South London protected characteristics dashboard

Photograph of a typical street in south London

This dashboard displays a breakdown of data related to the nine protected characteristics across south London at borough, ICS and south London level. The nine protected characteristics are:

Age
Gender reassignment
Being married or in a civil partnership
Being pregnant or on maternity leave
Disability
Race
Religion or belief
Sex
Sexual orientation

In addition to these characteristics, the dashboard includes data on life expectancy, education, unemployment, and deprivation.

It can be used to give key figures on the breakdown of these characteristics within south London, and also to explore how the south London boroughs compare to their wider geographical areas as well as each other.

Need support with understanding the characteristics of the south London population? Get in touch with our team.

Mapping of Bromley Virtual Ward Pathways

Background and context

Virtual wards allow people who need hospital care to receive the care they need at home, including in care homes, safely and conveniently rather than in a hospital. They provide systems with a significant opportunity to narrow the gap between demand and capacity for secondary care beds providing an alternative to admission and/or early discharge.

At the request of SEL ICB, The Health Innovation Network (HIN) gathered insights into the current state of the virtual wards in Bromley and highlighted current challenges, gaps, and opportunities.

More specifically, planned outputs were to:

explore what improvements would support the delivery of the pathway
produce a report highlighting key recommendations
produce a process map representing the current pathway

This report details our approach and method as well as the insights and recommendations.

The Bromley virtual ward service

Virtual wards in South East London are led and coordinated by the community providers.

The One Bromley partnership has developed a hospital at home service to deliver a range of monitoring and interventions in the community that would otherwise be delivered in an acute hospital.

The service is provided borough-wide to people who need hospital care that are registered with a Bromley GP. Referrals are currently from the acute hospital, other urgent community response services and Bromleag, the GP practice for residents of nursing and care homes in Bromley. The service is a consultant-led multidisciplinary team currently consisting of GPs, consultants, nurses, and health care assistants with clinical accountability for its patients.

Findings

Findings indicated that effective communication and collaboration between healthcare professionals are critical for the success of virtual wards. The workshop participants identified the need to ensure continuity of care and effective management of available resources.

Additionally, the participants of the interviews and workshop emphasised the need for appropriate skill mix and more support of advanced clinicians to facilitate discharge.

Text reads:

What difference do you feel the virtual wards have made?

• “Patients in the virtual wards today would have been treated in hospital three to four years ago”.
• “The wards have only been running for short while, still too early to tell but we have real positive patient feedback”.
• “Patients really seem to be enjoying the fact they can get a home visit, which shows someone cares”.
• “Enhanced skills set for community-based clinicians/Joint learning and Interprofessional learning”.
• “Streamlined approach. Demonstrates that things can be done differently. There is a cultural change and less risk of infection”.
• “I believe a lot of the patients we see would have ended up in A&E or called 111”.
• “Maintaining competency/inter-professional learning”. — Quotes on the difference made by the virtual ward

Recommendations

Based on the insights from the project, several recommendations can be made to improve the virtual wards process and enhance patient outcomes. These include:

Streamline the referral process
Review data on the utilisation of the patient and staff telephone line
Interoperability
Multidisciplinary team meetings
Review training, development, and skill mixing
Patient information
Review weekend escalation process

Recommendations from the co-design group

Following the workshops, the co-design group produced the below recommendations:

Embed patient voice at governance level; invite people with lived experience to join sections of the board/steering group meetings which they can influence.
Develop people-focussed outcomes for hospital at Home as well as clinical outcomes.
Actively reach out to and engage people from ethnic minorities, non-English language speakers and people with additional communications needs to understand their experiences. These views were not captured via co-design workshops.
Involve people with lived experience in staff training and development, invite people with lived experience to join training, offer training to informal carers and reverse mentoring for staff.
Ensure all community staff, not just the Hospital at Home team, undertake deaf awareness and dementia training.
Develop leaflets and advice on Hospital at Home in partnership with local people.
Produce communications in accessible formats upfront so that all users are immediately catered for rather than retrospectively sharing things in accessible formats.
Ensure all videos, technology and monitoring approaches are accessible to users with different needs.
Join up with existing long term health condition services and care homes.

Conclusions

Overall, the virtual ward process mapping was a successful exercise that identified valuable insights and opportunities for improvement. The findings from the interviews and workshop will help to inform future strategies for improving the virtual ward process in Bromley, ensuring that patients receive the highest level of care possible. The project demonstrated the importance of collaboration and communication across teams, the complexities of meeting national and local ambitions to integrate services around the needs of patients, and the need for ongoing efforts to improve processes and systems to do this effectively.

Download the full report

Development of a Digital Outcomes Framework

Do you want help developing an outcomes framework?

This article outlines an example of our work in developing an outcomes framework to facilitate the evaluation of digital-first projects across London. The Health Innovation Network provides support to help organisations understand the benefits of outcomes frameworks and deliver outcome monitoring solutions.

Background Information

NHS England is supporting primary care to move towards a digital first approach, where patients can easily access the advice, support and treatment they need using digital and online tools. These tools need to be integrated to provide a streamlined experience for patients, and quickly and easily direct them to the right digital or in-person service.

This means patients should be able to use online tools to access all primary care services, such as receiving advice, booking and cancelling appointments, having a consultation with a healthcare professional, receiving a referral and obtaining a prescription.

The London Digital First team are currently driving the digitisation of primary care to achieve these aims, through several innovative workstreams across five ICS geographies. Multi-year funding has been awarded and ICS teams are currently in their final year of delivery of this programme from 2023-24. To demonstrate the impact of all the initiatives underway, the Digital First London team commissioned the Health Innovation Network (HIN) to collaboratively develop an Outcomes Framework which will be implemented by each ICS team.

This is a working document to help local project teams to capture, review and track their outcomes relating to digital transformation. This will build into local and then regional outcomes registers to show the quantitative outcomes related to the Digital First Programme from year one. Further work is in progress at the HIN to capture qualitative patient perspectives of the Digital First Programme to provide a complete narrative of the programme by the end of 2023/24.

Outcomes Framework Design

The Outcomes Framework encompasses a series of structural, process and outcome measures which can be used to consistently monitor project/programme performance towards achieving two core goals – Improving Patient Outcomes and Improving Service Efficiency.

Why are outcomes needed?

To build the case for continued investment into digital transformation of primary care.
To demonstrate and measure the impact and achievements of the Digital First Programmes within each ICB and share regionally/nationally to shape the future of digital transformation priorities.
To understand if Digital First teams have successfully met their programme objectives and where there are opportunities for improvement.
To provide information on priorities for programme areas and provide an overall purpose for programmes of work.

HIN support included:

Needs articulation with the Digital First team to understand expectations and requirements for a digital outcomes framework, and defining the two core goals this framework would evidence progress towards – Improving Patient Care and Improving Service Efficiency.
Stakeholder mapping and interviews with ICS teams to gain an overview of the breadth of digital projects being implemented and which metrics would be most important for teams to help demonstrate the success and value of their work for clinicians and patients.
Iterative design and testing of the outcomes framework with input from each ICS region, resulting in the final framework being available in multiple formats as per ICS requests to meet the individual requirements and ensure ease of use for the different teams involved.
Utilisation of the breadth of HIN expertise’ for project support, including obtaining specialist evaluation expertise to advise on framework design and identifying suitable metrics for monitoring processes and outcomes of digital projects.
Extensive desktop research across the ICS regions to identify and share a collection of useful, readily available NHS data sources to support ICS project teams in identifying suitable sources to collect evidence for their project outcomes.
Design and facilitation of in-person and hybrid workshops for each ICS team to socialise their outcomes framework and help implement the framework into their unique projects – attended by over 50 project, programme and clinical leads from the Digital First teams.
Adaptation of outputs for additional workstreams – the Outcomes Framework is currently being used to support monitoring of the project outcomes for the 11 Digital First Automation Grant pilots

Stakeholder feedback

“At a regional level the workshop has helped our team to understand the application of the framework to our programme and the challenges that our ICB colleagues are facing.”
Sharon Sheldon (Senior Programme Manager, Digital First for Primary Care London)

“Being provided with space and time to work through the template as a team rather than individually was a valuable process. It enabled us to hear other people’s thoughts and gain insights we wouldn’t usually gain. A beneficial and engaging workshop.”
Ian Leigh (Programme Manager, Digital First Programme)

Outcomes Framework resources:

The framework is now available to access and download on the NHS Futures page.

