.

Physical activity and reduced pain

There is unequivocal evidence that physical activity can reduce pain, improve mobility and function, quality of life, makes people feel less depressed and gets people up, out and about, while simultaneously improving other health problems. Yet it can’t be prescribed like a drug and there is limited access to this effective treatment inside the NHS.

ESCAPE-pain is an innovation that integrates self-management and coping strategies with an exercise regimen individualised for people living with osteoarthritis. It is an evidence-based, group rehabilitation programme, delivered to small groups of people twice a week, for six weeks (total 12 classes). It was adopted as a case study in NICE’s Quality, Innovation, Productivity and Prevention programme [2013] and delivers the NICE core recommendations of exercise and education for the management of osteoarthritis.

The Academic Health Science Network (AHSN) identified ESCAPE-pain as a national programme for 2018-2020 and so currently all 15 AHSNs are supporting it across the country.

Scaling up
Originally facilitated by physiotherapists in hospital outpatient departments, in 2017 we moved to widen our pool of facilitators to include fitness and leisure centre instructors. We have now trained a total of over 1,000 people to facilitate this programme (629 clinicians and 380 fitness instructors). The widening of our approach to training; going beyond physiotherapists and into the leisure sector, has enabled the programme to be delivered at over 200 locations across the UK, including leisure centres and community halls, to over 4000 people.

Essential to reaching the millions more people who could benefit from this programme is having enough facilitators trained to deliver the it in local communities. Now that over 1000 people have been trained there is a trained facilitator of the programme in every region of England.

Delivering this programme in the community and outside of traditional hospital settings, is a great example of how we can deliver on the Long Term Plan’s ambition to boost out-of-hospital care. I hope the success of this model is, as it could be, replicated in many other areas of care.

Got 30 minutes to learn more about the NHS Innovation landscape? Listen to our AHSN Network Innovation Exchange podcast in which NHS Clinical Director for Older People, Martin Vernon talks Healthy Ageing, featuring Prof Mike Hurley.

Or find out more about ESCAPE-pain and it’s impact here or contact us at hin.southlondon@nhs.net to get involved.

Meet the innovator: Shaun Azam

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Meet the Innovator

In this series, we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Shaun Azam, CEFO at Sweatcoin; an app that incentivises physical activity by converting steps into points that can be exchanged for actual rewards.

Pictured above: Shaun Azam, CEFO at Sweatcoin.

Tell us about your innovation in a sentence

Through our digital app Sweatcoin, we incentivise people to be more active by converting steps into reward points that have real world value.

What was the ‘lightbulb’ moment?

Realising that modern technology makes us lazy, and as humans we need instant rewards for effort (which is why most of us struggle to go to the gym for sustained periods). Hence, our app that converts steps into points with real value.

What three bits of advice would you give budding innovators?

    1. Listen to your users! You are building your product for them, so listen and take on board what they want.
    2. Don’t test ideas, test a hypothesis – ideas are real life applications and sit above a core hypothesis. When you test a hypothesis, you also test a whole host of ideas, saving vast amounts of time.
    3. I coined an acronym for this – ABA – Always Be Adding. Everything you do should be always be adding value to the business – we’re in a digital age, so use as many tools and apps as you can to create efficiency + cost savings, so you can focus on things that will ADD value to the business. Also, delegate whenever possible.

What’s been your toughest obstacle?

Overcoming the complexity of the healthcare system – we are fortunate in that our product has the ability to improves the lives of everyone in the world. Along with this comes difficulties around ensuring our product accurately caters for these vastly different demographics.

What’s been your innovator journey highlight?

Academics at the University of Warwick investigated the impact of incentives on physical activity – they used Sweatcoin to do this. Their academic study was published in the British Journal of Sports Medicine and found that Sweatcoin helped users walk +20% more each day, even after six months.

That was the moment that we realised that we ARE making the world more active, and that all the struggles were worth it.

Best part of your job now?

Genuinely improving the quality of lives of millions of people, every day. We receive countless messages from our users, informing us that Sweatcoin has motivated them to walk more, and how it has contributed to their improved physical + mental health.

Receiving these messages is truly incomparable.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would include a line item in NHS budgets, that is designated to be spent with SME’s – this would foster the uptake of new digital solutions that have the potential to improve healthcare and patient journeys across the NHS.

A typical day for you would include..

Trying to grow and sell our product – we operate on two week ‘sprints’ – this means we aim to release new features of our product every fortnight. As you can imagine, this means countless user focus groups, product tests, and iterations.

The product is one aspect – selling it is the other! I’m a big believer in ‘people buy from people’ – so most of my remaining day is around meetings, understanding open opportunities, and communicating the value prop of Sweatcoin.

For more information, visit their website at sweat coin.com or follow them on Twitter @Sweatcoin

Latest innovation projects set to improve care for south Londoners revealed

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Latest innovation projects set to improve care for south Londoners revealed

Ten NHS teams, working with universities and a wide range of partners, have been given vital funding to kickstart innovation projects designed to help health and care teams improve care for south Londoners and help services evolve to meet future health needs. The funding comes from the Health Innovation Network Innovation Grants, which have been announced today.

The innovations that will receive support to spread or be piloted range from apps for women in pregnancy to understand the risk of preterm birth or manage diabetes, to new devices to detect dangerous bleeding, to virtual reality on acute mental health wards to reduce stress and new ways to access mental health support that improve access while taking pressure off primary care. One of the projects will also develop mobile simulation labs for the NHS to test and improve technology.

All of the innovations meet current NHS and care needs – whether by addressing major health challenges such as diabetes, mental health and stroke prevention, or specifically helping the NHS to meet nationwide goals on safety or the NHS Long Term Plan.

Each project has been given up to £10,000 in funding. Small amounts of funding can be crucial for innovation projects to become a reality. NHS teams often struggle to find the initial funding to pilot new ideas in real-world settings to demonstrate the kind of results they need for support for wider roll outs. Academic Health Science Networks like the Health Innovation Network play a crucial role by helping these projects prove themselves in real world settings before going on to spread across the NHS where successful.

The winners were chosen after a rigorous selection process from an expert panel. In total 68 applications were received, with ten selected to receive funding.

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

“When it comes to innovation we have no shortage of great ideas in the NHS. What we often lack is the initial finance needed to get a new idea off the ground, and to generate evidence of outcomes so that others will support the project. The projects we’re supporting today are truly exceptional and stood out to us as highly innovative approaches that meet pressing health and care needs. We’re looking forward to working with these teams to turn these ideas into real benefits for local people.”

Dr Lindsey Bezzina, Junior Clinical Fellow, Emergency Medicine, St George’s University Hospitals NHS Foundation Trust, who has won an award to develop visible electronic queues in hospital emergency departments to improve patient experience and reduce pressure on staff, 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 answer this and make a huge difference to their experience, as well as supporting our staff. Technology and innovation will allow us to answer this and more. We’re well supported by our colleagues and leaders to innovate and try new ideas: this funding is additional piece of the puzzle we need to propel our project to the next level.”

Dr. Nicola Jones, a GP and Chair of Wandsworth Clinical Commissioning Group, whose team has won an award for mass screening in Wandsworth to prevent strokes and reduce health inequalities, said:

“The people of Wandsworth can look forward to a new and innovative local approach to stroke prevention. At the moment, over a third of people invited for a health check do not attend. We’re using this funding to kickstart an innovative new collaboration between Wandsworth community leaders and the health service, working hand-in-hand with local groups to get our services to those who need them most. By targeting hard-to-reach communities we will reduce health inequalities and we expect this award to be the first step in developing a new approach to screening that will benefit the communities we serve.”

The ten teams will be supported by the Health Innovation Network over a 12 month period to develop their ideas and pilot them in south London.

The winning projects receiving support to expand, pilot or develop further are:

1. Diabetes Prevention Decathlon, South West London Health and Care Partnership

2. Engage Consult – Digital Self-Referral for MSK, Oxleas NHS Foundation Trust

3. ‘Mass screening!’ – an innovative healthcare delivery approach to stroke prevention in high risk, hard to reach communities in Wandsworth through ‘Stroke Busting Health Checks’ in local places of worship and community networks, Wandsworth CCG

4. Creating a toolkit for effective implementation of the QUiPP app, King’s College London & Guy’s and St Thomas’ NHS Trust

5. Transforming delivery of antenatal care in gestational diabetes, Kingston Hospital NHS Foundation Trust

6. CRADLE Scale up South London: Effect of a novel shock index early warning system on recognition and management of the compromised bleeding woman,
King’s College London & Guy’s and St Thomas’ NHS Trust

7. Improving Patient and Staff Experience and Safety with Queue Management Software in the Emergency Department, St George’s Universitys Hospital NHS Foundation Trust

8. Simulation Lab for Health Technology Development and Adoption: Discovery project, Oxleas NHS

9. Lewisham Primary Care Recovery College Pilot Project, South London and Maudsley NHS Foundation Trust

10. Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards, South London and Maudsley NHS Foundation Trust

Winners of the 2019 Recognition Awards Announced

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Winners of the 2019 Recognition Awards Announced

The Health Innovation Network (HIN) work together with a variety of health and care teams in south London to speed up the best of health and care for our communities. The HIN Recognition Awards 2019 celebrate some of the fantastic work and partnerships we are involved in.

Our membership is made up of organisations from across south London’s academic, local government and health and social care landscape. We work with acute and mental health trusts, clinical commissioning groups, community providers, local authorities, universities and third sector bodies.

Zoë Lelliott, Chief Executive of the Health Innovation Network said: “The enthusiasm and commitment across our membership to improve the lives of patients through innovation never ceases to inspire me. The Recognition Awards are a great opportunity to celebrate some of the very best work of our members. I am delighted the Health Innovation Network is highlighting examples of excellence in partnerships, Trusts and individuals in our community through these awards, and I congratulate the worthy winners.”

Over half of our team participated in the Recognition Awards in August 2019. We received many nominations and the winners were announced at the Health Innovation Network Award ceremony in Guy’s Hospital on Tuesday 24 September.

The results of the HIN South London 2019 Recognition Awards are:

Innovative Trust of the year

Winner: St George’s University Hospitals NHS Foundation Trust

Special credit is given to the innovation and improvement initiatives by Ben Wanless, the physiotherapy team, Emma Evans and the New Beginnings Experience Based Co Design project improving the experience of birth in theatres, and Edward Jebson’s work in adoption of innovation products.

Excellence in adoption of Innovation and Technology Payment (ITP) products

Winners: Lewisham & Greenwich NHS Trust

Special credit is given to Elizabeth Aitken and David Knevett’s strategic approach to the adoption of ITP with full commitment to adopting all relevant products across the hospital.

Winners: Kingston Hospital NHS Foundation Trust

Special credit is given to Jonathan Grellier for his continued enthusiasm and support for the ITP and Accelerated Access Collaborative, helping to achieve collaboration across the trust within both clinical and managerial teams.

Partnership of the year

Winners: Oxleas NHS Foundation Trust, South London and the Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust and the Metropolitan Police

Special credit is given to Rachel Matheson, Magda Berge, Jon Garrett and Superintendent Mark Lawrence representing the three trusts and the Metropolitan police who have worked together, sharing learning to help each other succeed to successfully implement Serenity Integrated Mentoring (SIM).

Innovator of the year

Winner: Chegworth Nursing Home (Sutton Homes)

Special credit is given to Rekha Govindan, the first care home nurse to create Coordinate My Care (CMC) plans single-handedly as part of the CMC in Care Homes project.

For more information on how we work with members on innovation projects please contact hin.southlondon@nhs.net.

CRADLE Scale up South London

CRADLE Scale up South London

CRADLE VSA at-a-glance

A handheld device that spots women who at at-risk of rapid deterioration due to bleeding.
Working with maternity units in developing countries where the shock index was developed to help recognise and treat bleeding promptly.
• Deteriorating patients are complex and speed really matters. Innovation in this area is vital.
• Recent reports have specifically highlighted earlier recognition of bleeding, and lack of recognition of deteriorating vital signs, as points for improvement in NHS maternity care.
• If successfully rolled out, this will help teams spot women who need help faster and make care for women safer.


Shock Index device introduced to save lives in maternity wards

HIN Innovation Award funding will be used to pilot a device that helps teams identify patients experiencing serious bleeding in maternity wards more quickly. The new device, CRADLE VSA (CVSA), is a hand-held, upper arm, semi-automated blood pressure device that has been specifically designed and validated for use in pregnancy and pre-eclampsia by King’s College London.

Globally, bleeding is one of most common reasons women die around the world in childbirth. The main reason things get so serious is that the issue is not recognised and managed quickly enough. Identifying women with dangerous bleeding can be very difficult and it is widely acknowledged that delays in spotting and starting treatment for bleeding patients contributes to death and harm. Additionally, clinicians are not able to predict haemorrhage (bleeding) from risk factors very easily. This means the focus needs to be on early recognition of a compromised patient, appropriate escalation and prompt management.

Although the NHS has sophisticated systems to spot deteriorating patients in many clinical settings, the predictive capacity of early warning systems in pregnancy is less well-evidenced and most blood pressure devices are not designed with pregnant women in mind. The CRADLE VSA device was created by UK doctors working in developing countries, in response to a severe and urgent need to spot bleeding patients in the context of very high maternal death rates. However, its simplicity and effectiveness could also have huge benefits in other healthcare settings globally, including in the NHS.

How does it work? CRADLE VSA uses a simple traffic light system to warn clinicians when a woman may be in trouble after giving birth. The lights are triggered by standard thresholds of blood pressure as well as shock index to alert health care professionals to a patients’ risk of compromise. The shock index is an innovative and simple measure. It is calculated by dividing heart rate by systolic blood pressure and it is a highly effective way of signalling that someone is in trouble and needs help.

The biggest impact of this device is expected to be on patient safety. Use of this device should reduce delays and reduce maternal death rates and morbidity. This would also lead to a reduction in length of stay for patients and faster return to daily activities and time with their newborn.

The Innovation Grant funding will be used to introduce the CRADLE VSA device into labour wards and high dependency units at Kingston Hospital and St Thomas’ Hospital. The results will be analysed using PSDA cycles and a quality improvement toolkit will be created so that the device can be used more widely if successful in these settings.

This ground-breaking device has been extensively validated. It was recognised in the PATH – Innovation Countdown 2030 award as one of the top 30 high impact global health innovations to help accelerate progress towards the United Nations Sustainable Development Goals. It also won the prestigious Newton Prize in 2017 for excellence in research and innovation.

Find out more about our work in maternity and patient safety


Innovator Spotlight

Professor Andrew Shennan, Professor of Obstetrics at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, said:

“If we can find ways to spot women who need interventions more quickly, we will save lives. I was inspired, with colleagues, to develop this device to help maternity wards in Africa but we believe that the simplicity and effectiveness of the device mean that it could also be really useful here.  I’m passionate about the potential for high-income countries to learn from low-income countries and think that some of most eye-catching innovations can come from teams working in extremely difficult circumstances.

“We’re starting with maternity wards for this initial project, but it’s possible that this device could improve safety in a wide range of settings in countries around the globe.”

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Creating a toolkit for effective implementation of the QUiPP app

Creating a toolkit for effective implementation of the QUiPP app

QUiPP at-a-glance

An app to predict the risk of pre-term labour more accurately
Wanting to improve the care for women at-risk and prevent people who don’t need to travel at this worrying time, travelling for specialist care. The team believed that technology and analytics must be able to help clinicians process the varied data needed to predict risk more quickly and more accurately, rather than this needing to be carried around and calculated in human brains. This tool supports better clinical practice by doing the analytics, clinicians handle the rest.
The new toolkit will help other units to adopt QUiPP more quickly.
• The app helps clinicians predict risk accurately, even in women with no symptoms. This means that treatment can be better targeted and outcomes will improve.
• This helps with a major and serious issue: in England and Wales, 7.9% of babies are born preterm. It is the leading cause for deaths under five years of age and survivors are at risk of major long-term morbidity. The economic consequences are estimated at £2.95 billion per year.
• As well as improving the use of treatment and specialist care, it is an effective communication tool for explaining risk and decreasing anxiety associated with threatened preterm labour. This means it has a role in improving mental wellbeing in pregnancy, promoting shared-decision-making and reducing anxiety that is in itself a risk factor for preterm birth.
• The NHS Long Term Plan has a specific commitment to tackle pre-term birth and a target to reduce it from 8 per cent to 6 per cent.


‘Better care for women at risk of pre-term labour 

The QUiPP app (Quantitative Innovation in Predicting Preterm birth) determines the risk of pre-term labour more accurately, helping to improve care for women at risk. Funded by the HIN Innovation Awards, this project will test the app in selected maternity wards in south London and create a toolkit to support wider adoption across other sites.

The app is an innovative and evidence-based diagnostic tool that uses analytics to help clinicians understand the risk of pre-term labour more accurately. This improves the lives of women and babies by identifying those who truly need medical intervention and reassuring those who don’t.

The app has currently been tested in 20 UK sites. The award funding will allow the app to be used in additional units at University Hospital Lewisham and for the team to develop and test tools for other units to adopt the app successfully. This project focuses on the implementation science aspect of the adoption of innovation: understanding the wider factors that impact on use and spread.

Pre-term labour is a clinical conundrum: it’s very common for women to be at-risk of pre-term labour, but the actual number of women who go on to deliver early is very low. To be safe, this means that many women are currently over-managed: they are treated as though they will deliver early even if the risk is low in reality. Because it is very dangerous to move an early baby once it is delivered, women at risk of pre-term labour are often moved to specialist hospitals further from home with specialist cots for early babies and are given more invasive care.

This tool has the potential to make a big difference and to improve care for these women. Whereas currently women are simply either ‘high’ or ‘low’ risk, the app calculates a percentage score so that clinicians can understand risk to a much higher degree of accuracy. This reduces the need for women at lower risk to move far from home and frees up the cots for the women who genuinely need them, so that people receive the care that is most appropriate to their risk and are not moved from their family and familiar midwife team if it is not necessary.

How does it work? It’s a clinical decision support tool based on a validated algorithm that incorporates existing point-of-care tests and risk factors. A clinician enters information about a number of biomarkers, such as the scan that measures the cervical length and the swab on quantitative fetal fibronectin. QUiPP uses all the data across risk range for each variable and provides a user-friendly clinical interface. This is more useful for making management decisions and women find it very useful to see and discuss their risk as a percentage, with a highly visual aid to support discussions and decisions around treatment.

The QUiPP app is free and has significant cost-savings associated with reducing unnecessary admissions and interventions. By freeing up NHS capacity for patients in the most need of care (e.g. maternal beds, neonatal cots), this intervention can save money and transform maternity pathways beyond the preterm birth setting. Qualitative findings suggest that the majority of clinicians involved in triaging threatened preterm labour found using the QUiPP app time-saving, simple and that it increased confidence in decision-making.

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Innovator Spotlight

Professor Andrew Shennan, Professor of Obstetrics at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, said:

“This is a great example of the way that technology doesn’t replace clinicians, it makes our lives easier and helps us to care more effectively for our patients. QUiPP calculates the risk in a quick and visual way, giving women reassurance at a worrying time in their lives. What you really want is an exact chance of what’s going to happen. That way women and clinicians can make the most informed choices.

“We know the evidence for this app is strong. The next step is to test it more widely in the real world. While the app itself is simple, the intervention as a whole is complex. We want to use this opportunity to better understand the environments and factors surroundings its use and create a resource for others that helps them manage these in their own roll-outs.

“These kinds of real-world testing are so important for scaling innovation. We hope that through this work, we can show the value of a tool like this and support others to use it in their practice.”

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Improving Patient and Staff Experience and Safety with Queue Management Software in the Emergency Department

Improving patient and staff experience and safety with queue management software in the emergency department

Visible queue management software in the emergency department at-a-glance

Visible electronic queues in hospital emergency departments to improve patient experience and reduce pressure on staff.
The desire to use techonology to reduce pressure on emergency department reception teams and improve patient experience and safety.
• Better patient experience in Emergency Departments.
• Improvements in staff experience in Emergency Departments.
• Fewer interruptions for busy reception staff, with knock-on efficieny benefits and a reduction in complaints about behaviour related to wait time information.
• Greater transparency and education around the complexity of wait times in Emergency Departments.

Visible queuing: a game changer in hospital emergency departments

HIN Innovation Grants will fund an innovative project to improve patient experience in the Emergency Department at St George’s University Hospitals NHS Foundation Trust.

This project will pilot a visible electronic queue management system so that patients can see where they are in the queue to be seen at any time. The team is understood to be among the first in the UK to introduce this.

The new system aims to improve patient experience and reduce the time receptionists in the Emergency Department at St George’s spend dealing with waiting time or queue position queries. Staff in Emergency Departments around the country deal with a high volume of these questions which can have a knock-on delay in booking-in new patients.

The idea for the new system came from junior doctor Dr Lindsey Bezzina who worked in the Emergency Department for a year and witnessed the problems reception teams and other staff encounter first-hand when it comes to waiting times queries. Currently, a whiteboard behind the reception desk is 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 leads to repeated queries to reception staff about the waiting time and these queries are not always easy to answer due to the complexity of queues. As well as frustration for patients, these queries can occasionally result in aggressive and abusive behaviours which put additional pressure on staff.

The new system will offer people a code when they first arrive and register their details. This code will correspond with a number shown on an electronic screen, showing where the number is in the queue. The display will be visible from all parts of the waiting room and will make clear that there are multiple queues at any one time and that if someone arrives who needs more urgent care, the queue positions will move accordingly.

This means patients will be able to monitor their own position and progress in the queue, which provides assurance that they have not been missed or forgotten, reducing anxiety as well as the likelihood of aggression directed towards other patients or staff. The transparency the system will offer has the potential to educate people waiting about the multiple queues in operation at any one time, aiding understanding about the way Emergency Departments operate and why some people are seen more quickly.

The grant awarded will be used toward developing and implementing the queue management software in the Emergency Departments department. If this innovative pilot is successful and adopted as business as ususal, the software can be spread and adopted by other NHS emergency departments. There is also an opportunity for use of this system in outpatient departments at a later stage.