To support the adoption of the Outcomes Framework a series of materials were developed. These include:

Outcomes framework guide detailing the approach to implementing outcomes and providing a blank template for completion.
An Excel version of the above pro-forma (as requested by ICS Digital First Teams)
A useful data sources repository.
An outcomes tracker for monitoring outcomes across multiple projects and life cycles.

Further information

The HIN’s Digital Transformation and Technology team have extensive experience in supporting outcomes monitoring and development for the healthcare sector, including public health, and primary and secondary care services.

For further information on our outcomes framework and how we might support your organisation in adopting outcomes monitoring, please contact hin.technology@nhs.net

Experiences of implementing remote monitoring in care homes in south west London

Academic Health Science Networks play an important role in promoting the spread of innovation across health and social care.

The HIN’s Healthy Ageing team interviewed staff involved in introducing remote monitoring technologies to care homes across south west London.

Introduction

In 2020, the Covid-19 pandemic challenged care home staff and their residents in new ways. One of the struggles was how to recognise deterioration in care home residents earlier and access the most appropriate healthcare services for this vulnerable group while having reduced direct face to face contact with healthcare providers.

Remote monitoring systems had begun to be used in some care homes in England since 2016. Use of these tools was accelerated in 2020 which also helped to meet the challenges of the pandemic. Central funding was provided, and London’s Integrated Care Systems came together with NHS England’s London team and local Academic Health Science Networks to implement increased use of remote monitoring systems in care homes across the capital.

South West London (SWL) Integrated Care System (ICS) set out a ‘Digital Integration Roadmap’ showing how it would support care homes to advance their digital capability. As part of this work two remote monitoring systems – VCare (now Camascope) and Whzan – have been introduced in care homes across South West London.

These remote monitoring technologies utilise Bluetooth enabled care technology and a digital dashboard to allow care home staff to take, record and monitor vital signs (blood pressure, heart rate and temperature of residents). Information is then stored digitally, and, with the care home’s permission, can be accessed by healthcare professionals, such as the GP. The systems automatically calculate a NEWS2 score (National Early Warning Score) which alerts care home staff to follow their local escalation plan. Having access to clinical information allows care homes to spot signs earlier that a resident is becoming unwell and escalate to healthcare services.

Here, members of the ICS project team, and managers from four care homes share their experience of implementing remote monitoring equipment.

The ICS Project Team

Jenny Freeman, Programme Manager, SWL Integrated Care Board

Working, learning and improving together with care homes.
Jenny Freeman

Jenny Freeman joined South West London’s Digital Integration in Care Homes Team in the Autumn of 2020, with responsibility for remote monitoring.

Tell us about your plan to implement remote monitoring in care homes?

Jenny described the significant task she took on to mobilise remote monitoring for SWL, an ICS with over 350 care homes. She recalls: “I’d managed change projects before but not on this scale or under these circumstances – we really did start from scratch and were unsure what we would encounter”.

While procurement processes for the remote monitoring services took place, Jenny devised a delivery plan based on using a newly formed team of Digital Integration Support and Liaison Officers (DISLOs), described below.

This approach was based on experience gained earlier during the pandemic when the ICS had to rapidly roll out NHS mail to care homes using redeployed NHS workers.

Building relationships with care homes, holding good conversations, being consistent and following up with clear information was considered key to the delivery model. The team began to develop and describe individual stages of implementation, which were supported by shared guidance, scripts and FAQs ensuring all care homes received the same message.

How far has the programme progressed?

Since the journey began, more than 107 care homes have digitally transitioned to use either Camascope or Whzan Remote Monitoring equipment.

We were all working remotely and learning at pace. We had to develop our approach and implement this new technology at the same time as familiarising ourselves with how the technology could improve the care home resident’s health outcomes. I’m pleased to say that we were successful.
Jenny Freeman

Reports from care homes are positive including increasing staff confidence in clinically assessing residents, escalating cases of deterioration, and building better connections with some GPs and other parts of the health system.

Jenny acknowledges however: “We’re still on the journey to full digital integration between the NHS and care homes. What we have learned and our successes put us in a good position to go forward”.

Successes

Data Security and Protection Toolkit (DSPT) – The gateway to all things digital

Jenny felt a key success in the remote monitoring implementation was the support the Care Homes Digital Integration team provided in helping care homes to prepare for and complete the Data Security and Protection Toolkit (DSPT). Even though data regulation requirements were relaxed slightly during the pandemic, SWL ICS set robust expectations for Information Governance checks. Jenny reflected: “although challenging at the time, it was the right thing to do. SWL planned for the long-term by preparing homes for when data regulations resumed and as a result is now one of the leading ICS for DSPT compliance, with 82.4% of care homes attaining DSPT ‘standards met’ level.”

Recruitment, Training & Development of Digital Integration Support & Liaison Officers (DISLOs)

In order to implement remote monitoring, Jenny recruited nine Digital Integration Support & Liaison Officers (DISLOs) on 6-month fixed term contracts in Autumn 2020. The team went through recruitment, induction and training remotely. No-one met in person for another six months. Employing considerate, engaging people with great interpersonal and communication skills was a priority. Jenny said positively: “I often thought of the team as great people who would have been working in other roles but couldn’t because of Covid-19 restrictions. We employed people from the travel industry, hospitality and film industry as well as new graduates who were out of work and we truly benefitted from this diverse and highly skilled workforce. I feel very proud of how we worked and learned together under very challenging circumstances.”

The first two weeks of virtual training included trust-building activities and the team developed their own set of values. Jenny facilitated these sessions and recalls: “I was constantly thinking what I would have done if we were all ‘in person’ and then converting the activity to work virtually. Online ice-breaking activities were a great way of developing trust and breaking down barriers.”

Skill mix and peer support

The team set up three working groups focused on communications, continuous improvement and data and analytics. As the programme of digital work expanded, dedicated posts were recruited to support some of these functions. Peer support was essential and MS Teams was used to set up shared channels to aid communication and file sharing, as well as a private DISLO team peer support channel.

The team values ensured that everyone had a voice, any concerns were able to be shared and resolved quickly and ideas for doing something differently were always welcomed.

Challenges

Implementation Model

The model for implementation was developed from scratch with help from the Remote Monitoring suppliers. The implementation cycle involved the DISLOs first engaging the care home and signing them up to the project then putting training in place, equipping the care home with the technology, and following up to ensure things were running smoothly.

Jenny said: “Implementation was complex and took time, there were lots of elements to the process and limited time to follow up to ensure remote monitoring was embedded, which meant homes didn’t always continue to monitor residents regularly.” These variable outcomes led to the development of the Digital Implementation Support Advisor (DISA) role. This role was less technical than the DISLO and could engage prior to and post implementation to support the homes.

A new process was established with updated documentation and guidance. Jenny said: “It feels like our approach to implementation and the toolkit used could now be taken and used by any other ICS wishing to introduce remote monitoring in care homes.”

Embedding

Jenny reiterated one of their key principles: “We were working with care homes not ‘doing to’ care homes.” Some care homes were able to implement remote monitoring more easily than others, but this varied from borough to borough and was influenced by a variety of factors e.g. staffing availability, attitudes, culture or the type of care home.

The message was clear from Jenny: “Don’t expect care homes to turn up to a meeting just because it’s in their diary – their work place is unpredictable and extremely pressured. Always be prepared, ‘phone them beforehand, check everything is ok, be understanding and always be prepared to rearrange and start again. Maintaining supportive relationships with the care homes is key to the embedding of remote monitoring. System users have continued to increase month on month showing how successful this model of implementation is in sustaining change in care homes.”

The Future

NHS SWL plans to implement remote monitoring in 162 care homes, which is 47% of care homes across the system. Jenny remarked that there remains some uncertainty amongst the wider health and care system about the use of this technology in care homes and suggested that further work will be needed to understand the impact of this for partner organisations such as GPs and community services. This, plus wider digital integration with the health and social care record, needs to take place in order for remote monitoring to deliver its full potential for care homes.

Lisa Atik, Project Manager, SWL Integrated Care Board

Streamlining the digital implementation process & making it easy for everyone involved.
Lisa Atik

Summary of challenge

Lisa began work on Remote Monitoring in March 2022, having led the roll out of RESTORE2 in care homes previously. Lisa’s role was to manage the project from an operational perspective and she was tasked with simplifying processes where possible, as well as taking an overview of other digital transformation projects in care homes

It was perfect timing for me to come in because people had been doing things in a particular way and were ready to hear about ideas regarding making things easier.
Lisa Atik

At the time, care homes were being offered lots of different digital opportunities, without a coordinated approach. For example, DISLOs were tasked with implementing and embedding Remoting Monitoring, while DISAs were working on implementation of eRedBag – a digital emergency information pack – and supporting care homes to complete annual digital readiness survey to assess appetite for regarding digital technology.

A review took place, and one of the outcomes was an agreement that a new approach should be taken where a DISA role would work alongside the DISLO role.

Process of change

Over the following six months, Lisa worked with the team to streamline and simplify the process of taking care homes from not having Remote Monitoring to being fully functional and embedded. The team engaged with staff at all levels and looked at the whole cycle of change. It was quickly understood that updated, clearer and interlinked resources such as process guidance, training and communication were required.

Having new DISLOs join the team gave a great opportunity for new processes to be tried, tested and further refined following feedback. The result was a toolkit which defined six stages of remote monitoring implementation, developed with the intention that anyone starting a role without any prior knowledge could pick up what to do from the toolkit. All the documents needed for each stage were included in the toolkit so everything was at the DISLO’s fingertips:

Stage 1 and 2: Engagement and Service Agreement

Stage 3: Configuration Form

Stage 4: Personal Confidential Information Form and Training

Stage 5: Baselining and Go Live

Stage 6: Embedding

Interaction between DISAs, DISLOs and CDEs

The implementation model then focused on recruiting Digital Implementation Support Advisors (DISAs) and Digital Information, Support and Liaison Officers (DISLO) to work together in particular geographical areas. The DISAs and DISLOs shared their soft intelligence and knowledge of the care homes to improve relationships which in turn enabled the team to more effectively bring multiple digital projects into one large integrated programme.

The DISAs revised role was to engage with individual care homes and develop staff interest in digital integration. Once a care home has been identified as being ready to start remote monitoring, the DISA would hand that care home over to the DISLO, the remote monitoring experts, who would implement and embed the vitals monitoring kit (the remote monitoring technology). Once the care home had been fully embedded (usually defined as 8 weeks post “go live”) and was using the kit, the DISLO would hand the care home back to the DISA for ongoing check-ins and support.

If the care home required further technical support, then the DISA would ask the DISLO to re-engage with the care home until the care home felt confident and able to continue.

A training programme is in place to support the continual development of the DISA and DISLO roles.

Lisa was also instrumental in developing the Clinical Digital Educator (CDE) role, an outreach role providing digital and clinical training to care home staff, to increase their skills and confidence in the use of health-related digital equipment. The CDEs are also competent with RESTORE2 – a tool used by care home staff to identify early signs of deterioration in a resident’s health – which care home staff had been trained on during 2020/21. The role of the CDE is to support the care homes and the staff to be able to use the vitals monitoring kit, understand the benefit of it and to provide all the necessary training associated to use it. This includes NEWS2, RESTORE2 ‘refresher’ and new starter training as well as the technical training associated with the kit.

To provide assurance and governance, meetings between DISAs, DISLOs and CDEs take place at Place level, to monitor progress against the plan and agree next steps. The soft intelligence gathered at these meetings is then fed into future digital planning.

Lisa also stated that bringing all levels of the project together to understand what worked and what didn’t was essential, whilst continually testing the changes made to ensure systematic improvement.

Paula Green, Senior DISLO (Kingston & Richmond), SWL Integrated Care Board

Supporting the transition to digital, tailored to the care home’s needs.
Paula Green

Paula works as Senior DISLO in Kingston & Richmond, having previously worked in Macmillan Cancer Support, and the Department of Health and Social Care. She reflected on her experiences supporting care homes with remote monitoring.

Understanding care homes at ‘place’ level

Paula said that the introduction of fortnightly Place meetings brought together all of the digital projects and personnel working with care homes in that Borough and this supported a joined-up collaborative digital approach to each home.

Following on from this, Paula noticed improvements in staff confidence and more effective working relationships. “By working together, we removed duplication and identified issues whilst instilling a ‘one size does not fit all’ ethos, which meant digital offers to care homes are now tailored to the home’s capacity and needs”.

By working together, we removed duplication and identified issues whilst instilling a ‘one size does not fit all’ ethos, which meant digital offers to care homes are now tailored to the home’s capacity and needs.
Paula Green

Increasing the spread and adoption of digital projects in care homes

Paula felt that having dedicated DISAs, DISLOs and CDEs in each borough has helped stimulate the spread and adoption of remote monitoring. Paula said: “You get to know your patch and they know who to contact for support”. The training model offered, which was once only virtual, have been adapted depending on the care homes’ size, type and complexity. For example, larger care homes are now trained face-to-face and in phases, allowing for more time to ensure embedding takes place, alongside support from the Clinical Digital Educator.

Continuing challenges

Paula mentioned that there is sometimes an assumption that everyone is digitally aware and familiar with the some of the terminology/jargon in use, but that this wasn’t always true for some care homes. Paula said: “We needed to be clear with the language we used and not assume care home staff are familiar with and confident to use IT. For example, not everyone knows what a Mi-Fi dongle is and how it works so we had to provide clear information about these solutions and encourage questions to ensure understanding.

There were also language barriers, and the merging of systems to consider.

Maintaining contact with care homes was also a challenge, and with regular staff turnover and the continuous presence of Covid-19, there was always a risk that homes disengaged. Some small care homes posed even greater challenges, as Paula described: “Some homes only have 1 or 2 beds and have always used paper, and do not plan to invest in anything digital. Some very small homes don’t even have Wi-Fi at the moment.”

What might the future look like?