Find out more about our work in patient experience


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Dr Lindsey Bezzina, Junior Clinical Fellow, Emergency Medicine, 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.”

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Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality on the wards at-a-glance

Virtual reality headsets with relaxing scenarios introduced to six wards to reduce stress and anxiety in service users with complex and serious mental health needs
Research has shown that virtual reality has enormous potential to aid relaxation and improve outcomes. The team was inspired by pioneering work in the Netherlands using virtual reality with outpatients and wants to pilot this approach with inpatients in south London.
• Reduced anxiety and stress, helping people to manage their mental health conditions.
• Reduced levels of stress and challenging behaviour on wards.
• Better environment for both service users and staff.
• Fewer incidents of challenging behaviour and a positive effect on reducing staff stress and burn-out.
• Reduction in the need for seclusion.
• Parity of esteem, ensuring that mental health service users benefit from the latest technology.


Virtual reality on acute wards to help people with complex mental health conditions

Service users on psychiatric wards often report high levels of stress and difficulties regulating emotions, which can lead to violence and aggression toward staff and others. A team at South London and Maudsley (SLaM) NHS Foundation Trust plans to address this through pioneering use of virtual reality.

Funded by the HIN Innovation Grants, this project aims to evaluate the implementation of a new virtual reality (VR) technology, VRelax, to reduce stress and arousal in service users with complex mental health conditions. The VR headsets allow people to experience calming and relaxing environments. Previously, the NHS typically asked people to think of positive mental imagery, which requires more concentration and imagination and can be challenging to sustain. Virtual reality will give people the chance to feel immersed in a more calming environment.

The team will introduce 12 new VRelax headsets and assess their effectiveness in reducing service user stress and associated risks (violence, aggression and seclusion) on six acute psychiatric wards within SLaM. VRelax consists of 360 degree videos of calm, natural environments. This includes a scuba diving experience with wild dolphins, a sunny meadow in the Alps, a coral reef, a drone flight, a sunny mountain meadow with animals, a guided mindfulness meditation on the beach or a wide range of other options, all shown in a VR headset. The team will train the nursing staff on the software and nurses will then be able to decide how and when to offer this to their patients, as an additional option that complements existing relaxation techniques.

Heightened stress reactivity is not good for individuals: it’s related to recurrence of mood, anxiety as well as psychotic disorders and it’s not good for staff or ward environments: difficulties regulating emotions can increase risk of violence and aggression, which put both service users and staff at risk. This can result in seclusion being necessary, with isolation potentially increasing service user stress and costs. A previous randomised cross-over trial of VRelax with 50 psychiatric outpatients showed strong immediate effects on stress level, and on negative and positive mood states. The team at SLaM wants to bring these promising findings to service users on acute wards in the UK.

In addition to improving care for service users, VR has the potential to have a real impact on the overall ward environment. By reducing stress and anxiety, the project hopes to reduce violence and aggression. This will create a better environment for both staff and service users.
The project has collaboration at its heart. The team will link three main institutions – SLaM, University Hospital Lewisham, King’s College London and University Medical Center Groningen, in the Netherlands.

Find out more about our work in mental health


Innovator Spotlight

Dr Simon Riches, Highly Specialist Clinical Psychologist, South London and Maudsley NHS Foundation Trust said:

“At a relatively low cost, this technology could have a major impact on the ward environment and the people in our care. Service users will have the chance to feel immersed in a more calming environment, meaning that both staff and service users can benefit from reduced levels of stress and challenging behaviour.

“We’ve brought a lot of people together for the project who are very passionate about digital health, including international colleagues. It’s still very new and the opportunity to collaborate on this emerging area of research is exciting.”

Dr Freya Rumball, Clinical Psychologist, South London and Maudsley NHS Foundation Trust, said:

“There is strong evidence that relaxation and grounding techniques can have a positive impact on stress and anxiety, and we will be among the first teams to test this exciting new technology on acute wards in SLaM. Our pilot will advance the evidence base and we are keen to disseminate our findings as widely as possible.

“Innovating in the NHS can be challenging, as it can be hard to find the time to think about things from a fresh perspective. However, we’re really passionate about bringing new technology to the forefront of our clinical work and are actively supported in this by our management and leadership.”

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Simulation Lab for Health Technology Development and Adoption: Discovery project

Simulation lab for health technology development and adoption

Tech simulation labs at-a-glance

Mobile simulation labs for digital technology
The need for smart technology procurement decisions and faster confidence in new digital tools.
NASA doesn’t send its astronauts into space without testing its technology in its simulation environments. Similarly, NHS teams should not have to use technology in high pressure environments before it’s been simulated in a hi fidelity environment.
• Higher staff confidence in new technology.
Faster uptake of digital technologies.
• Better understanding about how technologies will operate in real, high pressure clinical contexts at a granular level.
• Smarter procurement decisions taken after real-world testing.
• Faster optimisation and benefits from new digital technology.

Mobile simulation labs for health technology

A new type of simulation lab aimed for the NHS to test and develop digital health technology is being designed by NHS teams. The HIN Innovation Grants have funded a new discovery project aiming to bring the benefits of hi fidelity simulation to health technology procurement and implementation in the NHS.

The NHS has used hi fidelity patient simulation for high pressure clinical scenarios for many years, where either actors or sophisticated dummies act as patients and scenarios are played out and recorded. This gives NHS staff a learning environment that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. It also allows for changes in process and workflows to be identified and tested, to improve ways of working.

Simulation labs are well evidenced and used in contexts such as medical training (for example crash calls or trauma) but their application in a digital health context has not previously been systematically researched and tested in the UK. Given the abundance of new technology that NHS teams are now using, ranging from apps to new handheld devices to multi-million pound electronic record systems and equipment, this project aims to test the benefits of simulation for digital health.

At its most basic, simulation requires a screen and camera set-up, typically with cameras in the room that can show the action in real time. The simulation can use a mix of clinicians, staff and actors. Recording the action is crucial so that reflection and learning can take place effectively.

This project aims to show that simulation can be done in a cost effective, mobile way. For example, it will explore whether Trusts could create their own simulations by putting their own screens up and using in-house cameras and laptops at relatively low cost. If this is achieved it could help the NHS make better technology procurement decisions, help staff feel confident in stressful scenarios that involve multiple combinations of technologies and identify design improvements more quickly.

Technology simulation is the norm in many industries. NASA simulates its technology in the closest possible conditions to space using a neutral buoyancy lab. In healthcare, many American hospitals simulate technology on a regular basis. By contrast, while the NHS uses simulation for many traditional clinical scenarios it rarely tests new technologies in a genuinely live environment before they are procured.

The NHS invests millions in new technology every year. Roll outs of technology are complex and it can take many years for the full benefits of new technology to be realised. User testing of digital technologies at the development stage often take place separate to the clinical setting because tech companies struggle to access real-world practice settings as a result of governance, safety and capacity in teams. As a result it is not possible to identify, mitigate and manage problems faced by real users in the context of clinical care.

The team will be focusing on mental health contexts and will start with digital apps, aiming to create a simulation environment that is mobile so it can be easily repeated by other trusts without the need for an expensive standalone simulation lab. The pilot simulation model will be developed drawing on simulation theory and research, user-centred design, agile and implementation methodologies and technology engineering. The final result from this pilot project will be a powerful resource that supports adoption of digital technologies in practice and promotes a technology simulation culture within the NHS.

Find out more about our work in mental health


Innovator Spotlight

Dr James Woollard, Chief Clinical Information Officer, Consultant Child and Adolescent Psychiatrist, Oxleas NHS Foundation Trust

“The amount of technology we procure is only set to increase and often as clinicians, we find ourselves needing to use multiple new pieces of technology simultaneously to care for patients. The NHS has used clinical simulation for years and it’s time we applied this same theory to digital technology. At the moment, we’re asking our staff to use equipment that has very rarely been tested live in the kind of high pressure scenarios they face.

“Our focus is on developing cost-effective mobile simulation labs that will help us all learn, build confidence and make roll outs much faster. If technology companies can rapidly find and address real world problems associated with using their technology before they are rolled out to staff, we’ll see better product design, ease of use and faster adoption.”

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‘Mass screening!’ – an innovative healthcare delivery approach to stroke prevention in Wandsworth

Mass screening! – an innovative healthcare delivery approach to stroke prevention in Wandsworth

Stroke-busting health checks at-a-glance

Mass screening in Wandsworth to prevent strokes and reduce health inequalities.
People in hard-to-reach communities deserve better. Community groups and the NHS have been inspired to work together in new ways: to refuse to accept health equalities and to work in partnership for better outcomes.
• In Wandsworth, nearly 2000 people have undiagnosed atrial fibrillation (one of the main risk factors for stroke) and 35,000 people have undiagnosed hypertension.
• Detection of AF through health checks will prevent strokes, helping communities live longer, healthier and happier lives.
• If you are Black and of African or Caribbean origin you are twice as likely to have a stroke, and at a younger age, than the Caucasian population. This project aims to reduce inequalities by making sure everyone has access to the care they need.
• It’s a better experience – tailored to what people actually want and need.
• Trains people who are embedded in their communities to do new roles that can support the health service and introduces new models of care for people by working closely with community groups and faith leaders to target at-risk communities.


Stroke-busting health checks for Wandsworth 

To increase detection of the main cardiovascular risk factors across the most deprived areas of the borough, HIN Innovation Grants will fund a new project to offer ‘Stroke Busting Health Checks’ to 1,000 people at greatest risk of stroke in Wandsworth.

This co-produced, community-led scheme will see 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 will include Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index. They will be an opportunity to talk about the risk of smoking, including the direct link to stroke.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic (BAME) 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 is going to work in an innovative new way to go to these communities and work alongside local leaders to engage people.
In total, the project aims to perform at least 1,000 “Stroke Busting Health Checks” in hard-to-reach communities at high risk of stroke. It will use healthcare assistants from local GP practices to offer regular checks through a hub and spoke model of engagement in high volume places of worship and association, including temples, mosques and churches.
To support the checks and help engage the community in this work, the team will also produce a bespoke film, distributed through social media, featuring local faith and community leaders with a call to action to take part in the checks. This culturally specific content can support other health projects elsewhere in the borough and beyond.

The project is expected to increase awareness of stroke and cardiovascular disease as well as reduce the prevalence of stroke in the Borough. All those identified at risk of stroke through the checks will be supported to attend further tests and commence treatment. Faith and community leaders will trained and upskilled to support and encourage their communities to access additional services where needed, including registering with GPs.

Find out more about our work in stroke prevention


Innovator Spotlight

Dr. Nicola Jones, a GP and Chair of Wandsworth Clinical Commissioning Group said:

“The people of Wandsworth can look forward to a new and innovative local approach to stroke prevention. At the moment, over a third of people invited for a health check do not attend. We’re using this funding to kickstart an innovative new collaboration between Wandsworth community leaders and the health service, working hand-in-hand with local groups to get our services to those who need them most.

By targeting hard-to-reach communities we will reduce health inequalities and we expect this grant to be the first step in developing a new approach to screening that will benefit the communities we serve.”

Malik Gul, Director of Wandsworth Community Empowerment Network, Wandsworth, said:
“Together, we’re bringing health checks into the community in a way that is unique and transformational. The approach unlocks the value and capabilities held in communities – in mosques, churches, temples, as well as in community groups and associations. This is a vital network of microsystems – the project is creating an innovative, emergent system that can offer the NHS new ways to make early health interventions more effective and work towards reducing health inequalities.

“Leadership has been essential – senior people across Wandsworth have been brave enough to say yes, we need change and yes, we’re ready to get behind this. Without strong collaborative and cross-sector leadership, the NHS would not be working in these new ways.”

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Lewisham Primary Care Recovery College Pilot Project

Lewisham primary care recovery college pilot project

Recovery College Pilot at-a-glance

A new way to support people with mental health needs in primary care, through 10 week courses delivered by clinical experts alongside people with lived experience of mental health conditions.
The team wanted to find a way to help people whose mental health needs more support than a GP can offer in a short appointment, but don’t need acute services. They were also inspired by the power of these courses to connect people through shared experience.
• Improved and open access for people who need support.
• In South East London, 40 per cent of GP consultations relate to mental health. This could help reduce pressure on primary care at the same time as improving access.
• This is a new way to improve patients’ understanding of conditions, confidence in managing their health independently and personal resilience: and for this to have a measurable impact on their subsequent patterns of contact with a clinician.
• Increases opportunities for patients/service users and carers within primary care to work within a co-production framework, learn together and reduce of mental health stigma within the primary care environment.
• Strong example of care delivered in different settings and opportunities for primary care to offer new services in collaboration with other parts of the system.
• An opportunity to gather evidence and make the case for a sustainable roll-out.
• Recovery colleges quite new so evidence base is still emerging but studies to date show a high return on social investment – up to £10.81 for every £1.


Recovery College: innovating to improve mental health support in primary care 

A new project to take mental health recovery, self-management and wellbeing workshops into GP practices will be funded by the HIN Innovation Grants.

From the team that leads SLaM’s successful Recovery College, this project will take its model to GP practices. Recovery Colleges focus on hope, opportunity and choice/control- co production. They enable the students to become experts in their own self-care, and develop skills they need for living and working.

Students are usually individuals who do not currently need acute mental health services but do need more support than they’re able to get from busy GPs at present. It could be for a very wide range of conditions, for example long term stress or low-level depression and anxiety that affects people’s daily lives but not to the point where it needs acute intervention.

The project will provide free, co-produced self-management, recovery and wellbeing workshops and courses for patients, carers and staff in primary care, using shared perspectives, skills and knowledge to help people recover and live as well as possible. By extending into GP practices for the first care, it aims to reach more people with support and improve access.

The pilot college will be based within a health centre in Lewisham and aimed at service users/patients registered with five GP surgeries at in and around New Cross. A key part of the approach is that the trainers are paired together so that there is one ‘peer recovery trainer’ – someone who has lived experience of mental ill-health or distress as a service user – and a ‘professional trainer’ – someone who has professional experience. This means students get the clinical perspective and a personal narrative so that they can discuss and learn from someone who knows what it can be like, and feel more comfortable to share personal experiences.

Recovery College also helps people to network and meet people who are in a similar circumstance, increasing peer support. Often people are isolated and benefit from social networks. Learning about staying well in addition to having opportunities to stay connected can be very helpful for recovery. The team plans to offer a range of courses over a ten week pilot period. The courses will be co-designed, based on current SLaM Recovery College content, including topics around depression, anxiety, mindfulness, staying well and making plans and wellbeing.

The pilot will accept both referrals from GPs as well as self-referrals, with a maximum of 20 – 25 per workshop. Increasing access and routes to this kind of support will not only support people with their mental health, it aims to reduce the need for these individuals to use GP appointments for support that can be offered through the college.

The use of peer trainers has been very successful at SLaM Recovery College to date. Taking the peer trainer model into primary care is likely to be an extra and impactful support for the current NHS workforce when designing services and an additional forward step to tackle stigma and culture around mental health services.

Find out more about our work in mental health


Innovator Spotlight

Kirsty Giles, Manager (OT), SLaM Recovery College, South London and Maudsley NHS Foundation Trust, said:

“Our hope is that this pilot shows that recovery colleges can become an essential part of the primary care landscape, improving access to support for people with mental health needs while reducing the pressure on traditional GP appointments. Our trainers and our students are really brave, by putting themselves out there and sharing their story to help someone else. The approach is welcoming and effective.

“The college works with a really diverse group of people. As clinicians, we’re always learning from our students’ lived experience and are inspired by how they look after their wellbeing. This is a two-way knowledge exchange.”

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Transforming delivery of antenatal care in gestational diabetes

Transforming delivery of antenatal care in gestational diabetes

Improving care for women with diabetes in pregnancy at-a-glance

A package of innovative measures to help women with gestational diabetes: an app to help with monitoring blood sugars, a connected waiting room and guided support with food choices.
The team was excited by the potential of the new app to improve their communication and monitoring of women with diabetes in pregnancy. This is a chance to open up ways for women to continue to see their regular midwife team while still receiving specialist care.
• Potential to reduce deliveries before 36 weeks and caesareans.
• The NHS is working hard to make sure women have consistent midwife contact through their pregnancy by 2021. This could free up to 600 specialist appointments so that women can spend this time with their community team and have familiar faces throughout.
• Focus on education supports faster changes to diet and medication, helping to improve sugar levels more promptly over the course of the pregnancy.
• Values women’s time and creates a space to deliver education around food and exercise alongside specialist one-to one input.
• Gives women more control of their care as well as improving outcomes.

New innovations to improve care for women with diabetes in pregnancy 

A HIN Innovation Grant will go to fund the Kingston Hospital team to introduce innovative approaches to supporting women with diabetes in pregnancy (gestational diabetes). The team plans to introduce a sugar monitoring app (GDM-Health), guided shopping trips and a ‘connected waiting room’ with added benefits.
Currently women are required to prick their fingers four times a day, record this in a book and then have a face-to-face appointment once a fortnight. This new app and the changes that will be made to specialist midwives job plans will mean daily virtual clinics with midwives, run via the app and phone. Every day, midwives will go through all of the information received and contact anyone who needs support to get their blood pressure under control. Too often at present, such regular face-to-face appointments for diabetes in pregnancy can overly medicalise their pregnancy, increase anxiety, result in lots of time spent at the hospital and take away a woman’s feeling of control over their pregnancy as it is closely monitored by medical professionals.

Research has shown that gestational diabetes can be an indicator that a woman is more likely to develop diabetes later in life, and that the children of mothers with gestational diabetes are more likely to be obese and to develop diabetes themselves. Risk factors for this condition include increased body mass index, maternal age and non-caucasian ethnicity, factors which are present in south London’s population. Effective interventions that support education around diet, weight and exercise are essential to try and prevent poor health later in life.

There are three main aspects to the pilot:

• Using a new app, women will upload the sugar measurements they take four times each day so it can be reviewed in real-time by specialist midwives. Work arrangements for the midwives will be redesigned to ensure that there is someone available Monday to Friday to answer queries by phone or email, and proactively monitor results – so that the team can act more quickly with diet advice or medication adjustments to improve sugar control and reduce the risks to mother and baby.
• The team will also seize the opportunities of the waiting room to create a ‘connected waiting room’ that encourages exercise, healthy eating and peer bonding to help women explore ways to maintain good sugar levels alongside a healthy pregnancy. The waiting room is a key opportunity as women will often have appointments with more than one team member in the clinic, meaning that there is time spent in the room between appointments. To maximise the value of that time, the team will bring the room alive and introduce a library of recipe books, posters around diet and exercise in pregnancy and conversation prompts to encourage women to talk to each other. They will also hold drop-in education sessions covering diet tips, breast feeding advice, first aid for newborns and other topics suggested by the women using the service.
• To support the women in their care further, the team plans to pilot guided tours in a local supermarket, where they will guide women through changes they can make to their weekly shopping and hold an education session on healthy eating at the supermarket, suggesting alternatives and exploring barriers to change.

The project aims to reduce caesareans and interventions in birth through more responsive antenatal care as well as increasing the space for education around food and exercise. The plans are also designed to improve continuity of care. Most women with gestational diabetes are diagnosed at around 28 weeks. When their care is transferred to the diabetic clinic it breaks already established relationships with their community midwifery team.

The new app’s ability to monitor sugars more easily and remotely should mean that women need two fewer face-to-face appointments with the diabetic clinic. Instead, women can then make two appointments with their usual community midwifery teams, maintaining consistent contact with the team that will support them when they deliver their baby and in the community after delivery. Continuity of carer is proven to reduce preterm birth and pregnancy loss, as well as increasing maternal satisfaction with the care received. The team predict that if successful, the pilot could move as many as 600 appointments each year back into community settings.

Find out more about our work in diabetes


Innovator Spotlight

Caroline Everden, Consultant Obstetrician and Gynaecologist, Lead for diabetes in pregnancy, Kingston Hospital NHS Foundation Trust, said:

“It’s really exciting when you see something and realise the impact it can have on the women you care for. Women’s time in pregnancy is valuable and we want to use it effectively as we can. Whether it’s through the app to monitor sugars more easily, making the most of the waiting room or by giving them more time back to spend with community midwifery teams, we believe that there is more we can do.

“Our model will hopefully demonstrate that specialist input and education can be delivered in a way that values and supports the relationship established between a woman and her midwife, while also ensuring that expert attention is paid to a potentially very serious condition in pregnancy.”

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Diabetes prevention decathlon

Diabetes prevention decathlon

Diabetes Decathlon at-a-glance

A new ten week programme for people at risk of developing diabetes.
The team wanted to increase choice when it comes to Type 2 diabetes prevention support and want to make weight loss and physical activity easier to take part in and achieve.
• Reduce health complications for people and cost to the NHS through increased prevention of Type 2 diabetes.
• Potential for great clinical outcomes; including weight loss (targeted at 5% of their body weight) and reduced risk of Type 2 diabetes and the devastating complications that it can bring (such as blindness and amputation).
• Increases choice and offers GPs more prescribing options.
• Opportunity for people to try different types of physical activity and learn about their health;
• Includes psychological support and peer support from other local people.
• Builds new relationships between the NHS and leisure/physical activity sector.
• Aims to strengthen social prescribing evidence and models.


Diabetes Prevention Decathlon to increase choice and prevent diabetes

A new Diabetes Prevention Decathlon programme will be funded by the HIN Innovation Grants. This project will pilot a new type of diabetes prevention programme over 10 weeks that offers patients more choice and encourages them to work together as a team, by introducing different types of physical activity while learning key information that can help prevent the onset of Type 2 Diabetes.

There are currently five million people in England at high risk of developing Type 2 diabetes, which is largely preventable through lifestyle changes. If current trends persist, one in three people will be obese by 2034 and one in 10 will develop Type 2 diabetes. About 10 per cent of the entire NHS budget is spent treating complications from diabetes. Reducing this would have a major impact both on people’s well-being and on resources.