Paula feels the spread of remote monitoring will continue and offers great benefits for staff and care home residents. Mental Health and Learning Disability homes are now beginning to transition to remote monitoring alongside Residential and Nursing homes. These homes would typically provide care to younger cohorts and conduct fewer vital signs checks, but Covid-19 has led to some homes embedding a culture of routinely measuring residents’ temperatures, as they came to see the potential benefits. Paula explained: “it was identified through the regular monitoring of a resident in one mental health care home, who suffered regular seizures, that their temperature would go up just prior to a seizure.”

A future improvement would be greater integration between IT systems used in care homes. For example, remote monitoring suppliers are progressing integration with two widely used Digital Social Care Records (DSCRs) systems as well as with the primary care software provider.

Daniel McNamara – DISLO (Croydon), SWL Integrated Care Board

Daniel works as a Digital Integration Support and Liaison Officer (DISLO) in the south London borough of Croydon. He said “I’ve really enjoyed the role and the training and development has been brilliant.”

He remarked that his role changed substantially in a short space of time from initially working in isolation, to working in a coordinated way with DISAs.

His tasks involved on-boarding the care home throughout the 6 stages of remote monitoring including organising induction training, and then refresher training and/or train the trainer sessions when required.

Reflecting on his time in the role, he said that a vital component was liaison work between the different stakeholders when complications, issues, or concerns were raised by care home staff or the digital team. He recalled an example where a care home stopped using remote monitoring and returned to using manual, paper recordings as they were experiencing difficulties with certain aspects of the digital system. Daniel was able to trouble-shoot and after further liaison and training with the staff, the home returned to using the remote monitoring technology.

Ongoing monitoring

Daniel said that a dashboard had been set up so that DISLOs could identify trends in the use of the remote monitoring technology. Vital sign readings were also reviewed regularly by the programme and project managers, DISLOs, DISAs and CDEs to monitor whether the equipment was being used and to identify homes who might be having issues.

The future

Daniel remarked: “Care homes are amazing and digital is the future for this sector”. He felt enthusiastic about his prospects in the role, as well as the future of digital technology in Care Homes in general, citing a new Sensor-based Falls Prevention and Detection pilot that was underway.

The Care Home Managers

Rikesh Halkoree, Manager – Grange Cottage Residential Home, Sutton

Remote monitoring helps us do our jobs.
Rikesh Halkoree

About the Care Home

Grange Cottage is a 33-bed residential home in Sutton providing care for older people.

The home ‘went live’ with Remote Monitoring in July 2022 and have carried out monthly observations for residents since then. The home’s GP has access to view the data captured by care home staff using remote monitoring technology.

Benefits of remote monitoring for residents and staff

Rikesh said that staff felt that the Camascope App, system and equipment were easy to use, despite initial challenges. Staff like how the system automatically calculates the NEWS2 score (National Early Warning Score used to standardise the assessment and response to acute illness) and provides a risk level with colour recognition as this provides reassurance to the staff.

The efficiency and clarity of the Camascope system when staff are taking physical observations has facilitated the communication of risk internally with senior staff and management.

It has helped embed a clear escalation plan. Staffing confidence levels and decision-making capabilities have notably improved, [along] with resident care.
Rikesh Halkoree

The availability of the Clinical Digital Educator to help answer any questions related to the remote monitoring tool as helped them use the tool effectively.

Furthermore, the simplicity of the App and Camascope equipment means that experienced users are able to provide peer training to new colleagues.

Early challenges

Rikesh mentioned some initial difficulties during the first training session when the technology was being introduced to staff but that a second training session, and some additional embedding support from the DISLO, ensured the home got back on track.

Some early technical issues were also experienced e.g. the blood pressure monitor did not always sync with the tablet, but this was soon rectified.

Early on, GPs could not see readings via the web portal function, so residents’ readings needed to be conveyed via email or phone temporarily. However, this did not deter the GP surgery who worked with Camascope to resolve the difficulty.

Added benefits

Rikesh also highlighted the impact the technology had had on staff motivation: “My staff members have developed more confidence in communicating with healthcare professionals outside of the organisation and this has enhanced employee motivation. In addition, sharing knowledge and skills of using the Remote Monitoring System with new staff has instilled positive feelings of autonomy and responsibility within individual job roles.”

Irshad Maudarbacus, Manager – Roselands Residential Care Home, Norbury

I know physical health vital signs are not being missed. Camascope tells me when observations were taken and at what time.
Irshad Maudarbacus

About the Care Home

Roselands is an 18-bedded residential care home looking after people predominantly over 65 years of age. It specialises in the care of people with Alzheimer’s, Bipolar Affective Disorder, Dementia, and Schizophrenia.

Roselands Care Home started using Camascope in September 2020.

Benefits of remote monitoring for residents and staff

Irshad explained that prior to the introduction of the Camascope equipment, staff would take and record observations manually, then use these to calculate the National Early Warning Score (NEWS2), and record this in the residents’ electronic records. However, vital signs were not always being taken, and Camascope helps with this as it tells me when observations are taken and at what time. Plus, because the tool automatically calculates NEWS2 scores, iit potentially eradicates errors that could arise when calculating manually, meaning staff get time back to focus on their clinical duties. I now know physical health vital signs are not being missed.”

Staff like the way that Camascope can be used to generate reports, so clinical information can be printed off and shared with residents, their family members, and healthcare staff. He highlighted how the reporting function also enables him to demonstrate to partnering organisations and stakeholders how quality and safety standards are being met.

Practically, strong Wi-Fi access is essential to support the implementation of Camascope, and Irshad said that portable Wi-Fi devices provided by the South West London Digital Integration in Care Homes Team had been very helpful in ensuring that Wi-Fi was available across the home.

Regarding the ease of implementation, Irshad said that staff welcomed the introduction of Camascope, and that it took off from day 1. Shift leaders were trained first, and then they trained their staff at a convenient time.

Important success factors

Irshad stressed the importance of providing an easy ‘how-to’ guide for staff at all levels and keeping access to the Camascope system as simple as possible, as some staff had reported problems remembering their passwords.

Thoughts about the future of remote monitoring in care homes

Irshad said he would recommend remote monitoring equipment to other care home organisations, Irshad said: “For a smaller care home like Roselands, it can make a big difference to the quality of care and the experience of providing care for the staff members involved.”

Grace Nabus, Manager – Coombe Hill Manor Nursing and Residential Care Home, Kingston-Upon-Thames

The readings on the apparatus are great for sharing with other internal and external professionals.
Grace Nabus

About the Care Home

Coombe Hill Manor Residential Care Home in Kingston-Upon-Thames is a four-storey care home with 94 beds, caring for older people.

The home started using Camascope in June 2022.

Benefits of remote monitoring for residents and staff

Grace said that staff found the monitoring kit very easy to use and to transport between different areas and floors in the home. The way it automatically calculates NEWS2 scores was also welcomed as this can be challenging when done manually. Staff also like how the system centrally stores and analyses the information, and the way readings are clearly displayed as a baseline for each resident.

Grace said: “The readings on the apparatus are great for sharing with other internal and external professionals.”

Grace also mentioned that Camascope’s alert system was a reassuring feature for staff as it warns them of a potential

deterioration in a resident’s condition and acts as a prompt to seek further advice from the GP.

A further benefit is that the care home’s GP can access the residents’ observations via the Camascope web portal which could enable a remote review of the resident if clinically appropriate, thereby saving time for everyone.

Grace said it has been helpful to have clinical staff on hand to help support implementation of remote monitoring tools.