The new pilot programme will include all of the diabetes education and self-management aspects included in a typical programme but will be marketed as a combined education and fitness programme for diabetes prevention. It will be designed to offer choice to patients who can only currently access the NDPP.

The Diabetes Prevention Decathlon will:

• allow participants to try a different sport each week, and with their teams achieve goals based on activity levels and weight loss and participate in organised team activities at the end of every session;
• hold sessions in sports centres, overseen by qualified coaches;
• pilot the benefits of gamifying weight loss, while incorporating key messaging about diabetes prevention, psychological support, and healthy cooking advice;
• provide every applicant with a basic activity tracker, to encourage them to continue to remain active between sessions, and reward those who meet their goals with points for their team;
• integrate with mental health support from a psychologist;
• be considerably shorter in length than the national diabetes prevention programme: 10 weeks compared to nine months.

The diabetes prevention space is well represented by the National Diabetes Prevention Programme, which is the largest of its kind in the world and includes both digital and face-to-face providers. While it’s a proven programme, the dominance of a centrally funded programme has led to a lack of choice as CCGs/Public Health teams are under no pressure to seek alternative local solutions. This new programme seeks to offer more choice and test new ways of combining curriculums and activities for patients in south London.

All diabetes prevention programmes, both digital and face-to-face, need to align to the same NICE guidance and provide broadly the same advice, and this programme will be no different in that respect. The course will be designed by expert diabetes clinicians and will align to NICE guidance to ensure it provides the best possible health advice to people at risk of diabetes. The programme will also be designed with input from local people in Merton.
Its key innovation is to pair the usual behaviour change advice with a truly engaging physical activity programme, psychological support, and live cookery classes to provide a more holistic experience in the one programme.

The funding will help the team co-design and deliver this course.

Find out more about our work in diabetes


Innovator Spotlight

Chris Gumble, Project Manager, South West London Health and Care Partnership, said:

“Often, Type 2 diabetes can be prevented and we’re passionate about helping to do that in south London. At the moment we’re asking everyone to take up a one-size-fits-all prevention programme, rather than offering a range of options. The Decathlon will add something new and exciting, combining physical activity with diabetes prevention over a fun, interactive 10-week period.”

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Engage Consult – Digital Self-Referral for MSK

Engage Consult – Digital Self-Referral for MSK

Digital self referral at-a-glance

Faster, digital referral for people with MSK conditions
The desire to use technology to speed up the time between someone seeking help and being effectively triaged, so that care is safer and more efficient.
• It’s estimated that 30 per cent of GP appointments are due to MSK conditions. Self-referral could make a huge difference and reduce pressure on primary care while improving access for patients.
• The new system will ensure faster triage and picking up of warning signs that could indicate more serious conditions, improving patient safety.
• Aims to help patients that are anxious about their symptoms and/or pain. When people are anxious, this can worsen pain and may make it harder for their condition to get better. An early phone call to reassure and offer advice can make a huge difference and mean that when they do come in for a physio or other face-to-face appointment, recovery is already underway.
• It allows NHS staff to work flexibly.

Digital self-referral for people with musculoskeletal problems and pain  

HIN Innovation Grants will fund a new project to improve care for people with musculoskeletal (MSK) conditions or injuries.
Musculoskeletal (MSK) conditions affect the joints, bones and muscles, and also include rarer autoimmune diseases and back pain. More years are lived with musculoskeletal disability than any other long-term condition. This includes chronic back, hip and knee pain. It is estimated that 30 per cent of GP appointments are due to MSK conditions.

The project will introduce a new digital self-referral route that will allow for faster triage for people needing MSK treatment. Using a system called Engage Consult, people will be able to self-refer via a website. As well as triaging people for treatment, the site will include pop up information about other local services that could help such as weight management, exercise and walking groups. Over time, the system will link up with other digital technology in use so that patients and clinicians can see and discuss care plans, along with additional education and videos designed to help people manage their condition more easily.

At the moment, patients are referred via GPs and must first speak to an administrator before receiving a call from the triage team. Digital self-referral will improve this by picking up any worrying signs and symptoms more quickly, without the current gap between the administrator’s call and telephone triage. Engage Consult is able to ask smart questions to screen for sinister problems such as Cauda Equina, Metastatic Cancer ‘Red Flags’, or Charcot. This will allow for screening for serious warning signs from the point of contact, reducing the timeline between someone deciding they need help and the time they receive clinical advice. In some cases, this could have a significant impact on safety.

Additionally, the new system is expected to speed up telephone triage when it does take place. At present, it can take up to 20 minutes to take a patient’s history over the telephone. By placing the digital history in front of the clinician the length of these calls can be reduced, freeing up staff time to do more triage calls more quickly.

This means more people can be seen and access can be faster. The service receives approximately 2,000 referrals coming in via GPs every year. Even if only 50 per cent of people decided to go direct to MSK specialists, the impact on GPs and extra capacity in the system would be very significant.

The project is taking a longer term view and working hard to introduce a modern care model, supported by digital platforms.

Find out more about our work in MSK


Innovator Spotlight

Heather Ritchie, Service Lead and Operational Manager, Oxleas NHS Foundation Trust, said:

“MSK affects so many of us and puts huge pressure on primary care. We’re passionate about finding ways to speed up access to our expert team and our management team has supported us to develop and try new ideas.

If people can get clinical advice more quickly it doesn’t only improve safety, it means that individuals will feel more supported and less anxious. What’s great is that this is additional to the 1-1 care we provide at the moment, so it’s adding a better experience for patients while at the same time removing some of the pressure from our GP colleagues.”

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London’s Health Care Industry Booms as Millions are saved for the NHS

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London’s Health Care Industry Booms as Millions are saved for the NHS

DigitalHealth.London have launched their impact report confirming they are speeding up digital innovations across health and care in London, creating jobs and saving millions of pounds for the NHS. This supports the objects of the Government’s Long Term Plan to make digitally-enabled care the mainstream across the NHS.

DigitalHealth.London is a collaborative programme delivered by MedCity, and London’s three Academic Health Science Networks (AHSN) – UCLPartners, Imperial College Health Partners, and the Health Innovation Network (HIN). It is supported by NHS England (London) and the Mayor’s Office.

The DigitalHealth.London Accelerator is a flagship programme delivered by DigitalHealth.London to fast track innovations into the NHS and support innovators navigating the NHS system. Around 20-30 companies are selected onto the Accelerator programme each year and are given bespoke mentoring, training, networking opportunities to develop their business. This collaboration and support also enables the fast spread of cutting edge innovations into the NHS to benefit patients and support NHS staff. The Accelerator companies range in size when they begin the programme, from a single founder working on one product, to companies with in excess of 30 employees.

467 new jobs were created

Eighty-five percent of companies to have been on the Accelerator programme who participated in this report, reported an increase in their staff numbers. Of the additional jobs created by companies on both the 2016-17 and 2017-18 programmes, 30.3 percent (141) are attributed to their involvement in the DigitalHealth.London Accelerator. A total of 467 new jobs were created between August 2016 and November 2018.

“Anything we achieve as a company is in some way down to, or connected to, working with the Accelerator.” Elliott Engers, CEO, Infinity Health, Accelerator cohort 2017-2018

Over £64 million of investment raised by Accelerator companies

As discovered by the recently published report DigitalHealth.London Accelerator companies raised over £64 million of investment between August 2016 – November 2018. One company alone account for £28 million of this. Sixty-six percent said that the DigitalHealth.London Accelerator had helped them raise investment in their company.

“The DigitalHealth.London Accelerator is saving millions of pounds for the NHS while stimulating economic growth in the health care industry.  It supports innovations that will change the lives of patients, support NHS staff and create jobs.” Tara Donnelly, Chief Digital Officer of NHSx 

NHS Savings almost £76 million

The work of Accelerator companies has resulted in almost £76 million in savings for the NHS, with just over a third of this (£24.8 million) credited to the Accelerator’s support, based on information self-reported by companies involved. A conservative view that 50 per cent of the NHS savings attributed to the Accelerator are actually being realised, given that the Accelerator programme is 50 per cent supported by AHSNs (the innovation arm of the NHS) and their partners MedCity and CW+, the Accelerator programme has a return on investment of over 14 times: for every £1 spent by the NHS (via AHSNs) on the DigitalHealth.London Accelerator, £14.60 is returned, in some way, through the implementation of a digital solution. Some of these savings are made in efficiency gains, for example finding more efficient ways of supporting patients to manage their own health conditions, whilst others may help reduce inappropriate urgent care attendances by providing easier access to GP services.

Read the full impact report here.

 

The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

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The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

Dr Caroline Chill, Clinical Director for Healthy Ageing at Health Innovation Network looks at the potential of the new contract to support innovation.

I’ve worked in primary care for over 30 years, and have been involved in leadership and innovation for most of them. GPs have a history of being innovative with the early coded electronic health record systems being a prime example. In recent years, it has felt like this innovation has been stifled by increasing workload, staffing pressures and ever changing contractual requirements. I’ve seen innovation talked about in countless different ways and these days it seems to me that policy makers are falling over themselves to describe initiatives as ‘innovative’ or to talk about the potential to improve care through innovation but with less commitment to support the delivery of innovation in practice. So, I was fascinated to see how this would be expressed in our new GP contract which to my surprise did not mention the word ‘innovation’ at all. Not a single mention, despite the contract being extremely innovative.

An obvious area relates to support for Primary Care Networks and additional staffing. The aim of Primary Care Networks is to connect the primary care teams to help deliver more integrated and comprehensive local services, to allow new models of care to emerge and to support higher levels of self-care. From 1July, 1,259 Primary Care Networks become operational and backed by nearly £1.8 billion funding over five years with most of England’s nearly 7,000 GP practices participating.

Additionally, the interim NHS workforce plan and dubbed the “People Plan” was published in June.  This focuses on three key areas – recruiting more staff; making the NHS a great place to work; and equipping the NHS to meet the challenges of 21st century healthcare.  It re commits the government to delivering 5,000 full time equivalent GPs “as soon as possible” as well as nearly 6,000 extra nurses, and the creation of “nursing associates” offering a career route from care support into registered nursing.

The GP contract acknowledges the fact that the additional staff we need in general practice will not come from doctors and nurses alone. The money available through the contract can be used to help recruit a much broader range of professionals – Initially the scheme will meet 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers.

I think it will be down to the primary care networks to find innovative ways to recruit, train, support, mentor and part fund these new roles. This is no simple task as the existing training and skills of these professionals will need to be strengthened and adapted for working in community settings, where there is less supervision and where patients need holistic care, encompassing multiple physical, social and psychological issues.

I believe GPs will rise to this challenge and seize the opportunity. . It could be the beginning of a new, more modern and holistic way for patients to experience general practice.

Increasing the numbers of physiotherapists and other community-trained staff could lead to another important shift. Take MSK as an example which includes chronic knee, hip and back pain, has a major impact on an individual’s quality of life 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.

An intervention that relieves chronic joint pain, called Joint Pain Advice , already exists and can be delivered by a wide range of professionals and lead to lasting improvements in pain. The model focuses on reducing reliance on painkillers through exercise and education. Trained professionals, who could be physiotherapists, community health trainers, or others provide a series of face-to-face consultations, working collaboratively with people with hip and/or knee osteoarthritis and/or back pain, focusing on supporting self-management. 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 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. This has the potential to reduce pressure on existing physiotherapy services and potentially reduce demand for GP follow up consultations.

To date, more than 500 patients have used the service led by physiotherapists. In a previous pilot in Lewisham, south London, 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.

In addition to the patient benefits, 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.

Why not embed this training into these new roles? This could genuinely help deliver one of the aims of PCNs to empower people to self-care and improve the quality of life for people living with MSK pain. This one example could radically change the approach for addressing the needs of people living with MSK pain helping them to become fitter, more active and more empowered,  provided that the additional funding for primary care staffing does not result in reduced provision in other sectors.

Primary care will find countless other ways of using new staff to do more in primary care. While this doesn’t magically reduce our workload in practices, it has the potential to shift it and makes it easier for patients to access a broader range of professionals in community settings without the need for referrals to hospital.

These initiatives alone will not be enough to completely transform and modernise primary care but they are a great starting point. Change is easy to talk about but difficult and complex to enact. Even innovations that will lead to significant savings will often require upfront investment of resources, time and goodwill. The introduction of state based indemnity is very welcome to help retain experienced GPs, however,  changes to pension contributions and tax implications may have an equal and opposite effect impacting  the number of sessions doctors are choosing to work.

For me the key headlines which make the new GP contract so innovative and exciting are the significant increased staff funding, support for the development of Primary Care Networks, a five-year timeline and introduction of state based indemnity.  What we now need is the time and space to deliver.

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Innovation to reduce diabetic foot amputations in south London

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Innovation to reduce diabetic foot amputations in south London

Every day 23 people in England have a toe, foot or leg amputation as a result of diabetes related complications, according to NHS England. Through faster diagnosis and treatment this shocking intervention can be reduced.

In south London specialist new diabetic foot clinics known as Multi-Disciplinary Foot Teams (MDFTs) have been set up to deliver faster, local treatment to help reduce the number of people facing amputations.  Located in Queen Mary’s Hospital in Sidcup; Queen Elizabeth Hospital in Woolwich and Princess Royal University Hospital in Bromley, these services are providing urgent specialist care (within 24 hours) to people who have active foot disease. Research shows that if left untreated for long, diabetic foot infections can lead to further complications and in increasing number, amputations, which could be avoided. “Time is tissue’ when it comes to this disease.

The new clinics are being supported by consultant diabetologists, vascular surgeons and specialist podiatrists from Kings College Hospital, Guy’s and St Thomas’s and Lewisham and Greenwich NHS Trust, in order to improve the care that patients receive and bring it closer to their home. This also supports the existing community podiatry teams that can develop relationships with their local MDFT to streamline plans and treatment.

This innovative approach recognises it is not just podiatrists who come into contact with diabetic foot problems. It’s vital that other primary care clinicians can diagnose the condition and refer individuals to specialist treatment quickly.

The new MDFT clinics are for active foot disease only– including:

  • Any foot Ulceration
  • Acute Charcot foot (hot/swollen/painful foot)
  • Necrosis
  • Any foot Infection.

To refer, please use eRS for Diabetic Medicine (Speciality), Podiatry and Foot (Clinic Type) and Urgent (Priority) to see the spoke MDFT clinics at QEW, PRUH and QMS.  You can see the Directory of Services here, a video about the new clinics here and learn how to conduct a foot screening in primary care here.

For further information please contact Don Shenker, Diabetes Project Manager, Health Innovation Network.

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ESCAPE-pain programme reaches 200 sites

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ESCAPE-pain programme reaches 200 UK sites

This month the ESCAPE-pain programme launched its 200th site in the UK. It now operates in every region in England, with sites also operating in Wales and Northern Ireland. Over 13,000 people have attended the programme to date.

Originally rolled out by physiotherapists in hospitals, ESCAPE-pain is now also offered to people in leisure centres and gyms, church halls and community centres.

ESCAPE-pain is an evidence-based rehabilitation programme for people with chronic knee and/or hip pain, also known as osteoarthritis. It integrates exercise, education, and self-management strategies to help people live more active lives and manage their pain better. It offers an opportunity to reduce the number of GP consultations for knee and hip pain and reduces prescriptions of painkillers for these people.

The programme was developed by Professor Mike Hurley and is hosted by the Health Innovation Network. Nationwide scale-up is currently being supported by NHS England and Versus Arthritis.

ESCAPE-pain has been shown to:

  • Reduce pain, improve physical function and mental wellbeing.
  • Sustain benefits for up to two and a half years after completing the programme.
  • Reduce healthcare utilisation (medication, GP appointments, secondary care) equating to an estimated £1.5 million total savings in health and social care for every 1,000 participants who undertake ESCAPE-pain.

You can find your nearest ESCAPE-pain programme here.

How to find out more and hear personal real-life experiences here.

To find out more about ESCAPE-pain visit their website or follow them on Twitter @escape_pain

Meet the innovator: James Flint

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with James Flint, CEO and Co-Founder at Hospify; a compliant, trusted healthcare messaging app.

Pictured above R – L: James Flint, Co-founder and CEO with Neville Dastur, Co-founder at Hospify.

Tell us about your innovation in a sentence

Available for free in the Apple and Android app stores, Hospify puts a simple, affordable alternative to non-compliant consumer messaging services like WhatsApp, Viber, Telegram and Messenger directly into the hands of healthcare professionals and patients.

What was the ‘lightbulb’ moment?

Meeting with the Head of Health for the Information Commissioner’s Office in 2015 and discovering that, while a very big chunk of the NHS was using WhatsApp to communicate while at work, once GDPR arrived in 2018 they were going to have to stop doing this.

What three bits of advice would you give budding innovators?

    1. Be prepared for the long haul. And I mean long.
    2. Keep it simple.
    3. Never miss lunch.

What’s been your toughest obstacle?

Getting sufficient funding, without a doubt.

What’s been your innovator journey highlight?

Getting on the NHS digital heath accelerator last year. It felt like we’d finally been given the official stamp of approval.

Best part of your job now?

Meeting nurses and hearing directly from them what a difference Hospify can make to their working lives.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Implement and support proper health data interoperability standards. I know this Is finally happening, but it’s still the most important single thing that needs to be done.

A typical day for you would include..

Answering a lot of email, talking to my development team, meeting or calling potential investors, networking or promoting Hospify at some kind of health event, answering customer support questions about the platform. Usually all on the same day and sometimes all at the same time!

For more information on Hospify visit www.hospify.com, Facebook, LinkedIn or follow them on Twitter @hospifyapp

Meet the innovator: Lydia Yarlott

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Lydia Yarlott, Co-Founder at Forward Health; a secure messaging and workflow app, connecting care workers around patient pathways.

Pictured above: Lydia Yarlott.

Tell us about your innovation in a sentence

Forward is a mobile communications platform aiming to connect healthcare professionals for the first time.

What was the ‘lightbulb’ moment?

Probably being a first year doctor on my own in an NHS ward at 2am in the morning trying to get help for a deteriorating patient and being unable to contact anyone. Poor communication leads to a real feeling of helplessness, and I want to change that for doctors and nurses everywhere. It’s hard to believe we’re still using pagers and resorting to WhatsApp to get hold of each other in hospitals, so it wasn’t so much a lightbulb moment as an increasing feeling that something had to change!

What three bits of advice would you give budding innovators?

    1. Talk to everyone, and anyone, you can about your idea. You never know what will happen next. My great friend Will worked with me as a junior doctor; he’s now with us on Forward full-time. We never would have had him as part of the team if we hadn’t spent hours on night shifts discussing the problem together!
    2. Find a Co-Founder (or several!) I couldn’t imagine doing this alone. Philip and Barney are both amazing people and amazing leaders, and it’s their drive and optimism that got us to where we are today – 5% of the doctors in the UK and growing. Whenever one of you is losing faith (inevitable at times!) the others can put you back on your feet and help you with that resilience you need in spades to be a successful Founder.
    3. Care about your problem more than your solution. Get as close to it as you can and stay there. Your solution will be wrong first time around, but as long as the problem isn’t solved, you have a chance of something really worthwhile.

What’s been your toughest obstacle?

Personal doubt!

What’s been your innovator journey highlight?

Getting our first real use cases. Watching our product change the way people work, resulting in better, faster care for patients. We have an amazing group of physios and orthopaedic surgeons using Forward to streamline shoulder surgery for patients, and another group who are using it to coordinate the multidisciplinary team in paediatric allergy. I can’t get enough of those stories because I know how tough it can be on the frontline of the NHS.

Best part of your job now?

The great privilege of working as a doctor and as a Co-Founder. I love clinical work, but I get frustrated by outdated systems, and I would hate it if I couldn’t focus on changing that. I care about healthcare at a systemic level and I want the NHS to survive, but I know that for that to be the case things will have to move forward, fast. I want to be a part of that.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Get Trusts talking to one another and sharing what they do. Incentivise knowledge transfer – both successes and failures. Share the ways in which they are working with others, including start-ups and small businesses, to foster innovation at scale.

A typical day for you would include..

A typical day being a paediatrician is just that – looking after sick children! I’m a junior doctor, so I’m still learning a lot, and working closely within a team to achieve the best outcome for the patient. When I’m at Forward, I spend most of my time meeting with the team to discuss progress and strategy, representing the clinical face of the company and the problem we’re trying to solve. The two jobs couldn’t be more different, but ultimately they are focused on the same thing – improving healthcare for everyone. I love what we’re building at Forward and I love the team – even those of us who aren’t from a healthcare background are driven by the mission to improve communication, and you can feel that energy walking into the office.

For more information on Forward Health visit www.forwardhealth.co or follow them on Twitter @ForwardHealth_

Polypharmacy in Care Homes

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Reducing Inappropriate Polypharmacy in Care Homes

Aiysha Saleemi

Polypharmacy – literally meaning ‘many medicines’ – is defined by the World Health Organisation (WHO) as use of four or more medicines and is extremely common among the older population. In fact, on average, care home residents in the UK take seven medicines a day1. This mix of numerous medications, at times prescribed by multiple clinicians, comes with a massive 82% risk of adverse drug reactions2.

Dementia week

I have been a qualified pharmacist for over 10 years and I am currently completing the Darzi Fellowship; a one year leadership course accredited by London South Bank University (LSBU). Within this year, I have been tasked with a project to ‘reduce inappropriate polypharmacy in south London care homes’. An exciting but daunting task for a 12-month period, which if I am successful in, has the potential to reduce hospital admissions, 5-20% of which are related to adverse drug events, and subsequently contribute to saving the NHS millions of pounds per year3 As part of this project, I also aim to specifically reduce the use of anticholinergics in people with dementia. Anticholinergic medicines, often prescribed for various conditions (such as hay-fever and depression), can cause a number of uncomfortable side-effects such as constipation, dry mouth, dry eyes and confusion, but beyond that, they also block the beneficial effects of medicines used for dementia.

Dementia generally affects the older population, for whom polypharmacy is commonplace. Taking numerous medications poses the risk of medication errors, non-adherence and adverse drug reactions and is particularly dangerous for the older population as some of these individuals may also be extremely frail leading to increased susceptibility to illness and slower recovery times. Between this, and the fact that at the current estimated rate of prevalence, the number of people with dementia in the UK is forecast to increase to over 1 million by 2025 and over 2 million by 2051, I was determined that my project would contribute to improving the quality of life of care home residents living with dementia.

My project has been focussed on four care homes in south London. At each of these care homes, we are trialling several interventions. One involves the nurses and carers being informed on the dangers of anticholinergic drugs for people living with dementia and which medications have high anticholinergic activity so they can highlight their use to the pharmacist or doctor. The aim is that the medicines will be reviewed and hopefully reduced or stopped if no longer providing the most benefit to the resident. Another intervention involves educating residents and relatives on the potential risks of polypharmacy so they will understand why some medicines might be stopped. Data is being collected around the knowledge and confidence of nurses and carers to highlight these medicines for review to the pharmacist or doctor and if the reviews result in reduced use of anticholinergics.

Working on this Darzi project is very new to me, but it has been a great way to not only use my pharmacy background to have a direct impact on improving outcomes for a vulnerable patient group, but it has taught me a lot about project management and the importance of building good relationships with all your stakeholders. I have thoroughly enjoyed meeting new people from different organisations and getting to share my knowledge with others, knowing it might help them to improve outcomes for care homes residents. Although there are no results to report yet, I have learnt a great deal.

My top tips so far, for how to reduce inappropriate polypharmacy in care homes are:

1. Involve everyone in the decision-making. Polypharmacy affects the care home residents, relatives and staff members and so ensuring that everyone’s voice is heard is imperative. Consider holding focus groups for residents/relatives and attending GP and care home meetings to capture healthcare professionals’ opinions.
2. Keep your stakeholders updated and informed. Engaging all stakeholders once and then not communicating with them again will lose their enthusiasm for the project. Attend regular meetings or send information to be added to their local newsletters so that everyone is kept informed. Also, ensure that the GPs have agreed for any interventions to be trialled.
3. Target the type of medicines you want to concentrate on reducing. There are hundreds of medicines available in the UK and so it is important to pick the specific medicines you want to work on first. Think about the medicines that may be causing the most harm in your chosen population.

I hope the data collected from this project will demonstrate that these simple but effective interventions can contribute to reducing the use of inappropriate polypharmacy in care homes, and – most importantly – improve outcomes for residents with dementia. And if so, I hope that other care homes in south London will be able to easily adopt some of the methods used in my project and perhaps even spread it across the rest of London.
There are no results to report on this yet but final results will be published on the Health Innovation Network website in August 2019.

Be the first to read Aiysha’s final report, by signing up here

References
1. The Royal Pharmaceutical Society (2016) The Right Medicine – Improving Care in Care homes Available from https://www.rpharms.com/
2. Prybys, K., Melville, K., Hanna, J., Gee, A., Chyka, P. Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1: Overview, etiology, and drug interactions. Emergency Med Rep. 2002;23:145–53.
3. Barnett N., Athwal D. and Rosenbloom K. (2011) Medicines related admissions: you can identify patients to stop that happening. Available from: https://www.pharmaceutical-journal.com/learning/learning-article/medicines-related-admissions-you-can-identify-patients-to-stop-that-happening/11073473.article?firstPass=false

Meet the innovator: Vivek Patni

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Vivek Patni, Director and Co-Founder of WeMa Life; an online marketplace that brings customers and their families together with social care and community care service providers.

Pictured above: Vivek Patni.

Tell us about your innovation in a sentence

WeMa Life is an online marketplace that brings customers and their families together with social care and community care service providers; giving choice, accessibility and efficiency in the service procurement and delivery pathway.

What was the ‘lightbulb’ moment?

As an informal carer for my grandfather, I was immediately shocked by the lack of innovation in supporting families to find, coordinate and manage local care services for their loved one, hence WeMa Life was born. I find online marketplaces very convenient and use them for so many aspects of my life – products, clothes, hotels, restaurants – I knew a similar digital environment was needed for care services. Using WeMa Life as a customer I can search, compare, purchase and rate local care services whilst as a provider I can digitise the outdated, manual, paper-based visit records and manage my daily business activity.

What three bits of advice would you give budding innovators?

    1. Stay flexible: it’s tempting to start a business with a clear idea of how things will unfold; but this is rarely the case. Pivot and react to obstacles and have an open approach to finding the best solutions to all your problems.
    2. User experience: test your product constantly and get as much feedback as you can from all your user groups. Simple solutions sit very well in such a diverse industry.
    3. Be creative in your approach to developing tech and running your business. There are so many applications and tools to create efficiency and cost saving in finding resources, marketing and development, so use them!

What’s been your toughest obstacle?

Where I had faced the difficulty from a customer side of social care, I was less aware of the complexity in delivering publicly funded social and community care to different user groups. This meant learning the nuances of each service type/provider and creating a fluid product that would fit all.

What’s been your innovator journey highlight?

Designing the tech architecture from scratch, building an international technology development team and bringing my ideas to life in just eight months is something I am very proud of.

Best part of your job now?

Taking my product into the market! Now that the product is live, I am driving its use through digital marketing and sales. I meet so many interesting people on a daily basis who bring exciting new ideas to what we do – my mental technology roadmap is never ending.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would give more opportunity and financial incentives to SME’s. There are a huge number of SME’s with great ideas and technology, they tend to be more fluid, interoperable and customisable to the needs of the NHS; they would be able to make a real change to the daily lives of providers and customers.

A typical day for you would include..

Typically, my days are devoted to technology and selling. My morning tends to be engagement with my India tech team to make sure we are always refining and innovating our solution. Afternoons will be selling, calling and meeting as many people as I can. I get energised by talking to people about what we do so I try to do that as much as possible.

For more information on WeMa Life visit www.wemalife.com or follow them on Twitter @wemalife

Top Tips for innovators

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Top Tips for Innovators

Got a great innovation that could radicalise the health care system but overwhelmed by the complexity of the NHS? Lesley Soden, Head of Innovation gives her top tips on how to build relationships with NHS and local authority contacts so you can get your innovation successfully implemented.

With Secretary of State for Health and Social Care Matt Hancock’s increased focus on the advancements of digital and technological solutions for the NHS, the market for health innovations is booming. Whilst it is an exciting time for health tech, for innovators themselves it makes for a crowded marketplace. In addition to the competition you face, you are also expected to navigate the complex landscape of the NHS.

Getting your innovation adopted in the NHS sphere can feel like opening a sticky door that requires the hinges to be oiled continuously. At the Health Innovation Network, we are approached by about 3-4 innovators every week looking for advice and support with getting their innovation bought by the NHS. Whilst every innovation requires different proof-points, we have learnt a number of lessons through our experience of improving the take-up of the Innovation and Technology Payment products across South London, and developed some key steps that all innovators can follow to increase their chances of getting their innovation, product or service adopted.

Target the right people

Having an engagement plan to target the right people at the right time, will stop you wasting yours. For example, if the innovation helps with managing referrals more effectively then a General Manager or Operational Director will be your target audience. If your innovation addresses a patient safety issue, then the Medical Director of Director of Nursing will be the decision-maker you need to approach. Work out which part of the system your innovation will save them money and then work out who is in charge of spending for that department.

Tip: if your innovation has the potential to save money for an NHS provider don’t target commissioners. Also, Trusts often have transformation teams who could help with getting your innovation adopted if there is evidence that it will improve patient care.

Tailor your message

In general, all NHS Trusts or Clinical Commissioning Groups will have the same system pressures as everyone else. These could be A&E waiting times, or the increasing demand caused by more patients having more complex conditions. However, individual decision-makers will have different priorities that concern them on a daily basis. To make sure your message is getting heard you should tailor it to the specific pressures or problems that your innovation could help them with.  For example, the Director of Nursing will probably be concerned with their nursing vacancies and agency costs, or patient safety while the Director of Finance and Performance’s priority is more likely to be addressing long waiting lists, or meeting their savings target.

Tip: trust board reports and Clinical Commissioning Group board reports are all published via their website; by scanning these board papers you can identify their specific issues and make it clear that your innovation solves their problems.

Get clinician approval first

Don’t even think about approaching any director or commissioner if you don’t have sufficient clinician buy-in. After all, they are the people who will be using your innovation on day-to-day and will need to be convinced of its value if you want it to get implemented properly. Approach the clinical teams to highlight the clinical and patient benefits of your innovation, and test their interest, before trying to get it bought for their hospital.

Tip: you are more likely to have an impact with this audience if you show that you’ve done some research. Do the testing, build up an evidence-base and then make your approach.

Learn about procurement

Don’t underestimate the potential for procurement processes to slow down or even stall getting your innovation into the NHS. Procurement is often a lengthy process in trusts, (for very good reason given it is taxpayer money that is being spent) the complexities of which need to be understood and respected.

Tip: engage with procurement teams to understand the process for buying your innovation, so you can don’t delay getting the sign-off for your innovation being adopted.

Refine your pitch

Contrary to popular belief, products generally aren’t so good they sell themselves. I hear 2-3 pitches a week from individuals with a health innovation and the majority of them fall down at the same hurdles. Firstly, don’t start your pitch with the generalist tabloid problems with the NHS. An NHS manager hearing for the third time that week that the NHS has no money and national targets are consistently not being met they will disengage. Instead, touch upon the challenge that your innovation will solve and then give detail on how your innovation is the solution. And the devil is in the detail. All too often pitches include vague statements about an innovation rather than actual detail. The best pitches are those that give overview of the innovation, clinical evidence, quantify return on investment and give an example of past or current implementation within the NHS. Spell out the real benefits using robust data and evidence, but don’t promise you can solve all their problems if you don’t have the proof.

Tip: return on investment is extremely important to highlight early on in your pitch. For example, one company recently included the fact that a different maternity unit had commissioned their online platform because it would save them money on public liability insurance. This type of evidence is impressive, clear and makes it easy to forecast the exact numbers by which your product will make them clear savings. This will always grab people’s attention.

Show how your innovation works

This sounds simple – and it is. People don’t just want to hear about how a product works, they want to see it and even try it out where possible. If it’s a medical device, make sure you bring it with you. Or if it’s a digital solution, do a short demo to help people to visualise your innovation.

Tip: have a quick pitch on your product ready and ensure that it clearly explains how your product works. Practise a 60 second pitch for meeting potential customers on an ad-hoc basis at networking events.

Be persistent, but polite

It’s unlikely that the first email you send will result in a bulk order of your product. It’s probably unlikely it will even result in a meeting. But that doesn’t mean you should stop knocking on doors. ‘No replies’ are not the same as rejection. And rejection can sometimes be ‘not now’ rather than a straight ‘no’. If you believe your product can transform the health care system for the better, then there’s a good chance you can convince someone else of that too.

Tip: don’t assume the worst in people when they don’t respond. Your target audience are busy and overwhelmed by pitches. Maintaining your professionalism and manners at all times will always go further to getting an answer than aggressive chasing.

As I said, getting your innovation adopted in the NHS can feel like opening a sticky door that requires the hinges to be oiled continuously. If you take a hammer to it, it’s unlikely you’ll be able to repair the damage caused to relationships in the future.

Lesley Soden is the Head of Innovation within the Health Innovation Network. She has over 20 years experience in the NHS and public sector. She has worked in senior business and strategy roles in mental health and community NHS Trusts involving programme management, business development, bid writing and service re-design, all delivered in collaborations with a variety of public and private health partners.

For more information on how we work with innovators, visit our Innovation Exchange page or read about our funding opportunities here.

Time to Talk – mental health and the role of digital

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

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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

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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

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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.

Why do we need a leadership programme for care home managers?

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Why do we need a leadership programme for care home managers?

Written by Don Shenker, Project Manager for Healthy Ageing.

At the first workshop day for care home managers on the Pioneer Leadership Programme last January, participants were asked to list the things they did in a typical day as a care home manager. The 14 managers listed 55 tasks they typically undertook on a daily basis – ranging from dealing with funerals, preparing the staff payroll, dealing with complaints, checking medication systems and helping to move beds.

As someone who was very new to the care home sector, I was awed by the responsibility care home managers held and the loneliness of the job at hand – providing high levels of care to some of the most frail older people in society and dealing with the myriad regulations, controls and quality checks from CCGs, local authorities and the CQC. The managers on the programme nodded in recognition when talking about missed lunches, half-drunk cups of cold tea and waking up in the night, worried if everyone in their care home was alright.

To add to this, CCGs are continuing to push their care homes to reduce the number of residents going into hospital unnecessarily and to accept new admissions to the care home even at weekends – all to ease the pressure on hospitals struggling to cope with acute demand from a frail older population. One in seven over 85’s now live in a care home and there are three times as many care home beds as there are in the NHS. To add to this pressure on the NHS, emergency admissions to hospital from care home have increased by 65% between in the last six years (2011-2017).

The Health Innovation Network and My Home Life Care Home Pioneer Programme is a free leadership course for south London care home managers which aims to develop the leadership skills and confidence needed to lead care home teams in a demanding and pressurised sector.

The programme is run over nine months, with managers using exercises developed by My Home Life to improve deep listening skills, focus on collaboration, connect emotionally, discover what is working well and embed positive change together. The principle of appreciative enquiry is adopted – starting with recognising existing strengths as a team and building on that.

The overriding sentiment managers spoke of, to a packed room of care home managers, CCG commissioners and local authority staff on their Graduation day, in November, was how the programme had helped to build the confidence they needed to make changes and improve their home.

From changing how they ran team meetings to encourage staff to speak out, to developing culturally appropriate services and initiating new ways of involving residents in decision making, the care home ‘Pioneers’ spoke of how they had achieved a transformation in themselves and in their home. The programme evaluation shows a two-fold increase in the confidence managers felt in managing their team and their home.

Having developed our original Pioneers in 2018, the HIN is now recruiting a new cohort of care home manager pioneers for our 2019 programme, with the Pioneer Graduates being trained to co-facilitate and mentor the new cohort.

At a broader level for south London, the HIN hopes to support the care home Pioneers to now co-create the solutions required for older adult care with NHS, CCG and local authority colleagues to ensure continuing high-quality care pathways for older residents/patients. Having seen first-hand the remarkable resilience, strength and knowledge gained by the 14 Pioneers, I’m confident they will go on to achieve even greater things.

To find out more information and apply for the next cohort, please click here

Meet the Innovator

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Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Sukhbinder Noorpuri, Founder and CEO of i-GP, an online consultation platform to allow patients faster access to primary care for minor illnesses.

Pictured above L-R: Dr Sukhbinder Noorpuri with Co-Founder, Dr Aleesha Dhillon.

Tell us about your innovation in a sentence

i-GP provides digital consultations for minor illnesses, using interactive pictures and online questions. It is accessible to patients 24/7 from any device, and 90% of users can start their treatment within just one hour.

What was the ‘lightbulb’ moment?

When I was working as a GP, I met Michael, a 70 year old gentleman who waited three hours to see me at a walk in centre back in 2015. I thought that there must be an easier way to access healthcare. So I started looking into alternatives, and when I found none, I decided to go about creating one. I have been fortunate enough to have a great Co-Founder in Aleesha who has been instrumental in developing creative solutions to all the challenges that we have encountered.

What three bits of advice would you give budding innovators?

  • Have a vision and make it a big one – set your goals globally rather than just locally in the spirit of true disruption.
  • Be relentless in the pursuit of this vision and always try and learn from every experience or opportunity which comes your way – know your market, keep reading about it and stay focused.
  • Build a world class team and inspire them to believe in the company mission. Be confident in your leadership and enjoy the process. A successful entrepreneur may build a well respected company, but a successful team will change the world.

What’s been your toughest obstacle?

Healthcare innovation is very challenging because impact takes time to achieve. However, your clinical experience is really the key differentiator in the marketplace. If you genuinely feel you have a clear perspective on the problem and have created the solution then building the evidence for your product, despite being time consuming, is the clearest way to show its potential.

Some regard regulation as being a tough element of service delivery, but embrace the challenge as a well executed process is the reason you will stand out in the industry.

What’s been your innovator journey highlight?

Over the last three years, we have won or been shortlisted for 22 healthcare awards as a result of the innovations we have developed in digital care. This has led us to international recognition and the opportunity to showcase i-GP at Conferences all over the world.

Learning to adapt and raise healthcare standards has been a reflection of the dedicated team approach to the venture. However, this recognition is secondary to the feedback we receive from our patients as this is our main driving force. Impacting the patient journey to care on a daily basis  is the motivation and inspiration to transform traditional routes of service. For example last week, we treated a patient who was due to catch a flight abroad for her sister’s wedding but was suffering with a urinary tract infection. It was late at night, she was in a rush and her chosen pharmacy was closed. We managed to arrange her prescription at the chemist within the airport just before she was due to take off. When she returned she was so thankful that her trip hadn’t been ruined by illness and she had been well enough to enjoy the celebrations.

Best part of your job now?

Without a doubt, my greatest fulfilment comes from leading our team. We are all passionate about seizing this opportunity in time to showcase the good that technology can bring to healthcare and the NHS. Digital health is still very much in its early stage of adoption and even though smartphones have been commonplace for several years, we are still on the cusp of widespread digital use. The service that we implement today, we hope, will continue for many years to come.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

There has been a real drive recently with Rt Hon. Matthew Hancock advocating technology to modernise the NHS. Accompanying this, are the additional Government funds being made available to trial new products. This combination offers a paradigm shift from previous regimes and as innovators, we are very much looking forward to this filtering down to provide new opportunities. I also feel it is imperative that decision makers utilise patient feedback to help determine the future course and not just rely on industry advisers.

A typical day for you would include..

Most days are very varied due to the wide scope of avenues we are exploring at i-GP. I usually like to hold key meetings in the morning with either members of the team or board to review processes and define our future strategy.

We have a schedule over the week to assign time to all the key aspects of service from marketing to patient outcomes and from technology developments to the financial structure we have adopted. Reflection is part of this process and the opportunity to network with other innovators is often on the timetable to ascertain the potential for collaboration.

Liasing with the Accelerator team and our navigator Sara is also a key part of our time as we look to integrate further into the NHS.

We would like to take this opportunity to congratulate Dr Sukhbinder Noorpuri who recently won the Chairman’s Entrepreneur Award (pictured above) at the TiE Awards Wednesday 5 December. Find out more about the awards here

For more information on i-GP visit i-gp.co.uk or follow them on Twitter @wellness_igp_uk

Adventure before Dementia

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Adventure before Dementia

Written by Charlene Chigumira, Trainee Project Manager for Healthy Ageing and Patient Safety.

The Healthy Ageing team attended the 13th annual Dementia Congress in Brighton last month, and it was even more special than I had imagined it would be. 

Wednesday opened with people with dementia and their carers from DEEP (Dementia Engagement and Empowerment Project) and Tide (Together in Dementia Everyday) sharing their unique experiences with us (and inspiring the title of this post). Alzheimer’s International took the stage and shone a light on how informal carers were providing 82 billion hours of support to people living with dementia by 2015, a statistic that still surprises me. This figure is why they believe that both formal and informal carers should be viewed as ‘essential partners in the planning and provision of care in all settings according to the needs and wishes of people with dementia.’ 

The lived experiences of people with dementia and their carers were weaved in throughout the congress as they spoke in the different break-out sessions on various topics including culture, assisted living arrangements, music therapy and spiritual support. One ‘End of Life Care’ session I attended hosted by Hospice UK and Dementia UK opened with a carer explaining why every day care matters to her, and how it maintains the dignity and individuality of a person living with dementia. Subsequently, a dementia care advocate, who has the condition herself shared some of the ways it has changed her life, and how the right care can enable her to live ‘interdependently’ (with support when needed, but a degree of independence remaining). Personally, I don’t think this session could have come at a better time, as my team is currently working on a project around end of life care in care homes. I left with a deeper understanding of why co-production is so important in our project work. 

Finally, one of the many highlights of the congress was hearing Paola Barbarino from Alzheimer’s Disease International highlight the brilliant ways countries all over the world are supporting people living with dementia. Here were 3 of my favourite case studies:

1. China (The Yellow Bracelet Project) 

‘In 2012, the Yellow Bracelet Project was initiated to encourage safety and prevent people with dementia getting lost. Yellow Bracelet has now become a symbol of affection, and continues to attract attention across society’. More here

2. The National Dementia Carers Network (Scotland) 

The National Dementia Carers network in Scotland has been ‘fully involved in Scotland’s two National Dementia Strategies, including work on testing models of community support, improving acute care in hospitals and the monitoring of better support’. More here  

3. LMIC spotlight (Costa Rica) 

Costa Rica was the first LMIC to introduce a dementia plan in 2014. Asociación Costarricense de Alzheimer y otras Demencias Asociadas (ASCADA) works closely with the city council to achieve a Dementia friendly community. More here 

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

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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

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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

Language and leadership needed for the government’s new ‘tech vision’ to become reality

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Language and leadership needed for the government’s new ‘tech vision’ to become reality

The Health Secretary Rt Hon Matt Hancock recently launched his new tech vision at an event organised by HIN, on behalf of NHS England. The vision is good news for digital innovation, but there’s still much more to do. Here, our Head of Technology, Denis Duignan, highlights some of its main features.

Last week, Matt Hancock launched the government’s new bold ‘tech vision’ to a room full of SMEs and NHS digital leaders at our event in London.

He spoke with credible enthusiasm as he outlined his views on how we achieve lasting digital progress. His vision is for the NHS to lead the world in digital healthcare, just as the U.K. has been a leader in Fin Tech, as the NHS already has the essential ingredients. This recognition of the NHS’ strong points, or ‘ingredients’ was good to hear – it’s too easy for those of us working in the system to forget. But the hard part isn’t individual components – it’s connecting these ingredients up in a truly modern architecture, so that systems talk to each other and patients and staff lives are easier.