Implementation challenges

Another technology (vital sign monitoring equipment) had been put in place in the home prior to Camascope and it was proposed that this could be used alongside the Camascope kit. Grace felt that this had reduced the enthusiasm amongst staff as they required additional training. In hindsight, Grace felt that it would have been helpful for Camascope equipment to have totally replaced previously used equipment and training to be in place prior to the introduction of Camascope. She said: “Some staff needed to be sold the benefits, because when they realised what it can do, they were supportive.”

Grace highlighted potential issues in relation to implementation in larger care homes that had multiple units for both physical and mental health. She said: “We have had to train the home floor by floor which has led to confusion and delays in the estimated time to embed a more digital way of working.” She felt her staff and those at other large care homes would benefit from greater time and support during the implementation stages, and a staggered approach was suggested to support staff when being trained to use the equipment and software.

Grace also commented that having a longer battery life on the Camascope Monitoring Kits would be a helpful improvement.

Grace stressed that good Wi-Fi is essential. She had appreciated support from South West London’s Digital Integration in Care Homes Team who had provided portable Wi-Fi equipment.

Thoughts about the future of remote monitoring in care homes

Overall, Grace said that her staff felt positive about the benefits of remote monitoring. In summary, Grace said: “It’s very easy to use. The future is digital.”

Marie Bannister, Manager, Sutton Court Care Home, Sutton

Despite initial challenges, the system is good and it works.
Marie Bannister

About the Care Home

Sutton Court Care Home is a 63 bed residential care home, caring for residents with a range of conditions including dementia, general mental health conditions, palliative care needs, cancer and Parkinson’s Disease.

Camascope was implemented in the home during the covid pandemic.

The implementation experience

Marie said: “The Covid-19 pandemic devastated the care home and we sadly lost 20 residents. During this time, Sutton Court learnt a lot around digital communication.”

She said that staff had felt that Camascope was very important in logging and sharing information about residents with the healthcare team and that introduction of Camascope allowed staff to have more time delivering care, and less time spent writing and uploading recordings onto a resident’s clinical records.

Training to support the use of Camascope had been cascaded to new staff through a “train the trainer” approach. Senior staff members were initially tasked with supporting less experienced and newly recruited staff, but now the responsibility has cascaded to all staff to ensure usage continues correctly and effectively.

The Clinical Digital Educator in Sutton had supported the home with clinical queries.

Marie reported that the expertise and support from the South West London Digital Integration in Care Homes Team had helped smooth the implementation of Camascope, by ensuring there was effective Wi-Fi throughout the home, as well as using the equipment and troubleshooting issues (such as entering baseline data manually, synchronising the equipment, and accessing the Camascope dashboard).

However, Marie said: “Despite initial challenges, the system is good, and it works.” If a patient deteriorates under Camascope observation, staff are alerted through its internal alert system, which prompts staff to contact the resident’s GP. This allows deterioration to be identified earlier and escalated only when necessary.

This had improved the relationship and communication with the care home’s GP. Marie explained further: “Covid-19 made it even more challenging to see a GP. Liaising via email and telephone quite regularly was extremely time-consuming. Camascope has helped our staff communicate directly with the GP, and raise concerns through its interface, reducing time spent composing emails or conducting telephone calls.”

Challenges

Initial teething issues were experienced, including staff members having difficulties establishing baseline data for some residents. They also had to get used to checking the equipment regularly to ensure it remained charged when it was synchronising with the online web portal to upload data.

The future for remote monitoring in care homes

Marie concluded that she hoped that the use of digital monitoring would continue, and that the technology could also be extended for use with emergency services and hospitals.

Key themes identified by Care Home Managers enablers, benefits and future improvements

Enablers

Planning

The importance of robust planning in advance of implementation was stressed by the care home managers.

Training

All the care home managers felt that accessible and high-quality training was essential. They pointed out the importance of factoring in sufficient time for this. It was suggested that the larger the care home, the more time is needed for training.

The method of delivering training varied depending on the needs of each home. It was important to plan the training to maximise attendance and minimise disruption to the service, and to ensure the training suits the skills and capabilities of the staff. A “Train the trainer” model can be useful for sustainability.

Increased capacity during implementation

Being able to “backfill” staff time during the implementation period was seen as important as some homes could not find the additional capacity to release staff for training.

Access to Wi-Fi

Stable Wi-Fi in all areas of the care home was essential. Some of the care homes used portable wi-Fi devices to facilitate this.

Support for culture change

Successful implementation of remote monitoring requires a culture change for many care homes as they transition from paper to digital systems. This can be a challenge for many staff and good leadership, support and encouragement are helpful.

Provision of external support, which was easy and rapid to access to address any issues or obstacles, was also valued.

One of the ways to increase support for the system could be by highlighting the benefits of the technology to staff and residents.

Benefits

Improved Staff Confidence

Care home managers and staff members reported that the introduction of remote monitoring devices improved staff confidence in handling clinical data as the Camascope device automatically calculates, uploads, and stores NEWS2 scores onto the digital portal.

Time saved

The care home managers felt that once embedded, Camascope was quicker and easier to use than the previous systems – giving staff time back to deliver direct care to residents.

All three care homes agreed that communication with the homes’ GPs improved. The “alert” function helped identify those residents where GP input was needed and there were fewer unnecessary requests to the GP.

Suggestions for improvement

The three care homes in these case studies all used the Camascope remote monitoring technology.

They suggested the following areas for improvement:

Provide a simple ‘how to’ guide for operating the equipment, viewing, and extracting data, and developing reports.
Extend the Camascope Monitoring Kit rechargeable battery life.
Enable the Camascope Monitoring Kit to establish baseline data for all vital sign readings.
Reduce the delay between recording vital signs and the data appearing on the web portal.

Acknowledgements

The Health Innovation Network are grateful to South West London Integrated Care System for their contribution to these case studiesFor further information about implementation of Remote Monitoring in Care Homes in South West London, please contact Viccie Nelson, Associate Director of Transformation.

Contact Viccie

Report summary: Evaluation of the South West London Children and Young People’s Emotional Wellbeing in Schools Programme

Background and context

The Health Innovation Network (HIN) Insights Team recently completed an independent evaluation of the Children and Young People Emotional Wellbeing Programme for South West London Integrated Care Board (ICB). This Programme aims to improve emotional wellbeing and mental health in children and young people. The creation of school clusters, each with a Mental Health Support Team delivered by a mental health organisation, is a key feature of the Programme. The Mental Health Support Teams deliver targeted evidence-based one-to-one and group interventions to children and young people in schools/colleges, and to their parents and school/college staff. They also support schools and colleges in developing a Whole School Approach to emotional wellbeing.

Key statistics

44% of all SWL state schools and all Further Education (FE) Colleges can access support from one of 16 Mental Health Support Teams (October 2022).
Mental Health Support Teams had over 500 contacts with children and young people, parents/carers and staff in the 2021-22 school year.
5,739 children and young people in SWL registered on the Kooth online platform providing access to emotional wellbeing support (between September 2020 and March 2022)
79% (162) parents and carers were positive about the ethos and environment around emotional wellbeing in their child’s school

Evaluation approach

The HIN’s mixed methods evaluation involved analysis of quantitative data and in-depth qualitative work with four case studies. 196 stakeholders took part in interviews and/or focus groups, and 226 completed surveys. Feedback was captured from across the system, including cluster leads, teachers, mental health service providers, children and young people and parents and carers. School staff who were not involved in the Programme were also interviewed to provide a comparison.