The government’s desire to learn from the past is evident in the document’s focus on getting the national and local split correct. Mandating open standards at a national level is a key part of this, as is secure identity. But we need to retain local system flexibility. The architectural principles set out in the vision are:

  •         put our tools in modern browsers
  •         internet first
  •         public cloud first
  •         build a data layer with registers and APIs
  •         adopt the best cyber security standards
  •         separate the layers of our patient record stack: hosting, data and digital services.

These are sound principles. The focus on enabling healthtech innovation is equally promising and we hope something that signals a new era of support for healthtech innovators in and outside of the NHS. That being said, although the document speaks a lot about interoperability, with open standards and APIs providing the framework for modular IT systems, how level the playing field will really be in future remains to be seen. This is especially of concern to SMEs with products that require interaction with the established principle clinical systems, where quite often they need to pay significant ‘partnership’ fees to achieve satisfactory timely outcomes.

Some of the statements will raise a few (more cynical) eyebrows: “All new IT systems purchased by the NHS will be required to meet the standards we set out and existing services will need to be upgraded to meet these standards.” While the ambition is correct, many will wait with bated breath to see how this will practically play out for certain NHS organisations, especially those where particular suppliers are deeply entrenched or those with bespoke or heavily customised systems.

The language throughout the document is clearer than many policy documents in this space and feels like a step in the right direction. It says clearly: ‘This is not an IT project’ before going on to focus on ways of working. Those of us who regularly work on tech innovation projects know only too well that as long as tech is seen as just an ‘IT project’ we will struggle to realise the full benefits. Success depends on effective change management and changes in working cultures and habits.

Changing culture is hard. Leadership helps. For that reason, it’s also positive to see the focus on leadership in the vision. At the launch event a number of people talked about leadership and the difficulty of finding genuinely tech-savvy Boards. When it comes to finance, Boards can scrutinise the numbers. When it comes to people or projects, they can look at the staff survey or project plans. With IT, it can be a case of Boards just looking to a CIO and hoping for the best. Computer Weekly recently reported that even “at Leeds Teaching Hospitals  – a great example of a forward-thinking health organisation – there are 460 different IT systems in use.”  It’s not easy for Boards to get to grips with complex legacy situations like that.

The vision is clear about the need for this to change, saying that that tech transformation needs to be driven by leaders at every level. It goes on to say ‘all health and care organisations should ensure board-level understanding of how data and technology drives their services and strategies, and take charge of the digital maturity of their organisations – in the same way that they manage their finances and the quality of their services.’ In an effort to make sure Boards take that language seriously, the government is looking to regulatory and system levers, saying it will ask the Care Quality Commission (CQC) ‘how best to reflect the standards in their inspections of NHS and social care providers, and NHS Improvement and NHS Digital to work together on the use of spend controls to enforce the use of standards when procuring new systems for the NHS, looking at additional controls for spend on systems and services that are below current thresholds.’

On workforce, the report says the aim is that skilled professionals already working in the health and care system are supported to continuously develop, and that structures are in place to make innovation and information exchange easier through empowering and creating headspace for frontline staff. While this is a fine ambition and progress is being made through the likes of the NHS Digital Academy and the HIN’s IM&T Grads into Health Programme, there is still no mention of addressing the unsuitability of Agenda of Change pay scales for this staff group or adjusting training pathways and certain curriculums to increase numbers and the baseline knowledge required to make this vision a reality.

There’s no new money attached to the document and there’s no point underestimating the sheer scale of what we need to achieve. But the proposals it sets out, the focus on leadership and the language used to tell us that this isn’t an IT project, are a strong step in the right direction.

The government is currently consulting on the vision. You can take part here

If you’re working in health and care in south London and would like support with a technology innovation project, contact Denis and the team via hin.technology@nhs.net  

The power of making the invisible, visible

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The power of making the invisible, visible

Tara Donnelly recounts her experience of judging the 2018 HSJ Awards. This article was first published in HSJ on 15 October*

Recently, I spent an inspiring day, in great company, judging the Improving Care with Technology category of the 2018 HSJ Awards.

It was a privilege to hear direct from those involved about how their work was changing care, saving lives and making life simpler for clinical staff. There was a huge range of types of finalist, from small start ups, to GP practices, teams in large hospitals and mental health and ambulance services.

We heard from tremendously passionate and impressive pharmacists, doctors, physiotherapists, psychiatrists, psychologists as well as carers of people living with dementia and mental health issues. If we could have given them all a prize, believe me we would have. We also did a grand tour of the UK covering Manchester, Scotland, Yorkshire, Belfast, London and Surrey.

But for all the many differences, there stood out to me one predominant theme; the power of making what is invisible, visible.

Tools for busy mental health staff so they see the person who needs their help first, while not losing track of those who are due a contact, that prioritise patients most in need of a medicines review when admitted to hospital, using sensors and artificial intelligence to pick up problems in the home, almost before they happen, early alerts obviating the development of complications, tracking of sick children while transferring giving the clinical teams they have desperately missed, helping an anxious woman with a diagnosis of breast cancer know every step of the way forward, turning the process of tertiary referral from a messy, time consuming chore to a slick three minute procedure, saving days of doctor time every week.

These solutions are saving lives, bringing joy back to professionals and building a smarter NHS. They use highly evidenced techniques, such as clear visual management, and behavioural insights, to help busy humans make the best choice they can.

It’s the health service equivalent of the smartphone tools we now couldn’t be without in our personal lives, the maps that get us to new places, the nudges, reminders, quantification of how many steps we’ve done and the encouraging messages.

While undertaking the judging, my Apple Watch seemed to get quite concerned that I wasn’t as active as I usually am by that time of day. For me that’s mildly amusing, to be gently ticked off, for someone with depression this could be an important early indicator.

For the doctors running an e-hub for virtual consultations who were able to keep great GPs working for the NHS even when they had to move abroad, for the carer alerted to his wife’s condition change via a sensor so he could take early action avoiding an emergency admission to hospital, these technologies are game changing.

After a day of meeting these brilliant innovative staff and hearing how these great digital solutions, ranging from simple to those supported by algorithms, machine learning and AI, are already changing lives up and down the country I left with a spring in my step, and a keenness to help spread the brilliance, as all these ideas are well worth pinching (and, of course, they are all captured on the best practice database HSJ Solutions which can be accessed from the main site navigation).

So keep in mind, if you can make the invisible visible to your team, or organisation, you’re likely to help busy NHS staff improve care and love their job just a little bit more.

* https://www.hsj.co.uk/the-hsj-awards/making-the-invisible-visible/7023583.article 

Meet the Innovator

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Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Nicholas Andreou, Co-Founder of Locums Nest, a staff bank management app; connecting healthcare professionals to temporary work.

Pictured above r-l: Dr Nicholas Andreou with fellow Co-Founder of Locums Nest, Ahmed Shahrabanian.

Tell us about your innovation in a sentence

Locums Nest bridges the gap between hospitals and doctors. Making staff vacancies easier and simpler to fill, without the expensive agency middle man.

What was the ‘lightbulb’ moment?

Working as junior doctors in the NHS and experiencing first-hand the frustrations and inefficiencies of filling gaps in the rota.

What three bits of advice would you give budding innovators?

  • Be tenacious- don’t take no for an answer, have thick skin
  • Hire people with purpose who believe in your message
  • Be kind to everyone you meet.

What’s been your toughest obstacle?

Trying to positively change an established institution, with large long-standing incumbents. Challenging the status quo.

What’s been your innovator journey highlight?

With our help, a Trust managed to staff a winter pressures ward without going to an agency. This meant they saved £1.6m in the first 10 months.

Best part of your job now?

Meeting different people in different environments; realising the NHS is enriched with experience and expertise from a vast range of backgrounds.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Open up the barriers to meeting the right people in the system to support innovation.

A typical day for you would include..

There’s no such thing! One day I could be travelling across the country for meetings, in the office for a full day product meeting or spending the day supporting our NHS clients.

Contact us

W: locumsnest.co.uk

T: @locumsnest

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

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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.

Meet the Innovator

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Meet the Innovator

In our latest edition, we spoke to Mike Hurley, creator of ESCAPE-pain – a rehabilitation programme for people with chronic joint pain. Mike is currently a Professor of Rehabilitation Sciences at St George’s University of London & Kingston University as well as Clinical Director for the Musculoskeletal theme at Health Innovation Network.

Tell us about your innovation in a sentence

ESCAPE-pain “does exactly what is says on the tin”, it’s a rehabilitation programme for older people with chronic knee or hip pain (often called osteoarthritis) that helps participants understand why they have pain, what they can do to help themselves cope with it, and guides them through an exercise programme that helps them realise the benefits that can be attained from being more physically active.

What was the ‘lightbulb’ moment?

Not sure it was a lightbulb moment, it was more like one of the low energy lights slowly coming on! But there were two turning points that have led to ESCAPE-pain.

The first was realising the impact of pain on people’s everyday physical and psychosocial function was as important to them as the sensation of pain itself, and that addressing these impacts is as important as minimising pain.

The second was realising the importance muscle plays in causing joint pain and joint damage. We used to think joint pain was caused by damage to joints that resulted in pain, this stopped people doing their regular activities, which caused muscle weakness and makes the joint susceptible to further damage. However, we highlighted muscles are very important for protecting our joints from abnormal movement and suggested impaired muscle function that occurs as we get older may initiate joint damage. Thus, muscle is a cause rather than simply a consequence of joint damage. If that’s true then maintaining well-conditioned muscles through exercise-based rehabilitation programmes, we might prevent or reduce joint pain and damage, and improve people’s quality of life.

Coupling the first light bulb moment – addressing the psychosocial impact of pain – with the second light bulb moment – experience and understanding of the value of exercise – gives us ESCAPE-pain.

What three bits of advice would you give budding innovators?

  1. Prove your innovation works – if people aren’t convinced it is useful to them why would they use it?
  2. Surround yourself with a team of clever, hardworking people who believe in you and the innovation.
  3. Keep your eyes on the prize – wide implementation – and be prepared for lots of ups and downs and hard work convincing the multitude of non-believers that your innovation works.

What’s been your toughest obstacle?

Some of the conversations we had with commissioners would have been laughable if they weren’t so depressing. Financial pressures mean people delivering the programme continually want to reduce the number of sessions, but we know doing that reduces its effectiveness. And even though commissioners were often convinced about the need for the programme and wanted to do the right thing, the requirement to focus on short term benefits meant that anything taking more than a year to show benefits, whether health or cost, was of little interest. Many felt unable to invest in services where the benefits are felt by other parts of the health system, for example taking the pressure off primary care. Often commissioners could hear the madness of what they were saying even as they articulated it, but that didn’t change anything. It was tough and these issues really do slow the spread of innovation.

What’s been your innovator journey highlight?

Getting the unwavering backing of the HIN. In late 2012, I was about to give up on getting ESCAPE-pain adopted clinically, because there were no channels for innovative healthcare interventions to spread across the NHS and beyond. Then I answered an email enquiring about local MSK research in south London from its newly founded Academic Health Science Network, met with the Managing Director and frankly my professional life took a new, exciting and very fulfilling turn for the better.

Best part of your job now?

There are two:

Working with the MSK team is terrific and fun. They work so hard to make it everything work. It’s a privilege to work with such a lovely group of people.

The second great thing is the kick the whole team gets from the positive feedback we get from ESCAPE-pain participants. It never ceases to make me feel very humble and honoured to be able to help people.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I’d start “NICE Innovations”, a body that would screen potential (digital, models of care and service) innovations, pick the most promising, work with innovators and the health systems to find out what works (or not), why (not), and then actively promote and incentivise the health and social care systems to adopt or adapt effective innovations. Its kind of happening at the moment but feels fragmented, so it needs to be brought together to make it more effectual and “given teeth”.

A typical day for you would include..

The great thing about my work is that there is no typical day. I usually wake about six, make a cup of tea and listen to the news on the radio before heading into the new day. That could involve writing papers, grants, presenting at conferences, attending meetings at the HIN or St George’s, lecturing, mentoring students or clinicians, figuring out how to get our MSK work seen and adopted.

Find out more about ESCAPE-pain by visiting the website at www.escape-pain.org or following them on twitter @escape-pain

Contact us

W: chc2dst.com and ieg4.com (main company website).

T: @IEG4

Award-winning ESCAPE-pain programme now online

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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.

Meet the Innovator

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Meet the Innovator

In our latest edition of Meet the Innovator, we caught up with Simon Williams of CHC2DST, a cloud based digital solution for continuing healthcare assessments. Simon is currently the Healthcare Director at IEG4 Limited.

Tell us about your innovation in a sentence

CHC2DST supports the digital transformation of the Continuing Healthcare (CHC) Assessment process by digitising the forms used in the national framework and automating workflow processes to improve patient service, boost productivity and control CHC care package allocation.

What was the ‘lightbulb’ moment?

When we saw that a complex national process relied upon the copying and transmission of reams of paper across multiple stakeholders, it was clear that the process would be impossible to manage effectively and, that, through automation, efficiencies and service quality improvements could be realised.

What three bits of advice would you give budding innovators?

  1. Be sure the challenges you are solving are recognised within the NHS and then be prepared for a long gestation period
  2. Find some NHS body/bodies who become early adopters, with whom you can collaborate to prove the solution within the NHS
  3. Promote your innovation at multiple levels within NHS to gain ‘share of mind’.

What’s been your toughest obstacle?

Despite a direct call to action from Matthew Swindells and Jane Cummings in Summer 2017 to drive up performance against the 28 Day National Standard for decision turnaround, the biggest challenge is engaging with the CCGs who are struggling to run the existing paper-based process. From NHS England Quarterly Situation Reports for CHC, we can see that many London CCGs would benefit from digital transformation of the assessment process. We are keen to talk to the CCGs in South London. An hour invested in watching a webinar would bring the digital transformation benefits to life.

What’s been your innovator journey highlight?

When the alignment of NHS bodies came together effectively under the auspices of the Yorkshire & Humber AHSN to create a focussed, specific event targeted at an audience of CHC practitioners. NHS Strategic Improvement for CHC explained the importance of improving the area to NHS England. Cheshire and Wirral CCGs discussed their CHC transformation journey supported by our technology and through collaborative working with us. The result was a further take up of the innovation and an increased awareness amongst the 20-odd Y&H AHSN CCGs in attendance that an alternative to the status quo was available and proven to work.

Best part of your job now?

When people who are working very hard to manage and execute the existing assessment process see how our solution puts them in control of their workload.  The ‘lightbulbs’ go on during the demo and the feedback we receive is positive . It’s great to know that we are helping to making a contribution to improve ‘our NHS’ in this area.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

For all service leads, make exploring and championing innovation part of the job description on which they are evaluated. Create a National Innovation Channel which holds approved content which can be accessed by NHS professionals to make it easier to find solutions in use in the NHS.

A typical day for you would include..

Reaching out to NHS stakeholders in AHSNs, CCGs, and NHS Executive Management to highlight CHC2DST’s capabilities to them and share results visible from NHS Quarterly Situation Reports for CHC. The data shows that CHC2DST helps to improve productivity by reducing unnecessary work activities, improves decision turnaround timeframes and improves CHC care package allocation.

IEG4 runs regular webinars to demonstrate CHC2DST to NHS Professionals working within the CHC area, without obligation. If it works for them, we help build stakeholder support and the case for change.

Contact us

W: chc2dst.com and ieg4.com (main company website).

T: @IEG4

The NHS 70th Birthday celebrations at Westminster Abbey

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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

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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.

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

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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.

Meet the Innovator

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Meet the Innovator

In the first of our ‘Meet the Innovator’ series, we spoke to Asma Khalil, creator of the innovation ‘HaMpton’ (Home monitoring of hypertension in pregnancy). Asma currently works as a Consultant Obstetrician at St George’s NHS Foundation Trust.

Asma Khalil, creator of the innovation 'HaMpton' (Home monitoring of hypertension in pregnancy).

Tell us about your innovation in a sentence

New care pathway involving the use of an app for monitoring high blood pressure at home, empowering expectant mothers to be involved in their own care.

What was the ‘lightbulb’ moment?

I was having a dinner with my friend who had a heart attack and he showed me at the restaurant that he can monitor his heart rate using an App.

What three bits of advice would you give budding innovators?

  1. Do not give up
  2. Believe in yourself and your innovation
  3. Listen carefully for any feedback and think of it positively.

What’s been your toughest obstacle?

Finances. There are some small sources of funding that can make a big difference, like south London small grants, and I’d encourage people to take advantage of them. But finances are still the biggest challenge.

What’s been your innovator journey highlight?

2017 HSJ Innovation Award

NIA Fellowship

Finalist for the 2017 BMJ Innovation Award.

Best part of your job now?

The best part of any doctor’s job is when he/she helps someone who is suffering or could be going through a difficult/challenging time in their life.

When I come across a pregnant woman who used my innovation and hear her feedback (without knowing that it is me behind it).  I realise that I made a difference to this women’s life and her family. It makes me realise that my efforts are worthwhile.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would ensure that the NHS Hospitals have innovations at the Heart of their practice and potentially link innovation with financial incentives. I would also ensure that innovations are integral part of the hospital review/rating.

A typical day for you would include..

Looking after my patients and trying my best to provide the safest and the best possible care that they deserve. It is very rewarding to be proud of what you do.

Find out more about HaMpton here.

Innovation and Technology Payment (ITP): One year on

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Innovation and Technology Payment (ITP): One year on

Written by Tara Donnelly, Chief Executive at Health Innovation Network

The latest products available at low or no cost through the NHS Innovation and Technology Payment (ITP) have been announced by NHS England, and we were pleased to see some fantastic innovations that reduce the need for intervention, improve care, reduce infection rates and length of stay, and NHS resources.

Above all, we were struck by the potential for the innovations on this tariff to improve patient safety. Here at the Health Innovation Network, we want to do all we can to help NHS organisations in south London take advantage of them.

Nationally the tariff was a real success in its first year, with myCOPD leading the way. There are now more than 35,000 people actively using this great digital tool to improve their self-management and this number is increasing by 5,000 – 8,000 a month. In total almost 100,000 licences have been sold 60% through the tariff and the rest by CCGs and individual patients keen to self manage. You can read more reflections on the first year of the tariff in my related blog here.

It’s great to see the range of products available this coming year. But as an AHSN, we know that just because a product is free or low-cost that doesn’t mean it’s easy to implement, or that the internal resources are available to support implementation. We want to support Trusts as much as we can.

The support we can offer includes help with internal business cases, advice on information governance, connecting trusts to others who have used the products, advice on how to reclaim funds and use the tariff, and wider advice as needed. If you’re an NHS organisation in south London and would like to access HIN support, please do contact us at kate.covill@nhs.net and ian.knighton@nhs.net or on 0207 188 9805.

The products are:

Available completely free for 2018/19:

  • Endocuff Vision – a small device that goes onto the end of a colonoscope and improves the quality of colorectal examination.
  • SecurAcath – a device to secure lines that reduces the infection risk for patients with a peripherally inserted central catheter (PICC line). This type of catheter is normally used in people needing intravenous access for several weeks or months in both inpatient and outpatient settings. The use of this device makes cleaning the site much easier and reduces complications. NICE estimates it could improve care for up to 120,000 people each year.

Available free to eligible sites that do high volumes:

  • HeartFlow – advanced image analysis software that creates a 3D model of the coronary arteries and analyses the impact that blockages have on blood flow to rapidly diagnose patients with suspected coronary artery disease. The use of the device can avoid the need for invasive investigations such as coronary angiography, usually carried out under local anaesthetic, where a catheter is passed through the blood vessels to the heart to release a dye before X-rays are taken. NICE estimates it could improve care for up to 35,000 people each year.

Available at 30% discount to eligible sites (as eligible Trusts can reclaim the difference between this product and regular sutures):

  • Plus Sutures – a new type of surgical suture coated with Triclosan, that reduces the rate of surgical site infection. 32% of hospital acquired infections are surgical site infections (SSI), most of which can be prevented. Trusts with SSI rates of above 4% in certain clinical specialties are eligible.

In an effort to tackle the problem of missed hospital appointments NHS England is also supporting the use of DrDoctor, a digital tool which enables patients view, change and schedule appointments on their smartphone, in several demonstrator sites. Almost eight million hospital appointments were missed in 2016/17, according to the latest figures. With each hospital outpatient appointment costing the NHS c£120, it means almost £1 billion worth of appointments were missed, equivalent to completing 257,000 hip replacements or 990,000 cataract operations.

We’d also like to urge readers not to forget that the original products that came into effect in April 2017 remain available at either no cost or through Trusts being able to claim a tariff, until April 2019. They are:

  • Guided episiotomy EPISCISSORS-60guided mediolateral scissors to minimise the risk of obstetric injury, these are now being used in most south London maternity units, including Croydon University Hospital, Epsom and St Helier at both hospital sites, King’s College Hospital, on both the King’s and Princess Royal University Hospital sites and St George’s University Hospital.
  • Safe arterial connector Non-injectable arterial connector (NIC)arterial connecting systems preventing the accidental administration of medicationinto an artery, these are being used successfully at Kingston Hospital.
  • VAP prevention PneuXpneumonia prevention systems which are designed to stop ventilator-associated pneumonia.
  • Web based COPD rehab myCOPDweb based application for the self-management of chronic obstructive pulmonary disease. The scheme means that CCGs and Trusts can get the product free for their patients with severe/very severe COPD. It is proving very popular with patients with over 20,000 people having completed the online pulmonary rehabilitation programme to stay well for longer, and usage is currently being explored within SW London.
  • Day case prostate surgery UroLiftprostatic urethral lift systems to treat lower urinary tract symptoms of benign prostatic hyperplasia as a day case.

Another great safety innovation

As part of our role in promoting innovations that improve patient safety we are also supporting WireSafe which avoids the never event of a guidewire being inadvertently left in the patient. We know that sadly this never event has occurred in the past year in south London trusts. This ingenious and award-winning device, innovated by the doctor innovator of the NIC, makes it impossible to leave the guidewire in accidently, as you need to use it to open the closing pack. It is not free but is a low cost solution costing the average trust around £3k per year (or £5k for a very large trust).

As an AHSN Network we’ve also built an informative web page devoted to the Innovation and Technology Payment that you and colleagues can view here. Final guidance is awaited from NHS England but will be posted there once available. Free demos and training sessions are also being made available to enable staff to become familiar with and test the devices.

Contact us for support via kate.covill@nhs.net or on 0207 188 9805.

And read further reflections on the tariff here.

 

 

 

Digital innovation at scale: the story of MyCOPD and the NHS tariff

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Digital innovation at scale: the story of MyCOPD and the NHS tariff

Written by Tara Donnelly, Chief Executive at Health Innovation Network

MyCOPD is the first patient-facing digital product to be awarded funding under the innovation and technology tariff. I’ve a great interest in how we support people with long term conditions to support themselves to best effect, and think it is fantastic that we have now got a digital solution at such scale within this country.

The COPD challenge

As you may know Chronic Obstructive Pulmonary Disease (COPD) is the umbrella term for a range of relatively common progressive lung diseases including emphysema, chronic bronchitis, and refractory asthma. Progressive means it sadly inevitably gets worse over time. Features are “exacerbations” –  when breathing becomes exceptionally difficult and specialist assistance can be needed.

In fact, respiratory disease including the COPD group is the second most common reason for emergency hospital admission in this country, and it is highly seasonal. And we are – as you’ll be well aware – coming out of a particularly brutal winter with the worst performance in terms of access since records began in 2004.

It is also much more common in people who are vulnerable and are deprived / in lower social economic groups, with 90% sufferers having smoked and the vast majority having other comorbidities.

Although COPD is a chronic lifelong and worsening condition, it is highly amenable and responsive to self management. If people with COPD do all of the following they maximise their likelihood of living well for longer with the disease:

  • Stop smoking if still smoking
  • Undertake a Pulmonary Rehabilitation programme which is an exercise and education programme that is evidenced to make a significant difference
  • Keep doing the exercises after the programme
  • Achieve optimal inhaler technique
  • Track symptom scores regularly
  • Monitor the weather and environmental issues
  • Be able to cope well when breathless without panicking – learning and practicing mindfulness techniques can help.

It’s a long list. Challenging even for those with every advantage.

A digital approach

An entrepreneurial British Respiratory physician has developed a digital platform that covers all aspects. It uses the behavioural insights knowledge combined with great technology to make this a manageable task. The innovator, Simon Bourne, got early support from his local AHSN Wessex, also the Health Foundation, and won an SBRI grant (an R&D grant administered by the AHSN Network for promising ideas) and the product is now in use nationwide.

Examples of its amazing impact include:

  • Around 90% of people with inhalers do not have optimal technique meaning that these important drugs are unable to do their job. The tool has been demonstrated to achieve 98% optimal technique through patients watching and copying videos of how to use the particular inhaler that they have.
  • Over 20,000 patients have now completed the online Pulmonary Rehabilitation course. This is a huge number and we could anticipate that this year it will exceed those we manage to get on a Face to Face programme which is typically 15,000 – 20,000 across the NHS.

The Royal College of Physicians recently published an Audit of Pulmonary Rehab courses and demonstrated that most people have to wait over 90 days to get on a programme (60%). A very high proportion don’t attend at all, although it is a highly evidence based intervention. So complementing face-to-face classes with this online availability can only be a good thing.

In total 100,000 licences have been purchased. Part of the reason for this rapid growth is that it’s a great product but this is also a rare story of different parts of the NHS aligning with each other brilliantly and to great effect. After that early support Simon Bourne was successful at getting on the NHS Innovation Accelerator, and then made the NHS England tariff. It was one of the first products to join the NHS Apps Library, and if, as a patient, you look up COPD on NHS Choices it tells you all about it there.

The end result of all this? Tangible benefits for patients. Like Paul, a COPD patient who tells his story in this terrific short film.

Are we in the business of healing?

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Are we in the business of healing?

Written by Catherine Dale, Programme Director – Patient Safety and Patient Experience at Health Innovation Network

I was recently lucky enough to present on co-designing healthcare with patients at the Beryl Institute’s US-wide conference in Chicago. I was reunited with Tiffany Christensen a Vice President at Beryl.

While at this conference on Patient Experience I found myself talking to plenty of people about the relationship between ‘patient safety’ and ‘patient experience’. It seems to me and to others that there is an artificial differentiation between these elements of healthcare and that, to most people not working in healthcare, they are inextricably linked. In order for healthcare to be a good experience, it has to be and feel safe.

One of the keynote speakers was Lee Woodruff whose journalist husband Bob was significantly injured in a roadside bomb in Iraq. In her description of the recovery of Bob and the whole family, Lee told the audience that we were “in the business of healing”. There was something about the way she put this that made me realise she meant me too, not just my clinical colleagues. It reminded me of what I learned working in PALS and regularly dealing with the concerns of patients and their loved ones.

When someone gets a letter with the wrong information on it; when the clinic staff cannot access their medical records; when the waiting room is cluttered, messy and hectic in healthcare this is not just annoying – it is frightening. People feel: “if these people are making mistakes with these things how will they get my surgery, treatment, or care for my mother right?”

As a non-clinical person working in the NHS, I had thought that my impact on people’s health was only ever indirect, but this keynote made me think about how all of our work to improve healthcare can contribute to people’s healing.

Find out about the projects that we’ve been working on in the Patient Safety team here

L to R: Allison Chrestensen, Jonathan Bullock, Catherine Dale and Tiffany Christensen (fellow presenters on co-design).

 

NHS personal health budgets – an opportunity for digital innovation?

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NHS personal health budgets – an opportunity for digital innovation?

Written by Lesley Soden, Head of Innovation at Health Innovation Network

Just weeks ago it was announced that personal health budgets will be expanded for people with complex health needs. The Department of Health says that this will “put power back in the hands of patients”. Indeed, the proposed roll out of personal health budgets could achieve genuine patient power and drive bottom up demand for innovation. By funding services such as online health support and remote monitoring for patients in areas where these aren’t currently commissioned, digitalised innovations that have been shown to be clinically effective and provide cost savings could become more readily used and available across the country.

Consider the range of potential scenarios:

  • Harry has diabetes and respiratory problems. He wants to use a self-care management app to better manage his diabetes; using his personal health budget he purchases the app. Could personal health budgets help to drive innovation from the bottom up by empowering patients like Harry to have greater control over own healthcare through innovation and technology?

 

  • Priya has acute asthma and attends A&E frequently suffering from asthma attacks, she would like to manage her medication better and wants to use Aerobit, an online asthma management platform that transforms inhalers into smart devices using sensor-based technology that gives users the ability to connect them to a mobile app that reminds them to take their medication. In her local area, this app is not available through the NHS but she is eligible for personal health budgets and uses this funding to purchase Aerobit. As a result, she has had less A&E and GP attendances.

 

  • Mary is in her 80s who lives by herself in her own home, she has had several falls and complex health conditions but would like to keep her independence by staying at home. Her family are concerned that they can’t physically check on her every day. Mary, in partnership with her GP, uses her personal health budget to fund a discreet activity monitoring and alert system using sensors positioned in the home to monitor movement and temperature. Mary’s daughter can monitor her movement and keep a gentle eye on her by being notified via text or email if something out of the ordinary happens to Mary. This ultimately saves health and social care funding by keeping Mary independent for longer rather than requiring residential care.

 

  • Ahmed requires continuous physiotherapy for his rheumatic condition but struggles to travel to his physio appointments and often misses his appointments. His physiotherapist tells him about Mira Rehab which uses gamified online physio exercises but could not be paid through his local NHS physiotherapy service. Ahmed uses his personal health budget to pay for this online solution and this means his physio can monitor his use of Mira Rehab and his progress. This saves the physio time and improves Ahmed’s clinical outcomes.

The opportunity to fund assistive technologies as part of an integrated care and support package is a further example of the potential. Adults with learning disabilities could choose to buy ‘My Health Guide’, an app to help them take an active role in their health care. The app lets them record important items (text/audio/video/image) in easy-to-make ‘boxes’.

In situations like these and no doubt many others, personal health budgets could help to drive the spread and adoption of innovation from the bottom up, by using patient power to drive those solutions that meet their individual needs.

For our commissioners within the Health Innovation Network, the expansion of personal health budgets could help groups of your patients that would benefit from the many digital services that could help with self-management, remote monitoring or most importantly improved quality of life for patients.

For providers, you may discover innovative health technology to help your patients but know that your service would not fund the technology at present. If so, these personal health budgets are a possible avenue of funding.

How does it work?

Under the Department of Health proposals, the money will be paid directly to eligible patients to pay for their own healthcare for both goods and services, if their support plan is jointly agreed by their local Clinical Commissioning Group (CCGs).

In the past, personal health budgets have been criticised for wasting NHS money on unconventional treatments and ‘luxury’ items. However, the budget and care package must be agreed by CCGs with a clear healthcare need being met. The Department of Health’s evaluation in 2012 found that the costs under personal health budgets were overall cost neutral with savings in some areas. There could also be wider system benefits:

  • Reduced A&E attendances;
  • Reduced unplanned hospital admissions;
  • Reduced social care costs.

It is worth noting that The Department of Health evaluation also found better outcome indicators where pilot sites had:

  • Explicitly informed their patients about the budget amount;
  • provided a degree of flexibility as to what services / goods could be purchased;
  • Given greater choice as to how the budget could be managed.

Further information can be found here.

 

 

 

 

 

 

Meet south London’s new Digital Pioneers

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Meet south London’s new Digital Pioneers

DigitalHealth.London has announced the launch of its prestigious 12-month Digital Pioneers Fellowship. It will support 23 ‘transformers’ (healthcare professionals from a range of disciplines), chosen from across London, in designing and leading transformation projects which are underpinned by digital innovation. Beginning in May 2018, the programme will help the chosen ‘transformers’ to accelerate their knowledge and capability, including supporting them in influencing, problem solving and business case development.

Nine of the 23 are from south London:

  • Rafiah Badat (Speech and Language Therapist and Clinical Research Fellow, St George’s University Hospitals NHS Foundation Trust) is investigating the feasibility of a novel digital intervention for caseload children.
  • Rebecca Blackburn (Commissioner, East Merton Transformation and Partnership Manager, NHS South West London Alliance) is working on a project which will double appointment offerings in Merton, by creating two hubs within GP Practices.
  • Dr Thomas Coats (Haematology Registrar and Clinical Research Fellow, King’s College Hospital NHS Foundation Trust) has built a tool which digitises text-rich clinical data from multiple sources, will calculate complex prognostic scores. give diagnostic prompts and highlight significant data.
  • Faye Edwards (National Programme Manager, AHSN Network) is leading a project advising AHSNs on an agreed approach regarding information governance and data collection, in order to demonstrate the impact of digital mobile ECG devices distributed to NHS providers via the AHSNs.
  • Jack Grodon (Senior Specialist Musculoskeletal Physiotherapist/Fracture Clinic Team Lead, Guy’s and St Thomas’ NHS Foundation Trust) recently undertook a three-month project exploring the used of the app Physitrack to record patient exercise adherence, in addition to patient and staff satisfaction. The trial was successful, and he is hoping to implement Physitrack across his department.
  • Dr Husain Shabeeb (Consultant Cardiologist and Cardiac Electrophysiologist, Croydon Health Services NHS Trust) is screening patients for atrial fibrillation using Alivecor Kardia in the community.
  • Haris Shuaib (Magnetic Resonance Physicist, Guy’s and St Thomas’ NHS Foundation Trust) is developing an AI-driven medical imaging quality assurance web application. His ambition is to host it on a cloud-hosting service as a community resources for radiology departments in the NHS, allowing them to contribute test images for performing quality analysis on their clinical imaging equipment.
  • Dr James Teo (Consultant Neurologist, King’s College Hospital NHS Foundation Trust) is increasing patient safety by developing dashboards for operational management of infections, such as influenza and norovirus outbreaks.

Digital transformations are already vital within the public healthcare sector. The need for these skills is only set to increase, as our population ages and increases, with complex and diverse health needs, and as new, exciting (but sometimes difficult to spread) technologies become available and affordable.

Here’s why we love the project:

It will bring like-minded Digital Transformation Pioneers together

It takes a lot of patient, trouble-shooting and solving, training, and unfortunately, meetings, to make even small-scale changes in the NHS. In their January 2018 report, ‘Adoption and spread of innovation in the NHS‘, King’s Fund described the decision to introduce just one innovation in the NHS as creating a ‘domino effect’ – becoming, “in short, a lengthy period of iterative testing and refinement”. The eight case studies that the report draws upon are proof of the arduous nature of implementing change. Implementing new digital solutions means developing new methods, building new habits, breaking from the status quo, and – as is very often needed with any innovation – changing stubborn mind-sets. Throw in that this is within a complex system and an organisation which is 70 years old this year – and it’s easy to see that drive and passion is needed.

Programmes like Digital Transformation Pioneers put all that drive and passion into a room together – with experts who can create new, exciting possibilities. It provides a great support network for those who are attempting their digital transformation project.

It encourages wider collaboration

When organisations fail to collaborate and to communicate with each other on a regular basis, it leaves ample room for wastage and the reinventing of the wheel … over, and over, and over again.

Collaboration across London creates a better environment for all aspects of achieving fantastic patient care. The sharing of ideas – even ones as simple as Croydon University Hospital’s fall initiative (asking patients which side of the bed they prefer to get out of, in order to dramatically reduce falls) or the roll-out of new technologies, for example, via the new ITP – is a catalyst for positive change. We know that collaborative cultures create better conditions for research, learning and patient care. Schemes like the Digital Pioneer Fellowship encourage wider collaboration beyond the Fellows themselves.

Helping people to get things done

Anyone who has tried to attempt to have a hobby on top of their regular day-job can tell you that it’s a challenge. Imagine trying to instigate  a large-scale, transformation project which encourages use of new digital technologies, innovations and processes whilst also coping with the ever-challenging budget changes, population increases, and the wide range of additional issues that can occur in a busy health and care environment.

Through support and skills training, the Digital Pioneer Fellowship will quite simple provide the support these ‘Transformers’ to get things done. If they hit a road-block, the Fellowship team will be there to help them through it. If time is against them, having the protected time to take part in the Fellowship modules could make a huge difference.

Resilient, skilled digital leaders need all of the support we can give them. We wish them the best of luck and hope that they enjoy the programme.

If you want to find out more about the Digitial Pioneers Fellowship, visit DigitalHealth.London’s website.

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

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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.”

Speeding up the best in mental health together

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Speeding up the best in mental health together

Speeding up the best in mental health together with the four SIM London pathfinder NHS Trusts, South West London and St. George’s Mental Health trust, South London and Maudsley, Oxleas, Camden and Islington NHS Foundation Trust alongside the Metropolitan Police is a pioneering mental health project for the Health Innovation Network.

SIM London is a new way of working with mental health service users who experience a high number of mental health crisis events. SIM brings mental health professionals and police officers together into joint mentoring teams. The police officer and the mental health professional work together to provide intensive support service users to reduce high frequency and high-risk crisis behaviours.

Central to SIM is the Care and Response Plan completed by the service user, SIM Police officer and the SIM Mental Health professional.

‘SIM London is the start of a revolution for the co-production of 1st person singular care plans.’
Dr Geraldine Strathdee, Clinical Director, Health Innovation Network Implementation team

SIM developed by Paul Jennings (recipient of multiple awards) on the Isle of Wight, has gone from strength to strength in terms of the lives improved, fewer 999 calls, fewer Emergency Department attendances and fewer hospital admissions.

SIM is going national, the benefits of the involvement of the HIN in leading the London pathfinder implementation, the new sites will we be able to measure. We will share resources, highlight obstacles and solutions and capture and spread the dedication, commitment and enthusiasm we are encountering to implement the programme.

SIM London pathfinder sites are due to go live April 2018

Learn more about SIM and the High Intensity Network here.

To speak to someone about the project, please contact Aileen Jackson, Mental Health lead on aileen.jackson@nhs.net or Josh Brewster, Project Manager on josh.brewster@nhs.net

A manifesto for spread

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A manifesto for spread

Innovation – the word is ripe with the prospect of a better future. However for me, the most exciting part of innovation in healthcare is not the invention or discovery element, it is that crucial part of getting the idea to many hundreds or even millions of citizens to benefit their health says Health Innovation Network Chief Executive Tara Donnelly.

While we have a great reputation for discovery in healthcare in the UK, which long predates the existence of the NHS, my recent chapter in Leading Reliable Healthcare argues that there is much more we could do to achieve spread, and that a focus on this would be an important way to achieve legacy from the abundance of entrepreneurial and creative talent that exists in this country in life sciences, digital health, clinical research and process improvements.

This blog expands on this topic further, bringing in thoughts both from the chapter and elsewhere to outline ideas on a manifesto for spread that I think we need to find a way to put in place, as a matter of some urgency.

It is important to acknowledge that there is a variety in the types of innovations; from new devices to digital tools, concepts and processes can be the most significant in changing care design. The chapter starts with a working definition:

“When we talk about “innovation” in the NHS, what do we mean? In the author’s opinion, the most useful is “an idea, service or product, new to the NHS or applied in a way that is new to the NHS, which significantly improves the quality of health and care wherever it is applied” (Taken from Innovation, Health and Wealth, Sir Ian Curruthers, Department of Health 2011).

Spend on spread

Spread has a cost, it is not a free good as clinicians and organisations need some support in adopting any new intervention or product within their practice. In innovative companies they see that communicating and supporting spread really matters and invest in spread related activities. Analysis completed by the AHSN Network indicates that there is a consistent ratio that the most admired companies seem to use.

Regardless of whether you are Apple or GE or a pharma company, the spend on spread activities including sales and marketing is typically over 2.5 times your investment in R&D, so 250-300%. In the NHS, we currently spend less than 1% of our £1.2bn R&D annual spend, on actively spreading it, and this ratio simply looks wrong. It was cited recently in Falling short: Why the NHS is still struggling to make the most of new innovations, a Nuffield Trust publication.

Within the chapter, I interview a range of people to hear their perspectives, particularly on spread and diffusion. Sir Bruce Keogh observes that “the spread can be more important than the innovation in terms of making a difference to people’s lives”. He offers that perhaps the most important single technical innovation to impact the health service is the microscope, invented by the Dutchman Antonie van Leeuwenhoek (“the father of microbiology”) in 1683. But what made a huge difference to adoption was that the president of the Royal Society, Robert Hook, wrote a beautifully illustrated book in English about it called Micrographia, understanding the significance this breakthrough could have in understanding disease. His book became “the first scientific best-seller” and “captured the public’s imagination in a radically new way; Samuel Pepys called it ‘the most ingenious book that I ever read in my life”.

 

Valuing innovation as much as invention

I’m currently reading James Barlow’s comprehensive assessment of “Managing Innovation in Healthcare” where he puts the distinction between invention and innovation beautifully: “an invention is merely a nascent innovation and it may be many years before it makes it to innovation status” p43. He also quotes Schon’s succinct definition: “Innovation is ‘the process of bringing inventions into use’” p25, and I believe we forget this at our peril. James is Professor of Technology and Innovation (Healthcare) at Imperial College Business School and I’d heartily recommend his new book if you’d like to get into this topic in greater depth, details are referenced at the end of this blog.

Elsewhere – in an article entitled “We’re serious about innovation – now let’s get serious about spread” – I state “spread – meaning at scale adoption of an innovation – is the way we will move from unwarranted variation in the NHS; from pockets of poor performance contrasting with beacons of excellence, often in a single geography, to improvements at scale to touch many more lives”. Within the piece I suggested if we were really serious about it we might celebrate and reward spread activities more vigorously, for example, introducing a Nobel Prize for spread rather than only congratulating discovery. Intelligent alignment is also critically important, so that different parts of the NHS and social care systems are set up and incentivised to adopt, including but not limited to financial rewards and methods of tracking data on progress. A transformation fund for hard pressed NHS institutions keen on spread would make a real difference in the current climate. It is welcome that the Office for Life Sciences has announced it will be setting one up, particularly to help parts of the NHS adopt innovations, and interesting that this is coming from a separate part of government than health, as a result of the Accelerated Access Review.

Importantly, that’s not to give the impression the NHS wouldn’t benefit hugely from additional resource as has been articulated clearly by the CEO of the NHS, Simon Stevens. In my view, this is essential, as we face the combined demands of an ageing population and increasing chronic disease burden. But were the NHS to receive an appropriately generous financial settlement, I would like to see proper funding of spread activities, so that we can get the best well-evidenced solutions – that help patients, clinicians and often make better use of resources in the longer term – to as many people, as quickly as possible.

It is interesting to see that across the channel the French government has established 14 regional tech transfer hubs with a budget of one billion euros to draw up, including investing in the strongest digital ideas, many of them in the health sphere. Eight years ago, it also introduced a system to make certain innovations available entirely free of charge to its healthcare system, as referenced by Barlow: “Since 2010, France has operated a system for conditionally covering the full cost of selected innovative devices, services or interventions which appear promising but for which there is insufficient data on the clinical benefit.” (p218)

Reaching many patients as a priority is a sentiment agreed with strongly by all of the interviewees, Tony Young emphasises the unique opportunity we have within the NHS: “The NHS is the single largest unified healthcare system in the history of the human race. This gives us some opportunities that no one else has had the chance to do— and one of them is to innovate at scale. It’s complex and divided— but that’s what gives us the opportunity to say well let’s have a go at it. If you really want to do this at scale, then we can do this in the NHS. Recently, 103 of the brightest clinicians you could ever want to meet were selected to be a part of the Clinical Entrepreneur programme and came together for their first weekend recently. Never before has there been a cohort at such a scale of clinical entrepreneurs who’ve worked together on the planet, ever”.