Figure 1 Eight principles to promoting a whole school or college approach to mental health and wellbeing[1]

[1] Source: Public Health England working with the Department for Education (2021) Promoting children and young people’s mental health and wellbeing. A whole school or college approach. HM Government. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1020249/Promoting_children_and_young_people_s_mental_health_and_wellbeing.pdf

Programme impact

The evaluation provides considerable qualitative evidence of positive change associated with the Programme. There is a general consensus that it has achieved improvements in the provision of support around emotional wellbeing in schools – for children and young people, parents/carers, and staff. Improvements were identified across the eight Whole School Approach domains. The increased capacity the Programme provided for additional support to cope with increased emotional wellbeing needs as a consequence of the COVID-19 pandemic, was seen as a specific benefit. Stakeholders from across the system were positive about the principle of the Programme and felt it should continue into the future, though most also suggested adaptations.

Evidence from quantitative data demonstrates a good deal of new activity aimed at improving emotional wellbeing in schools, most significantly the delivery of one to one and group interventions by the Mental Health Support Teams and access to self-help resources and direct support via the Kooth online platform. However, the impact of the increased activity around emotional wellbeing is challenging to measure quantitatively due to a number of factors, not least Covid-19.

Figure 2: Quarterly average number of referrals to each Mental Health Support Team (n = number of quarters data was available for). Source: SWL Integrated Care Board and the Mental Health Support Team Providers: SWL and St Georges NHS Foundation Trust (SWLSTG), Achieving for Children (AfC), South London and Maudsley NHS Foundation Trust (SLaM) and Off the Record (OTR).

Features of the Programme associated with success

The evaluation identified features of the Programme that were associated with the successes. There is a strong common theme around leadership and management running through these features. Additional funding had enabled provision of direct support to be increased through the Mental Health Support Teams. However, it was the availability of additional resources for leadership around emotional wellbeing in schools in combination with the governance mechanisms that had enabled an improved dialogue between schools and external organisations, including the ICB, local authorities and particularly, the mental health trusts. It was leadership that had driven improvements around system-level thinking about the mental health of children and young people in SWL.

In the first quarter of 2020/2021, 600 children and young people accessed mental health support through the Kooth online platform.

Areas for improvement

The evaluation identified areas for improvement that the Programme Steering Group have committed to review, including:

Programme level processes to systematically monitor success
Sharing information about the Programme across the school community, with children and young people, parents, and staff, to broaden understanding of the Programme and extend engagement
Flexibility in the Mental Health Support Team staffing model to address problems with recruitment and retention
Increased resources for central Programme management and support
Sharing learning around addressing challenges faced by schools in supporting pupils experiencing mental health difficulties beyond the remit of the Mental Health Support Team and actively engage with schools in co-producing an effective solution.

Download the full report here

A Magic Cure for the NHS? Prioritising Digital Innovations to Support NHS Staff

In December 2022 we hosted a roundtable discussion to explore the financial and operational complexities of implementing digital workforce technologies. This report sets out our recommendations and reflections to stimulate further debate.

Background

The Health Innovation Network (HIN) is a founding partner of DigitalHealth.London (DHL) which connects NHS staff, digital health companies and academics, to support them to improve the NHS and social care in London through digital technology. Since the Covid-19 pandemic, there has been a rapid uptake and adoption of digital and technological solutions used within the NHS with a particular acceleration of the use of digitally-enabled health services. However, it seems that digital workforce solutions have not had the same fast track adoption. There are a wide range of workforce solutions including:

improving employee well-being eg mental wellbeing apps, menopause support;
supporting organisational development and retention activities eg online soft skills training, automation solutions;
digitalising temporary staffing eg digital platforms to manage locum and agency staffing and collaborative digital staff banks across regions;
streamlining skills and competencies eg digital clinical competency record.

In early December 2022 the HIN and DHL hosted a roundtable discussion with stakeholders exploring adoption challenges, with a particular focus upon the financial and operational complexities of implementing digital workforce technologies. The roundtable was attended by 15 representatives from across industry and NHS stakeholders and generated an honest and interesting discussion on:

How can digital workforce innovations be prioritised amongst significant operational pressures?
What are the main challenges of embedding digital workforce solutions?
What are the opportunities for using digital solutions to optimise the use of temporary and flexible staffing?

This paper intends to stimulate the debate, whilst setting out the key opportunities and challenges for the NHS to make the most of the potential for fundamental improvements offered by digital tools. Seven recommendations from the roundtable are included.

The HIN would like to thank all those who attended the roundtable and shared their valuable insights.

A list of participants in detailed in the appendix.

Current NHS workforce challenges

The health sector is facing a deepening workforce crisis, which has been exacerbated by the Covid-19 pandemic. The latest NHS Digital vacancy statistics showing both overall and nursing vacancies at record high levels of 9.7 per cent and 11.8 per cent respectively. The recent BBC report revealed a rise in agency spend of 20 per cent to £3bn last year^[1], and the latest NHS staff survey detected worsening results in a number of areas including care standards, workload, burnout, resilience and morale, feeling valued and pay satisfaction.^[2]

For the first time in history, the Royal College of Nursing’s members are taking part in planned strikes to demand fair pay and improved patient safety. Ambulance workers in parts of the country are striking over pay and NHS physiotherapists have recently been on strike.

While there is no silver bullet to solve these multi-faceted problems, the NHS will need flexible and innovative approaches to tackle the workforce emergency and the dire consequences it is having on its staff. The HIN and DHL are keen to help the NHS harness the potential of digital workforce innovations and we have set out seven recommendations following the roundtable discussion that address these issues.

Prioritising digital workforce innovation at a time of significant pressure

Demand for NHS services was already exceeding capacity before the Covid-19 pandemic, with growing waiting lists for emergency, routine and cancer care. Covid-19 has exacerbated the crisis, with the latest data showing a record number of 7.2 million patients waiting for consultant-led elective care, 2.9 million waiting over 18 weeks and over 410,000 waiting over a year for their treatment.

The performance target (93 per cent) for patients to be seen within two weeks of an urgent referral for suspected cancer was last met in May 2020 and has since dropped to 77 per cent in October 2022. The number of GP referrals to consultant-led outpatient services via the NHS e-Referral Service (e-RS) that have been unsuccessful due to lack of capacity has increased by 87 per cent. ^[3]

If the NHS is to meet its current and future operational challenges, it is imperative to look at evidence-based digital workforce solutions; whether that is improving the resilience and mental wellbeing of our workforce, or streamlining skills training to make their jobs easier.

A common barrier to digital adoption is that operational teams are constantly “fire-fighting” crises due to increasing demands. Operational and clinical leaders have insufficient time or headspace to focus on how digital solutions could contribute towards improving workforce processes, retention or the overall well-being and morale of our NHS staff. Workforce-focused innovations should be considered by decision-makers as enablers that contribute towards tackling increasing operational pressures, not as a “nice to have”. There needs to be a shift in paradigm away from focusing solely on finding and recruiting more staff to one where digital solutions for the workforce are recognised as part of the solution.

Furthermore, digital transformation projects often fail to adequately involve operational and frontline staff who have a critical role in successful implementation of solutions that benefit the workforce or make workforce processes more efficient. This can be addressed by clearly defining their problem areas and using regional AHSNs to help identify and review relevant innovations on the market.

Recommendation 1

To allow time and “head space” NHS organisations should prioritise and realise the return on investing in this important engagement. They can do this by providing protected time for frontline operational staff and clinical champions to co-design and implement digital workforce solutions. Maximising the support that AHSNs can provide will help to reduce the time required for frontline staff to contribute and make the process efficient as possible.