Skilling up for ‘scale ups’, not just ‘start ups’

Helen Bevan draws a distinction between the skills required for start-up v scale up: “What I think is one of the biggest problems that I see now, is the issue between start-up and scale-up. We have, in my mind, a system that is primarily designed for start-up— and what we keep doing is to put in charge the kind of people that love doing early-stage invention and early innovation. They’re your pioneers, your early adopters. What we keep doing is going over and over the cycle, of start-up again to attempt to spread and scale. But we’ve only got so far. We need a lot a lot of additional thinking … and need to find the people who are good at scale-up, and put them in charge of this activity, not the people who are good at start-up”. Her addition to David Albury’s work at the Innovation Unit, in creating a “checklist for scale” is incorporated as a figure in the book.

Research and data

James Barlow highlights that spread in healthcare has been under-researched to date: “situations involving collective or organisational decisions have been relatively neglected by researchers. Finally, until relatively recently, there was little research on the adoption and diffusion of innovation in the public or non-profit sectors.” P161. The exceptions to this include pioneers such as Trish Greenhalgh of Oxford and Ewan Ferlie of King’s as well as Ritan Atun at Harvard and those in the Imperial group.

Ian Dodge adds “We’re also systemically atrocious at using data systematically. For instance, looking at population outcomes of what’s happening at the end of a service line change, getting rapid feedback, iterating. Some of the initial bit of improvement science is so vital to getting stuff off the ground, but then typically we see really poor engineering discipline, factory style, around how do you actually convert this at scale”.

Clinical innovators and spread

In the chapter, some interesting examples of where spread activity is beginning to work in the English NHS are referenced, calling out the NHS Innovation Accelerator which seeks to accelerate uptake of high impact innovations and provides real time practical insights on spread to inform national strategy. Given publishing deadlines, I wrote the chapter more than a year ago, and it is both fascinating and encouraging to see how the NHS Innovation Accelerator – a programme supported by all 15 Academic Health Science Networks (AHSNs) and NHS England, coordinated by UCL Partners – has gone from strength to strength in this time in terms of tangible results of achieving scale.

It is also striking that many of the innovations on the Accelerator have been developed by innovative NHS clinicians who spotted opportunities to improve care – making it safer and more effective. For instance, Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD, an online platform that helps patients self-manage with dramatic results, Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented Episcissor-60, scissors specifically designed to make childbirth safer, Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with the NIC a device that prevents tragic accidents with blood lines, Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care.

All the products referenced are now eligible for NHS England’s Innovation and Technology Tariff which began in April 2017 and enables NHS Trusts and CCGs in England to use these innovations either for free or to claim a charge per use. It is an important scheme and would be very valuable to see it expanded in future years.

Taking the myCOPD example, it is really interesting to see the impact of this support in terms of scale-up. Chronic Obstructive Pulmonary Disorder or COPD is a progressive disease, meaning it gets steadily worse over time, and people living with it find that exacerbations increase and they are admitted to hospital more and more frequently. In fact, COPD is the second most common reason for hospital admissions in the country, causing a great deal of distress to people and families and costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% of people with COPD are unable to take their medication correctly. The myCOPD on line platform has been found to correct 98% of inhaler errors without any other clinical intervention.

If you have COPD, there is a great deal you can do to help yourself avoid exacerbations, but it can be hard to do these things consistently, alone. The evidence demonstrates that those who manage to quit smoking, do regular exercises known as pulmonary rehab, have optimal inhaler technique and are able to resist the understandable urge to panic when breathless, do much better than those who do not. Simon’s support system for people with COPD has educational, self-management, symptom reporting, mindfulness and pulmonary rehabilitation aspects, all delivered online. Typical quotes from grateful patients include “Since I started using myCOPD, I have lost weight, my depression has lifted, and I see my GP just once a year (compared with twice-monthly visits previously). I have not needed hospital treatment for 18 months”, “last year, before using myCOPD, I had 12 exacerbations. This year I have had just two.”

The programme is now being used by over 55,000 people with severe COPD in England, which is roughly one-quarter of that population, with more CCGs and respiratory teams coming on board each week. I think it is fantastic that people living with this chronic condition that responds well to regular exercise and relatively simple interventions, now have a tool in their pocket that can help them better manage it, and it is very appropriate that this is NHS funded. What’s more, this expansion has been pacy and achieved in around 18months.

I discuss this further in a blog entitled “Finally, a tariff for digital innovations” – you can perhaps hear the note of impatience in the title – and state that while it is a much needed start, we need to go further faster and expand the scheme to accelerate the adoption of great tools like these that are essential for patients with long term conditions seeking to stay as well as possible. Funding six devices/tool types in its first year, only one of which is digital, the programme has started very modestly compared to the scale of investment of our counterparts in France for example.

 

Patient-led innovation

There have also been some great examples of patient-led innovations succeeding recently. The three London AHSNs founded Digital Health.London with MedCIty in 2016 and established an accelerator focused on spreading the best digital health solutions across the capital. On our founding cohort was Michael Seres, an incredibly entrepreneurial patient who had designed a tool to link stoma bags with smartphones via Bluetooth, to increase the dignity of the user and ensure alerts were provided when bags were reaching capacity, who is now CEO of 11 Health. The ostim-i had achieved sales in other countries but not the UK when Michael joined our programme and we were delighted that the first NHS contract has been achieved in west London. It is also available to patients to buy direct, as is the myCOPD tool. The ostim-i has been a beneficiary – as was myCOPD – of the development fund we have to support interesting UK concepts, the Small Business Research Initiative or SBRI fund – subject of my most recent blog “Why SBRI matters”.

But there are many more ideas out there, developed by patients, parents of patients and carers alongside entrepreneurs and clinicians and we need to radically increase the capacity to give them the support they need. I am encouraged that the Office for Life Sciences, part of the Department for Business, Energy and Industrial Strategy, is investing in creating Innovation Exchanges, hosted by AHSNs to increase the support to local innovators, with funding due early in this new year and committed to for three years. The need to provide stronger support to UK companies and ideas is felt all the more intensely given Brexit.

I conclude the chapter “While there is plenty to do, it feels as though there is reason for optimism that the entrepreneurial zeal at the heart of our health system will continue to burn brightly and that more recent learning and focus on collaboration and scale will help us to ensure that the best ideas in health and care are disseminated more widely across the NHS.”

A system for spread

A year on, I remain optimistic; we’ve had commitments made as a result of the Accelerated Access Review, it has been announced that AHSNs will be relicensed to operate as the innovation arm of the NHS and we have strong spread and progress particularly through our major collaborations – the NHS Innovation Accelerator and in the capital through Digital Health.London, NHS England has made an important start in a tariff for innovation.

However, my view is that we need many more including our regulators, politicians, NHS staff, patients and their representatives to join this movement if we are to achieve the change we need to take place, and be much bolder about our commitment to spread. To see all NHS organisations join the best in  moving beyond “not invented here” to truly rewarding adoption and diffusion activities and acknowledging that change needs support to be durable, and happens at the speed of trust.

We need our inspection regimes and regulators to really get this and understand the behavioural insights we now know about achieving sustainable diffusion and change, and leaders supporting staff through these changes not resorting to an over simplistic and non-evidence based paradigm that telling will result in adherence.

If the spread movement was to achieve this level of support across the NHS, we would then be able to enact all aspects of the manifesto for spread and with support for these principles, and the action required, including investment in supporting NHS organisations scale up innovation, and I believe it could be possible to make significant change happen quickly.

Acknowledgments

I am very grateful to all those people I’ve discussed this topic with and particularly Suzie Bailey, Richard Barker, Helen Bevan, Ian Dodge, Sir Bruce Keogh, Becky Malby and Tony Young for the generous support they have lent to the chapter and to Stephanie Kovala for all her assistance in compiling it.

Suzie Bailey is Director of Leadership and Quality Improvement at NHS Improvement, Richard Barker is Chair of Health Innovation Network and CEO New Medicine Partners, Helen Bevan is Chief Transformation Officer, Horizons Group, NHS England, Ian Dodge is National Director, Strategy and Innovation, NHS England, Sir Bruce Keogh was Medical Director, NHS England to Dec 17, Becky Malby is Professor Health Systems Innovation at London South Bank University and Tony Young is National Clinical Lead for Innovation at NHS England as well as Consultant Urological Surgeon within the NHS. Stephanie Kovala was my Business Manager and is now Project Manager within the Strategy Team at NHS England.

Author: Tara Donnelly is CEO of Health Innovation Network, the academic health science network for south London. Health Innovation Network exists to speed up the best in health and care, together with its members in south London, and is part of the AHSN Network and Digital Health.London.

Follow Tara on Twitter at @tara_donnelly1­­­­

References:

AHSN Network: ahsnnetwork.com

Al Knawy, B. Editor, Leading Reliable Healthcare, Chapter 12 – Health System Innovation and Reform, Productivity Press CRC, Dec 2017

Barlow, J. Managing Innovation In Healthcare, New Jersey: World Scientific, 2017

Castle-Clarke S, Edwards N, Buckingham H. Falling short: Why the NHS is still struggling to make the most of new innovations. Nuffield Trust Briefing Dec 2017

Curruthers, I and Department of Health, NHS Improvement & Efficiency Directorate, Innovation and Service Improvement, 2011. Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS

Digital Health.London: digitalhealth.london

Donnelly, T. Sept 2016. We’re serious about innovation— now let’s get serious about spread. Health Service Journal

Donnelly, T. Nov 2017. Finally, a tariff for digital innovations. Healthcare Digital

Donnelly, T. Dec 2017. Why SBRI matters

Health Innovation Network: healthinnovationnetwork.com

Creating waves across the Pond

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Creating waves across the Pond

Written by Catherine Dale, Programme Director – Patient Safety and Experience.

My friend gave the opening keynote speech at this month’s Institute for Healthcare Improvement (IHI) National Forum in Orlando, Florida. I was moved to tears in the audience watching her.

I got to know Tiffany Christensen this April when we both taught on the IHI’s inaugural Co-Design college in Boston, Massachusetts. I was teaching the Experience-Based Co-Design approach. Tiffany shared her insights both as a life-long cystic fibrosis patient and as a professional patient advocate with a working career in healthcare improvement.

Tiffany spoke of contending with a double lung transplant which was unsuccessful, meaning she was facing imminent death. When offered a second double lung transplant, Tiffany was initially completely thrown as she had accepted the fact that she was going to die. Being offered another chance of life was an enormous challenge to her, but in coming through that experience Tiffany chose to dedicate her working life to enhancing healthcare for others. She joined a Patient and Family Advisory Council – a core part of healthcare structure in the USA – and trained in improvement methods.

When we met at the Co-Design college, she was struck by the way that Experience-Based Co-Design enables patients to have a more active and influential role in improving healthcare. This reminded me that when ‘patient involvement’ became a buzz phrase in the NHS in the early 2000s I had often wondered ‘involvement in what?’ you can’t just be ‘involved’ without context or purpose. For me the most compelling area for patients to be involved in is improving and re-designing healthcare. I am biased as this is the field of work I have devoted myself to for the past decade and a half. But I find it so rewarding that I want to provide others with that same opportunity – hence training people in Experience-Based Co-Design every chance I get!

Tiffany and I delivered a workshop ‘Co-design is Caring: Experience Meets Experience’ at the IHI National Forum with Andrea Werner from Bellin Health in Wisconsin. The participants were extremely enthusiastic about the approach. One tweeted “It was amazing! It’s all about the ‘we’ not ‘me’ – value and include the voice and experience of patients!”

It was fantastic to have this opportunity to share and encourage co-design between staff and patients. So I was incredibly proud that ‘co-design’ was a core message in the keynote discussion between Tiffany, Derek Feeley and Dr Rana Awdish

When Tiffany gave her closing thought in her keynote I found myself gently weeping: we should not consider our efforts to improve healthcare to be drops in the ocean, every one of us is a ripple and we don’t know how far that ripple will have an effect.

If, like Derek Feeley, CEO of IHI, you would like to see healthcare evolve from patient-centred care to partnership with patients you can start here or contact me for further encouragement. If we add all our ripples together we will create waves.

Pictured above: Tiffany Christensen (left) and Catherine Dale (right)

Note: Many thanks to the Point of Care Foundation, IHI and the Health Innovation Network for enabling me to attend the IHI National Forum in December 2017.

Local innovations set for national spread

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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.

Picture above: ESCAPE-pain in action

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

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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.

Keeping active is a vital part of keeping steady

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Keeping active is a vital part of keeping steady

Written by Dr Adrian Hopper, Clinical Lead Falls Prevention & Aileen Jackson, Senior Project Manager for Health Ageing

Strength and balance, Strong, Straight & Steady and improving Mind and Body were some of the key messages given to our south London delegates who attended the Health Innovation Network’s Falls Prevention and Mildly Frail Older Adults workshop on Wednesday 18 October.

Delegates from health and social care, voluntary and leisure sectors heard how falls in older adults are really common. One third of people over 65 years of age will fall. These falls may cause a serious injury such as a broken hip or head injury which requires hospital treatment, but most falls go undetected and unreported but are likely to contribute to the individual’s confidence; ultimately, leading to social isolation and yet more serious falls. Some falls are “just” an accident, but for others a fall is caused by early changes, such as worsening balance, vision or dizziness that can be improved.

There is an established evidence base for the exercise and interventions that can really make a significant difference for strength and balance. Public Health England will be publishing a return on investment study later this year to evidence the cost savings of the interventions. Bone health is crucial to the falls prevention agenda and the National Osteoporosis Society are also due to publish evidence on beneficial exercise for people with Osteoporosis late 2018/19.

Speeding up the spread and adoption of evidenced good practice is a key mission for the Health Innovation Network and our event showcased the brilliant examples that exist in south London , including embedding vision tests in Falls Prevention services, reducing waiting times through innovative triage, sustaining exercise, video games, digital physio prescribing, allotments and gardening, London Ambulance and Fire Service initiatives.

Finally, do download Age UK staying steady booklet and all become ambassadors for the Strength and Balance message.

Are you or do you know someone over 65 who has had a fall or has a fear of falling? Check your balance – are you feeling more unsteady? Is it getting more difficult to do everyday tasks? If you are unsteady you can get better by exercising. This involves doing simple strength and balance exercises (mostly standing) for about 20 mins two or three times a week or more which reduces falls by 30% and will give you confidence to go out of doors again and live life.

Follow #StrengthAndBalance on Twitter or our watch our video for all the highlights from the event.

ESCAPE-pain featured in Daily Telegraph Arthritis Awareness

 

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

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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/.

Older Adults recover well from common mental health conditions

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Older Adults recover well from common mental health conditions

We all need to do more to recognise older adults who may have depression and anxiety; older adults engage well with IAPT (including digital IAPT interventions) and most importantly they recover well, evidence shows that the recovery rate of older adults is better than working age adults. These were the key messages given to a capacity audience at the recent Health Innovation Network’s Improving Older Adults Access to Psychological Therapies (IAPT) event which took place on 19 September. All these points seem relatively simple, so why can’t we quickly fix this problem?

It seems everyone has a part to play, we should not be treating older adults as a homogeneous group 65 – 100 years old is a large age span and perceptions and needs will be different.

The third sector, housing and social care organisations have significant role in facilitating referrals to IAPT and ensuring older adults are aware that depression and anxiety can be resolved through talking therapies. We should encourage older adults to share their experience of IAPT and we need all to listen. IAPT services need to train their staff to work with this large older adults age range and liaise more closely with their secondary mental health colleagues particularly the memory service who are diagnosing people with dementia.

Finally, our very busy GPs who are often the gateway to supporting referrals to IAPT services. Think always that chronic health conditions go hand in hand with mental health issues, don’t just refer the physical issues, address both mind and body to make sure the older adult is enabled to maximise independence and live a happier life.

Aileen Jackson, Senior Project Manager Healthy Ageing and Mental Health lead, Health Innovation Network

£114k awarded to drive NHS innovations across south London

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£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.”

Where are all our graduates?

Where are all our graduates?

Insight

Recruiting into entry level positions in health has been a real problem for years. When I first started the Graduates into Health programme, one of things that struck me was the high number of managers – regardless of organisation type or business function – that kept saying they just couldn’t recruit to band 3 – 5 roles.

They would place an advert on NHS jobs and 180 applicants would apply. It would take three days to go through short-listing, and if they managed to get five candidates scheduled for interview, most wouldn’t turn up and for those that did, they just didn’t have the skills. This meant having to re-advertise.

All this time and energy to find a suitable band 3-5 role. This just wasn’t working.

Businessman with his team

The other thing that struck me was how we got inundated at University careers fairs from graduates once they started to realise the NHS could have a career for them in IT, HR, Finance etc. And the thanks we got for helping them find their first role out of them was heart-warming.

The NHS doesn’t have a brand issue – it’s working just fine. What we didn’t have was the right mechanism to get to our graduates. That’s where we were falling down. We now have a solution, we have a mechanism that is working, and it’s so very simple. It’s Graduates into Health programme.

We have over 1,000 students and graduates on our books, clambering to start their career in the NHS/healthcare sector and have access to 1,000s more across London and South East. They want to work with us, we just need to pick them up, before some other employer does – don’t we deserve to have the brightest talent coming out of our universities?

Written by Graduates into Health programme manager Louise Brennan

What are we doing to prevent strokes?

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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.

South London Small Grants Winner 2016: Dr Rachel Hallett

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South London Small Grant Winner 2016: Dr Rachel Hallett

This blog series have been written by the winners of last year’s South London Small Grants (Innovation & Diffusion Awards).

South London Small Grants Logo
The first blog is by Dr Rachel Hallett, who is using the grant to investigate how leisure centre managers decide whether to deliver exercise programmes for people with chronic health conditions.

Where I got the idea for the project:

I joined Kingston and St.George’s Joint Faculty in early 2016, as a researcher working with Professor Mike Hurley, the physiotherapist behind ESCAPE-Pain. Developed in an NHS context with physiotherapists, it can be delivered by fitness instructors in a leisure centre. There are, however, other factors in play: the leisure sector is changing, as is the NHS, with varying remits and budgetary challenges. If research is going to make a difference, researchers need to understand the wider context of delivering health interventions in the community and ensure their schemes are practical to deliver as well as effective. Mike was working hard to spread the scheme so that more people who needed it could access it.

This project arose from a need to understand better how the leisure sector works, what the priorities and concerns are within it, and how schemes like ESCAPE-Pain can be beneficial for providers as well as users.

Stretching, Image from Pixabay
How I Found out about the Small Grants:

Information about the Small Grants scheme was circulated by our Research Development Manager. For a small, short-term project with somewhat unpredictable outcomes, it was ideal.

Progress of the project so far:

The project has three stages, and we’re currently at the end of Stage Two, ready to start Stage Three.

Stages:
1. Initial scoping interviews with those involved in community leisure provision to generate a broader understanding of key issues
2. Circulation of a survey to managers working in community leisure provision, informed by the understanding gained in the interviews in Stage One
3. Follow-up interviews with some of the survey participants to explore their answers and the issues in more depth.

What I would do differently next time:

The project has not been without challenges: these have mainly been about participant numbers. Recruitment – as with many research projects – has been difficult. Those who have participated have been generous with the information they’ve shared, so although participation is lower than we’d hoped, there is no shortage of information that will be useful for researchers to take forward. With hindsight, the initial focus on leisure centre managers should have been broader, to recognise the influencers in organisations such as social enterprises to whom local authorities have outsourced provision. Fortunately, some were included in Stage 1, as their details were passed on during the recruitment process. This meant the survey could be better targeted, and made suitable for people in a range of different roles.

Intented impacts of the project:

The impact is likely to arise after the project is complete and the findings are circulated. We already know from the survey data that leisure centre managers are interested in research and collaborations, whether or not they have already been involved. By working together, there is plenty of scope for long-term impact.

#CatheterCare Tweetchat

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#CatheterCare Tweetchat

On Thursday 15th June, the Health Innovation Network hosted a Tweetchat on #cathetercare with @WeNurses. We wanted to know about people’s experiences of catheter care in their workplace, examples of good practice and challenges around catheter care. We were also interested in finding out about innovative solutions that people were using to overcome the barriers and stigma associated with catheter care and how we can increase awareness of catheter care with patients, healthcare professionals, carers and the general public.

An interesting blog about the evidence and practice around urinary catheters can be found here.

Good examples and challenges around catheter care

There was lots of discussion around the challenges associated with catheter care, and it being a huge part of workload, particularly for district nurses. Another challenge that presented was that lots of people have long-term catheters without any information or clinical reasons as to why. These discussions were met with suggestions around increased education for patients and the catheter passport was raised as a means of educating patients, as well as being able to provide healthcare professionals with discharge information.

#CatheterCare: The word cloud generated from our Tweetchat

#Cathetercare: The word cloud generated from our Tweetchat

Overcoming the barriers and stigma associated with Catheter Care

Educating clinicians on good catheter care practice was a strong theme throughout the chat. I felt this was particularly relevant as there is a national push to prevent healthcare-associated gram-negative bacterial bloodstream infections – CAUTIs being a main cause. More on that here.

Many people felt that a short video to depict a patient’s experience would be a powerful educational tool, as well as teaching junior staff ‘in the moment’. To that end, the Health Innovation Network has developed an animation for healthcare professionals, which they are more than happy for people to use. Find it here.

A highlight of the chat for me was hearing from @NurseDeJaeger about a great initiative around increasing patient advocacy and awareness through a weekly nurse and patient catheter cafe, called ‘Meet the TWOCcers’. So simple yet so clever, and a great way of de-stigmatising catheters.

Increasing awareness around Catheter Care

The challenges around urinary catheters and reaching more people to increase awareness were identified as ongoing issues. Through collaboration with passionate people, sharing good practice and initiatives and learning from one another as a community, we can make a difference. Keep the conversations going by following #cathetercare and letting @HINSouthLondon know about anything you think people may be interested in.

To coincide with #WorldContinenceWeek, we are running #CatheterCare Awareness Week (19-23 June) and aim to tackle the stigma around catheter care and breakdown the associated barriers.

For more information and resources, including our animation, pledges cards, posters and several short videos click here

If you have any questions, please email hin.southlondon@nhs.net.