Taking a culture-change approach increases the likelihood of successful digital transformation for both staff and patients. Successful transformation programmes demonstrate the crucial role that clinical leaders have in enabling adoption of technological innovations into routine clinical care. If there are time and resources ring-fenced, clinical digital champions can support their frontline colleagues and guide them through the implementation. By embedding co-design principles within transformation programmes, digital champions can easily explain the benefits of digital and technology solutions whilst engaging others in design and implementation. This approach increases the wider acceptance by members of the team. For example, if you are rolling out a digital solution that defines and measures clinical competencies for a patient pathway, designing with the right clinicians will increase likelihood of adoption.

Recommendation 2

Harness and legitimise the staff with an “innovation mindset” who see opportunities for challenging the status quo and have the passion to drive innovation for patient and staff benefit. These internal innovators should be celebrated as pioneers and encourage wider digital champions across teams.

Demand for flexible working

It was reported that many clinicians are choosing to leave the profession or feeling forced to join bank or agency work to regain some autonomy over their working lives. Between June 2021 and June 2022, the NHS saw a 25 per cent increase in the number of nurses leaving their role. That equates to 7,000 additional nurses leaving the NHS.^[4]

In order to boost staff retention, organisations are seeking ways to become an employer of choice and reduce the pressure felt by many frontline professionals through solutions such as digital staffing banks and self-rostering platforms which can provide job flexibility. This enables clinicians to retain their permanent NHS positions whilst also being able to easily access opportunities to work extra shifts like the flexibility afforded to locum and agency staff.

Recommendation 3

NHS providers should maximise the opportunities that digital solutions provide to increase staff retention and attract clinicians by providing more flexibility of work patterns, overtime etc through the use of technology.

Adoption challenges of embedding digital workforce solutions

NHS bureaucracy slows down or drives innovations away

Even when NHS commissioners and providers are interested in commissioning digital solutions, the bureaucracy of NHS procurement procedures are seen as major deterrents for companies. The rapid roll-out of the COVID-19 vaccine and the use of the NHS app has demonstrated that the NHS has the potential to adopt at a pace not previously considered possible. We need to learn from these lessons and the government recently announced they are building on the Vaccine Taskforce model to harness world-leading research expertise and remove unnecessary bureaucracy to support the Life Science Vision for the UK. The government recently announced they are building on the Vaccine Taskforce model to harness world-leading research expertise and remove unnecessary bureaucracy to support the Life Sciences Vision for the UK^[5]. If a digital solution is validated and demonstrates impact, it should be fast tracked for adoption at a wider scale.

Recommendation 4

Standardise and streamline the procurement process for commissioning digital solutions, to enable wider adoption at ICS level rather than in the piecemeal way that currently exists. Both NHS organisations and innovators should have the flexibility to enable faster and wider roll-out.

Cashable benefits and efficiency savings

As with many innovations it is difficult to demonstrate in-year cash releasing savings for digital workforce solutions. However, companies need to better understand and address priorities and challenges for NHS organisations. Often, companies prioritise spending their resources on the integration of their digital and technology solutions with existing IT systems rather than building the business case for demonstrating how their innovation creates savings and prioritising time and resources to understand the financial challenges facing the NHS.

Sometimes demonstrating savings robustly can be challenging for workforce solutions compared to other digital and technology solutions adopted within clinical care. Companies should frame their business cases for digital workforce solutions around quantifiable benefits: for example, detailing how their solution saves x minutes of nursing time or how a health and wellbeing solution reduces sickness or retention rates by x per cent. Many digital innovations will generate workforce efficiencies but often these results are not clearly articulated or evidenced.

Recommendation 5

Companies need to identify and understand the financial pressures of NHS organisations and better articulate how their workforce solution will deliver efficiency savings.

Interoperability with existing electronic staffing systems

Minimal progress has been made on interoperability with NHS workforce systems such as the Electronic Staff Record (ESR) compared to the integration of electronic patient records. Lack of interoperability is a major hindrance when software suppliers are not providing the necessary application programming interface (APIs). For example, if competencies are not recorded in a staff member’s electronic record this could create additional bureaucracy for that staff member. Some suppliers demand significant reimbursement to open their APIs, making interoperability unrealistic.

Recommendation 6

NHS stakeholders and national policy makers at NHS England / NHS Digital should ensure that the systems such as ESR have open APIs. For example, the procurement of the replacement for the Electronic Staff Record should detail open APIs as a requirement in the specification.

Digital literacy

Health Education England’s evidence^[6] suggests that people who have better digital literacy tend to have more positive attitudes and behaviours when it comes to adopting new technologies. A lack of confidence can prevent use of technology and often staff have difficulty securing time during work to undertake online learning or explore the use of emerging digital workforce solutions. Improving access through flexibility to digital training or onboarding and allowing time for the development and improvement of digital capabilities are all essential to improving digital literacy and ensuring digital inclusion across the NHS workforce.

Recommendation 7

Digital inclusion and time for digital skills training or onboarding needs to be embedded into rolling out solutions. This should take place alongside involving staff at all levels in the development and testing of the solution, to reduce the risks of failure that are normally associated with adoption of innovation within the NHS. To make solutions accessible for all staff, provide bite-sized or micro training that is embedded into their everyday work practices rather than taking clinicians away from frontline care.

Conclusion

The adoption of digital workforce solutions within the NHS provides a real opportunity to address some of the workforce challenges facing the NHS in 2023. These innovations should be seen as a core part of the solution rather than as optional way to address the challenges. There needs to be renewed thinking about digital solutions to support, train and provide flexibility for our staff in order that they can continue to provide excellent patient care through the NHS.

Read the report as a PDF

References

^[1] https://www.bbc.co.uk/news/health-63588959

^[2] NHS Survey Coordination Centre. NHS staff survey 2021: national results briefing. Mar 2022.

https://www.nhsstaffsurveys.com/static/423ee2faa3495b47585ce70d25dc4a92/ST21_National-briefing.pdf

^{^[3]} https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis

^{^[4]} King’s Fund (2022) The NHS nursing workforce – have the floodgates opened?

^{^[5]} https://www.gov.uk/government/news/government-to-use-vaccine-taskforce-model-to-tackle-health-challenges

^{^[6]} Improving Digital Literacy, Health Education England / Royal College of Nursing

Appendix

The roundtable discussion was attended by:

Adam Igra	Director of Innovation and Incubator	Centre for Innovation, Transformation and Improvement, GSTT
Sara Nelson (chair)	Programme Director	DigitalHealth.London
Ruth Bradbury	Senior NHS Navigator	DigitalHealth.London
Nick Bennett	Co-Founder & Co-CEO	Fika
Dr Amanda McNamee	Senior Mental Fitness Scientist	Fika
Lesley Soden	Programme Director – Innovation	Health Innovation Network
Lavinia Pamparau	Project Manager- Innovation	Health Innovation Network
Louise Brennan	Head of Service – Graduates into Health	Health Innovation Network
Dr Agatha Nortley-Meshe	Regional Medical Director for Primary Care (London)	NHSE
Roseanna Cawthorne	Innovation Adoption Education Programme Lead	NHSE IRLS
Steve Tolan	Allied Health Professions Lead	NHS England – London Region
Dr Anas Nader	CEO & Co-founder	Patchwork
Tiba Rao	Director of Innovation & Co-founder	Soar Beyond
Lorissa Page	Programme Director – Workforce, OD and HR, SWL ICB	SWL ICB
Jonathan Knight	CEO	Tefogo (Compassly)

Health Innovation Network Involvement Strategy 2022-2025

We want to work in partnership with people in south London to achieve our mission of speeding up the best of health and care together.

We believe that, by sharing their insights and knowledge, people with lived experience of health and social care services can help us to improve and innovate health and social care.