A Tariff for Innovation

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A Tariff for Innovation

It’s one thing to innovate. It’s another to spread that innovation across the NHS and that’s exactly what a new tariff system could do, says Tara Donnelly

A new tariff came into play in April this year and for the first time we have a payment scheme to encourage the spread of innovation within the NHS. This is significant, laudable and we need to do everything in our power to ensure that we make the most of the opportunity. Even better, the focus of the tariff in its first year is innovations that make hospital care safer.

Most of the devices that are eligible for the tariff have been developed by innovative clinicians who saw opportunities to improve care – making it safer and more effective.

Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented scissors that make childbirth safer; Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with a device that prevents tragic accidents with blood lines; Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care; Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD an online platform that helps patients self-manage with dramatic results; Robert Porter, a consultant microbiologist at Queen Alexandra Hospital has developed a treatment that cures Clostridium difficile through faecal transplantation.

Accelerating the uptake of innovation

We should be proud that as a country we are not only inventing these superb devices, we are also designing systems to help accelerate their uptake. NHS England’s Innovation and Technology Tariff (ITT) enables NHS Trusts in England to use these patient safety innovations either for free, or to claim a charge per use.

The 15 AHSNs have lobbied for a tariff to support innovation for some time, and it was the NHS Innovation Accelerator – a national programme supported by all 15 AHSNs – which was a key influencer in its development. The AHSNs therefore are delighted with this development, and are working to support uptake of these innovations within their geographies.

Obstetric Anal Sphincter Injuries (known as OASIS) during childbirth is the leading cause of faecal incontinence in women in the UK. It is a devastating injury, requiring surgical repair, with 30% of women having some level of symptoms a year later. OASIS costs the NHS approximately £57 million annually in repair and litigation costs and is on the rise. Dharmesh developed guided mediolateral episiotomy scissors, known as EPISCISSORS-60 that minimise the risk of obstetric injury, they are set to 60 degrees, the optimal angle to avoid serious injury. A number of studies have proven their efficacy.

Maryanne’s non-injectable arterial connector (the NIC) enables conventional arterial line sampling for patients in theatre or intensive care with the huge bonus that it is not possible to accidently inject medicine into it. This prevents wrong route drug administration, which, while rare can have terrible consequences including in the most extreme circumstances, amputation.

Peter’s PneuX invention has also been proven in studies to reduce the rate of ventilator acquired pneumonia (VAP). In its guidance, NICE quotes a plethora of studies including a recent UK randomised control trial which found that PneuX tube halved the rates of VAP after cardiac surgery from 21% to 10.8% patients. Bearing in mind VAP has a 30% mortality rate this is very good news, and would mean many more ITU beds available across the NHS.

Chronic Obstructive Pulmonary Disorder or COPD is the second most common reason for hospital admissions in the country costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% people with COPD are unable to take their medication correctly. Simon’s support system known as myCOPD, has educational, self-management, symptom reporting and pulmonary rehabilitation aspects, all delivered online.

Robert’s innovation helps people with Clostridium difficile, a serious bacterial infection affecting the digestive system, who have a one in six chance of dying within 30 days. Antibiotics are the first treatment and cure the condition in many cases. But for a proportion – about 20 per cent – antibiotics do not work. A frozen microbiota transplantation will cure 90% per cent of these patients.

UroLift is an alternative surgical procedure for the treatment of the common condition of benign prostatic hyperplasia, where the enlarged prostate makes it difficult for men to pass urine, leading to urinary tract infections, urinary retention, and in some cases renal failure. It is considerably less traumatic than existing surgical treatments.

Guidance on the new tariff

Guidance came out from NHS England recently, circulated to Finance Directors. However it will be important to others such as CEOs, COOs, Medical, Nursing, Midwifery and Clinical Directors, Operational Managers and Patient Safety leads are aware so that high rates of uptake can be achieved quickly.

We have in the past bemoaned that the NHS doesn’t support clinical entrepreneurs, and that the period between discovery of an innovation and its widespread uptake at the often quoted time of 17 years is too long.

Here we have a handful of fantastic inventions that improve safety and reduce cost, devised by UK clinicians who have been hugely supported by the NHS to date. Increasing uptake is now down to all of us. What about getting over 50% uptake in 17 months instead of 17 years? Are you up for ITT?

Self-managing chronic pain with the Joint Pain Advisor

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Self-managing chronic pain with the Joint Pain Advisor

Fay Sibley, Senior Project Manager for the musculoskeletal theme, writes about how the Health Innovation Network’s Joint Pain Advisor helps those with osteoarthritis.

The increasing burden of an ageing population on NHS services is well documented. GPs are struggling to cope with the ever increasing demand on services; lacking both capacity and expertise to support people to change their behaviour and adopt healthier lifestyles.

Patients with long term conditions, such as osteoarthritis (OA) often tell us they feel GPs are unable to help, at best they are prescribed palliative medication which they tell us they don’t like to take and at worst they are told it is just part of “getting older”. Despite this patients are unsure of where else to turn for advice and support.

Self-management is a hot topic in healthcare at the moment, often heralded as the answer to some of the NHS’s most complex problems. But does it really work?

At the Health Innovation Network, we have been focusing on helping people to self-manage their chronic joint pain and have piloted a new approach to managing osteoarthritis (OA) in Primary Care – the Joint Pain Advisor.

The Joint Pain Advisor takes the form of up to four 30 minute face-to-face consultations between the advisors and people with hip or knee OA. People 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 NICE guidelines for the management of OA. They are then invited to attend reviews after three weeks, six to eight weeks and six months to access further tailored support and advice.

To date over 500 patients have used this service and 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.

Have a look at what some of the 500 participants who have undertaken the programme say, in our Joint Pain Advisor film.

In our original study we used physiotherapists as Joint Pain Advisors but recently we have worked with health trainers and coaches. We think that the Joint Pain Advisor could significantly reduce the cost of helping people with chronic joint pain.

If you would like to find out more about Joint Pain Advisor, join the webinar we are holding on Friday 24 March. To register for the webinar please click on the link below. Once you have registered you will be sent a calendar invite containing details on how to join. Please note there are limited spaces for this webinar so attendees will have to register on a first come first served basis.

Register

You can also contact us at the Health Innovation Network, by emailing Fay at fay.sibley@nhs.net.

Partnership for change: First impressions in Freetown

Partnership for change: First impressions in Freetown

By Laura Spratling, Programme Director for Diabetes and Stroke Prevention. Laura is currently working in Freetown, where she’s using her skills as a hospital management volunteer with the King’s Sierra Leone Partnership (KSLP). Read about her experiences in her new blog.

Image by Simon Boots

I’d always wanted to volunteer in a developing country, motivated like many by an interest in applying my skills to help a place in great need. I was attracted to the strong partnership ethos of King’s Sierra Leone Partnership (KSLP) and delighted to have the chance to come and work with Connaught Hospital colleagues.

I joined the NHS as a graduate general management trainee in 2009, after which I worked in various operational and strategic roles including most recently as Programme Director for Diabetes and Stroke Prevention at Health Innovation Network (HIN), the South London Academic Health Science Network. I am grateful to my managers at HIN for kindly allowing me a six month career break to come to KSLP in Freetown.

During my first month at Connaught I was struck by how hospital life is on the one hand of course so totally different, and yet on the other hand many of the issues are similar to the ones that NHS managers devote their careers to solving.

Probably the most striking difference is the spectrum of common diseases. Infectious diseases (such as TB, malaria, HIV, measles, meningitis, pneumonia and others) are very prevalent. Spending time observing in an outpatient clinic during my second week here I was also taken aback by the severity of advanced disease that Connaught staff are treating. In my years in UK hospitals I have never seen so many patients so poorly as I have seen here in just a few weeks.

But while there is what sometimes feels like an overwhelming amount of suffering, there is also a good deal of hope. Patients, relatives and staff are incredibly warm and friendly, greeting strangers they pass in the corridor and one person who I hadn’t met before thanked me profusely for my work! I have met some incredibly strong and resilient people here who have survived some terrible times and are committed to working towards a better healthcare system. The work they do every day is truly impressive and humbling, particularly when you remember that they have far fewer resources of all types than we do in the NHS.

The issues that Connaught has in common with the NHS that I’ve discovered so far are as follows (I’m sure there are more!):

  1. Issues around flow of patients through the hospital – together with Connaught doctors and nurses we’ve started some process mapping to better understand the problems before co-designing solutions
  2. Rotas and handover processes
  3. Ways to embed effective multi-disciplinary working
  4. Estates and maintenance issues
  5. Effective management of outpatient services and ensuring patients do not become lost to follow up
  6. Health records management
  7. Robust systems for audit and quality improvement

And it’s the last two issues where I am focussing my energies for now.

There’s a great deal of enthusiasm in the hospital for improving the health records system, both to improve patient safety and care quality as well as enabling staff to undertake meaningful clinical audits and quality improvement projects. The records office staff in particular are fantastic and we have been working together on the first stages of our improvement plan.

It’s also a fascinating process working with colleagues to start up a rolling programme of quality improvement projects. We’ve established a committee where projects can be proposed, registered and reported on when completed. Our first two projects are about implementing the new international guidelines for the treatment of malaria and improving antibiotic prescribing. We’re going to be running some multi-disciplinary training sessions soon on quality improvement tools and methods. I am learning a lot from colleagues here showing me what is likely to be effective and what is not, and why.

My third project is an evaluation of a major educational programme working with the medical, nursing and pharmacy schools at the College of Medical and Allied Health Sciences (COMAHS). I’m developing some new skills in designing qualitative evaluations and it will be interesting to hear the views of staff and students in the focus groups and interviews early next year.

I’ve always thought that the role of an effective healthcare manager is to provide the best possible environment and conditions for clinicians and patients, so that the best possible patient outcomes are achieved. This means making sure that systems work and that staff have the right skills, equipment and support to meet patients’ needs. As one of my first managers in the NHS memorably put it, “you have to be the glue” that brings the various parts of the system together. These principles are exactly the same here. I’m enjoying learning about how the Connaught management team is approaching this task and trying to make the best contribution I can.

Volunteering overseas is a “less trodden path” for healthcare managers than it is for clinicians, but I would encourage anyone who has an interest to pursue it and get in touch via volunteer@kslp.org.uk if you would like to know more. Whilst there are some tough times, it’s an incredible and very worthwhile experience.

Laura’s blog was first published on the King’s Sierra Leone Partnership (KSLP) website here.

If you would like to learn more about the opportunities to volunteer with KSLP in Freetown, you can find out more, including how to apply, here.

KSLP is a partnership between King’s Health Partners – itself a partnership between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts – and three key Sierra Leonean institutions; Connaught Hospital, The College of Medical and Allied Health Sciences (COMAHS), and The Ministry of Health and Sanitation.

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Going digital: What it’s like for less tech savvy communities to use healthcare services

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Going digital: What it’s like for less tech savvy communities to use healthcare services

Rahel Gerezgiher, Health Innovation Network Communications Project Support Officer, writes about what it’s like for less tech savvy communities to use healthcare services.

More and more we hear about the move into digital; not only within the NHS, but also in commercial sectors. Although there are many positives that come with moving into a more digital realm, such as having a wider reach, easier and more streamlined use of services, we also need to be aware of the downsides, which could potentially alienate members of the public who regularly use health services.

Case Study

My mother’s first language is not English; she is currently in college trying to improve on her speaking skills as she finds it easier to understand but struggles with responding. My mother is able to use her smartphone for the basics such as making and receiving calls, messages, using Viber to call abroad and WhatsApp. She also has arthritis and Type 2 diabetes, which require regular trips to her GP.

If the NHS brings digital technology into every aspect of healthcare, I believe my mother would struggle to get to grips with this new technology. She is not the most tech savvy, but there is also another challenge – English is not her first language. I’m sure that this would be a concern for others, including those who may be intimidated by technology.

Some points to consider:

  • As we move into digital healthcare, it could be useful to have training opportunities in primary care settings for patients to learn how to use digital systems, such as classes on ‘How to book an appointment’ or ‘How can I check my results?’
  • Without such training opportunities, which would show people how to use the new system, this could put pressure on family members and friends to help their less tech-savvy relatives.
  • The move into digital could result in more easily accessible materials, and a wider selection of translated materials would be a positive benefit. I am fluent in Tigrinya and so is my mother, but at present we rarely come across materials translated into our language. This is something to be considered going forward.

Those who are not tech savvy will not be the only group of individuals who will not be keen on moving into the digital realm. There will be some groups who prefer not to use technology and still prefer face-to-face interaction. By increasing the reliance on digital, are we pushing these groups up against the wall?

This group may not only prefer face-to- face communication, but they could also be worried that their information may be easily accessible. How do we reassure this group that their information is safe, and could they have the choice to opt out if they preferred?

I think that the move into digital is imperative for the NHS, as there are a number of opportunities that can come from it. However, if the move will not be utilised by all groups we really need to put provisions in place for this to ensure that we are catering to all groups, such as running training sessions or still having a main point of contact in primary settings, so that we are giving people the option to use the service, which is more in line with their wants and needs. After all, the NHS is there for everyone, so it’s only right that there is tailored accessibility for all.

Accelerating Access

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Accelerating Access

The NHS has huge potential to be creative and innovative yet the system as a whole is slow to adopt innovation and best practice. Academic Health Science Networks – AHSNs – exist to speed up this process, to improve patient care and reduce system inefficiencies.

We act as honest brokers within our region, mobilising expertise and knowledge across the NHS, academia and industry to help improve lives, save money and drive economic growth through innovation. Our regional partnerships are helping to deliver system transformation locally, described by the Five Year Forward View. As 15 AHSNs we work together in ways unprecedented across health and care, delivering improvement at pace and scale. This is having real impact through our collective work including the successful NHS Innovation Accelerator – now reaching 388 organisations within the NHS Patient Safety Collaboratives and the Innovation Pathway; improving health and driving economic growth.

The latest work to recognise the unique role that AHSNs can play is the Accelerated Access Review, (AAR). This was an independently chaired review of innovative medicines and medical technologies, led by Sir Hugh Taylor and supported by the Wellcome Trust and the Office of Life Sciences, which published its final report in late October 2016.

It contains a series of recommendations to the NHS, which will need to be properly considered by NHS England and others, but encouragingly, the report contains a letter from Simon Stevens, where he commits: We’ll support the AAR’s streamlined pathway to identify high value innovations. We’ll then help pull them through into mainstream care – building on our AHSNs, innovation testbeds, and our new Innovation and Technology Tariff. And where it makes sense, we’ll be increasingly open to agreeing innovative win/win product-specific reimbursement models …” (Taylor, 2016, p.10).

The report outlines how the UK can make far more of its Life Sciences and research expertise, speed up clinical trials and subsequent endorsement and adoption of new drugs, medical devices and digital technologies. The AAR’s approach is shown in Figure 1, below.

It also considers the lessons learnt from when we have got this right, the triumph of the speed of development and dissemination relating to Ebola is rightly highlighted as a fine example of this, with the MHRA’s Clinical Trials Unit fast tracking Ebola studies, Expert Advisory Groups and trial sponsors.

Figure 1: A summary of the Accelerated Access Review’s proposed approach (Taylor, 2016, p.14, reproduced with permission)

The report is well worth a read and is available here. From the 70 pages I’ve précised the top 10 areas for AHSNs and summarised these.

Accelerated Access Top 10 Changes for AHSNs

Key changes for us from the review include:

1 Strengthening of remit: The report calls for “A new mandate for AHSNs should support the local spread of adoption and enable as standard framework for local evaluation” (Taylor, 2016, p.50). It is described as a “new, strengthened remit for AHSNs” (Taylor, 2016, p.50) and that AHSNs – among others – will “drive and support the evaluation and diffusion of innovative products” (Taylor, 2016, p.12).
2 Clarity of role through a Charter for Innovation Support:AHSNs, with their existing local networks that include NHS providers and commissioners, academia and industry, should play a vital role in supporting the testing and diffusion of technologies in the NHS. This role should be set put in a new charter with input from NHS England and NHS Improvement which clearly articulates what is expected from AHSNs and enables them to be held to account for local delivery” (Taylor, 2016, p.50).
3 Strengthening of our National Network of 15 AHSNs: The offer to innovators will include “access to a strengthened AHSN network which can facilitate local evidence-collection and adoption of innovation” (Taylor, 2016, p.13).
4 Better funding: AHSNs should be funded to a level that allows them to fulfil the role outlined in this report (Taylor, 2016, p.51), and there follows a recommendation to provide between £20million and £10million to AHSNs baseline budgets from 2017.
5 Providing capacity: the review proposes an additional role for AHSNs in providing capacity and capability locally to NHS organisations who require it, in order to make the most of new innovations. This new role would require funding of around £30million a year, and there is a suggestion that AHSNs that are able to generate match funding through working with charities or industry partners could access these resources (Taylor, 2016, p.52).
6 Creation of Innovation Exchanges: AHSNs should galvanise and support local innovation partners to create a network of “innovation exchanges” responsible for diffusing clinical and cost effective technologies across the system” (Taylor, 2016, p.50).
7 Supported more strongly: We also recommend that NHS Improvement plays a greater role in leading AHSNs, including supporting them to undertake these activities (Taylor, 2016, p.51).
8 Link to Test Beds: AHSNs have been supporting the national Test Bed programme where combinatorial innovation is being explored. The Test Bed we support in the London Test Bed, CareCity, which is bringing together technologies to keep people with dementia as safe as possible. “AHSNs should build on their current involvement in the Test Beds programme by using this learning for their own evaluation role and seeking to collaborate to promote mutual recognition of local evaluations using the national framework” (Taylor, 2016, p.51).
9 Testing and dissemination: AHSNs are noted to be “ideally placed to play a role in post-CE mark testing and dissemination of medical technologies, diagnostics and digital products in particular” (Taylor, 2016, p.51).
10 Horizon scanning: In Digital Health AHSNs are seen to have a key role in the earliest stages where “AHSNs identify unmet needs” at the ideas generation and identification phase (Taylor, 2016, p.26).

The following figure shows how the AHSN Network will embed within the system to enable speedier spread and uptake of innovation.

Figure 2: Local and national spread of innovation (Taylor, 2016, p.51, reproduced with permission)

At the Health Innovation Network we, along with colleagues across the other 14 AHSNs, warmly welcome the Accelerated Access Review and are keen to progress its findings at scale and pace, to speed up the best in health and care, across the country.

 

Reference
Taylor, H. (2016). Accelerated Access Review: Final Report. Department of Health, available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/565072/AAR_final.pdf

Improving Catheter Care: My Catheter Passport

Improving Catheter Care: My Catheter Passport

Dr Adrian Hoppper, Consultant Geriatrician, Guy’s & St Thomas’ NHS Foundation Trust on improving catheter care.

Last month, we launched My Catheter Passport across Guy’s and St Thomas’, King’s College Hospital and our teams working within the community which has been a triumph for everyone involved.

We developed the Passport in response to concerns about the lack of clear information about patients’ catheters being shared across care settings, including why a patient even needs a catheter. We believe that these issues contribute to  the rates of catheter associated urinary tract infections (CAUTI) developed within the community, as well as why patients attend hospital with issues such as blocked catheters, which could have been prevented with clear care plans.

It always amazes me when I hear of another patient who is unaware of why they were given a catheter in the first place or who has contracted a catheter associated urinary tract infection (CAUTI). People are at a higher risk of UTIs when they have a catheter inserted, and unfortunately CAUTIs have been associated with increased mortality, length of stay in hospital and healthcare costs. It can be frustrating when I know that with the right care and information, CAUTIs can be prevented.

As a consultant geriatrician at Guy’s and St Thomas’ and chairperson of the Southwark and Lambeth Integrated Care Infections Working Group (a group made up of people with catheter care experience and health and social care professionals), I’m driving forward the fight against CAUTIs and the impact they have on people. I also want to make sure that GP practices, community services and hospitals communicate more effectively with each other, so patients receive the best care.

The My Catheter Passport was a fantastic opportunity for us to co-design something with patients and health and social care professionals. It is a patient-owned document packed full of useful information and contact details for people with catheters, to empower them to live as independently as possible. The Passport will now be given to all adult patients when they are discharged from hospital and to those currently receiving care in the community; and patients should have it with them whenever they are seeing a health and social care professional about their catheter. This is because there is a section of the Passport that health and social must complete to record any changes or issues with the patient’s catheter. We hope that this will improve communication between care settings. I am extremely pleased with how the Passport turned out, especially as it is a true example of co-production with local people and professionals.

The Passport is one of a number of interventions that we want to spread across the five South East London hospitals, as part of the ‘No Catheter, No CAUTI’ campaign. The campaign is led by the Health Innovation Network’s(HIN) Patient Safety Collaborative, and I am the Clinical Director for Patient Safety for the HIN. Follow the campaign on Twitter – #HINstopcauti.

The collaborative has recently been set up to share best practice across partners to improve catheter care with the aim of significantly reducing CAUTIs. This will be achieved by testing a series of interventions that support avoiding unnecessary catheterisation, the prompt removal of catheters, learning from rapid review of CAUTIs, as well as community based interventions such as the Passport.

We have achieved a lot in the last year, all of which we should be proud of. However, in the process of developing the Passport, we discovered further challenges to delivering a gold standard in catheter care for patients. Most notably, the catheter care pathway is fragmented, so patients are coming to A&E with issues that could be managed in the community; and there is a disjointed prescription process, which can lead to duplication of prescriptions and an increase in cost.

As you can see, we are not without our challenges in catheter care and it’s clear we still have a lot of work to do across Southwark and Lambeth. It was agreed that these challenges need to be explored further and solutions drawn up to address them. The conversations to do this have already started and the Infections Working Group will come together to map out a new service model that would work for people with catheters.

I’m lucky in that I get to work with people that are equally passionate about catheter care and addressing the challenges we face. I had the pleasure of witnessing this enthusiasm at the #CatheterSummit at the beginning of the year. I am excited about the future and what we can do together so patients with catheters in Southwark and Lambeth receive the best possible care that is right for them.

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