The Health Innovation Network (HIN) has a history of involvement and co-design activity and we want to build on this and create a more embedded and consistent approach.

This strategy, and the plan that will deliver it, has been co-developed with people with lived experience and HIN colleagues, other partners and stakeholders.

Introduction

This strategy represents a reset in our thinking and a moment of renewed effort to co-produce health innovation.

Our experiences of the last two years, and recent conversations with people with lived experience of health and care, have given us a new perspective. The COVID-19 pandemic has further exposed the importance of innovation and improvement, including digital experience.

Since the HIN formed in 2013, our project teams have tried lots of great ways of involving people in our work and intend to build on this learning and energy.

It is of prime importance that our work improves the health and care outcomes for the diverse populations within south London and reduces inequalities. We want this belief in equality, diversity and inclusion to be enshrined in our approach to involvement.

Development of this strategy has involved an open and honest look at both the psychological and practical barriers to involving people and co-production within the HIN.

We are fortunate in that we have an experienced team, people throughout the organisation with knowhow, a committed leadership, and an openness to learning and trying new approaches.

We want to build on our local connections and encourage more organisations and people to join us in our work.

Involvement: why does it matter to the Health Innovation Network?

Involvement is a critical factor in enabling our organisational priorities. Through effective involvement, we can:

Ensure the voice of people who live and work in south London is embedded in the selection of national innovation priority programmes, and their local translation.
Prioritise the outcomes that matter to people to be integral to our health and care change programmes.
Begin with the needs of people who use services as the starting point for the adoption of innovations.
Include the personal experiences of people and communities in evaluating the effectiveness of innovations in real-world settings

Development

We have brought together over 65 people from across south London: people with lived experience of health and care, HIN colleagues, partners and other stakeholders to explore:

• Why involvement and partnership with patients and the public is integral to the HIN and what we need to do to strengthen this.

• How we can cultivate meaningful involvement and partnership with patients and the public.

• How we can move to a more structured approach, with involvement and co-development embedded in our work.

• What would a successful community of people supporting involvement look like.

• How we can strengthen involvement in the decisions we make as an organisation.

Our strategy

Who

Alongside Health Innovation Network staff, our strategy is also relevant to our partners and the wider health and care ecosystem, including:

People who live or work in south London
Patient groups and Community and Voluntary Sector
HIN member organisations, including health and care organisations across south London, academia, local government and industry partners
Innovators; organisations and individuals helping health and care to advance and improve
National and other stakeholder organisations, including the AHSN Network
Funding bodies

Why (our Involvement Values)

Our Involvement Values closely align to the values which guide the Health Innovation Network’s mission:

Brave: We encourage and support our colleagues to be open and willing to change as a result of involving people
Kind: We care about our communities and want people to have a positive experience when they work with us.
Together: Our core belief is that we can close the health inequalities gap by including diverse communities in the design and development of innovations.
Different: We find strength in our differences and are committed to involving people with a multitude of perspectives so that we can identify areas to improve and try new things.
Open: We’re open about what we do, and we continuously share what we learn with those who have been involved and helped us to make a difference.

What (our Involvement Principles)

Ensure that involving people is embedded in all our work.
Embed our belief in equality, diversity, and inclusion in our approach to involving people.
Extend the profile and influence of people’s voices in the decisions we make as an organisation.
Build on our local connections and inspire more organisations and people to partner with us in our work.
Demonstrate where involving people has made a positive difference.

Involvement at the Health Innovation Network

At the HIN, we seek to understand, design and improve the experience of health and care for staff, service users and their families. This requires a deeper understanding of people’s experiences in order to improve things. Some examples of this include:

Psychologically Informed Collaborative Conversations (PIC-C)

Psychologically Informed Collaborative Conversations (PIC-C ) is an online training programme for physiotherapists. People with lived experience were included throughout the programme, helping to co-design the project from the start. They also helped to design the training materials as well as supporting with evaluation and dissemination of learning.

Find out more about PIC-C in our full project report.

Diabetes patient reference group

We have developed a diabetes patient reference group, making a personal connection with the members to gain a better understanding of the areas of diabetes care they each have a particular passion for. This has allowed us to work more effectively with them in the future with pieces of work that most suit their experience and interests.

Find out more about ongoing diabetes work.

DigitalHealth.London support for innovators

DigitalHealth.London provides advice, mentoring, education, peer networking, brand awareness and partnership opportunities, to digital health leaders who are tackling the biggest challenges facing patients, and NHS and Social Care staff.

Support delivered through DigitalHealth.London’s programmes often includes guidance on effectively involving people and communities. For example, DigitalHealth.London supported Peppy (a menopause support service) to engage with the Black Mums Matter Too campaign, recruiting 200 Black mums and mums-to-be to access the app for free.

Feedback was gathered from participants to inform the service, including positive feedback around black mums being cared for by black practitioners.

ESCAPE-pain

Many of our evaluation programmes work with patients and the public to design the evaluation and to collect feedback on services, incluing ESCAPE-pain, a rehabilitation programme to help people manage chronic knee and hip pain.

110 interviews were completed with people to understand their experience of ESCAPE-pain. A survey was also undertaken with 200 participants to understand the impact of the service on health service utilisation and economic activity.

HEAL-D

HEAL-D is a type 2 diabetes education programme designed to challenge diabetes-related health inequalities in African and Carribean communities.

Through a co-design process, HEAL-D has developed into an accessible, culturally-sensitive programme that helps people from African and Carribean communities develop their self-management skills and achieve their health goals.

HEAL-D is currently being scaled up for wider adoption; co-design and collaboration will continue through a lived experience reference group.

Find out more about our Involvement Strategy in the video below:

Need support with involving people or communities in your health and care project? Get in touch with the team.

Get in touch

To sign up for our Partners with People newsletter and hear more about involvement opportunities at the HIN, please contact Sophie Lowry, Implementation and Involvement Manager.

Contact Sophie

Protected: Communities of Practice Leadership Development Programme 2023

South East London Cancer Alliance: understanding the personalised care market

Older man sitting on sofa with mobile phone

The NHS Long Term Plan states that every person with cancer should have access to health and wellbeing information and support before, during and after their treatment, making up one of the four personalised care interventions within the Plan. Information should be accessible and include advice on emotional support, coping with side effects, financial advice, getting back to work and making healthy lifestyle choices.

Covid-19 severely impacted the delivery of previously run face to face health and wellbeing events for people living with cancer. The South East London Cancer Alliance (SELCA) is committed to supporting the system through the provision of a multimodal health and wellbeing offer, which includes a digital component.

To help clarify this digital component, SELCA and the three other London based Cancer Alliances sought to understand the market for personalised care platforms applicable to cancer, enabling person centred decision making and improving patient management for clinicians. The focus for SELCA was to identify platforms that have the capability to provide tailored health and wellbeing support resources and information and integrate with clinical systems such as EPRs or the Macmillan Electronic Holistic Needs assessment platform.

SELCA’s aspiration was to offer patients an accessible platform that provided personalised information and care advice, including nudge reminders, to engage patients in self-management activities and support health and wellbeing behaviour change which would deliver better outcomes. It was believed that patient engagement would be increased through a platform’s ability to integrate with cancer services’ oncology patient records and processes and use this data alongside data entered by patient on the platform to effectively tailor responses and content to the individual.

The work had three core purposes:

Consolidate market information

Enable clinical and project staff to navigate the market and better manage engagements with companies that approach them.

Assess the current market

Identify and compare solutions that deliver personalised care in the context of cancer services. This work explored the capabilities and commercial offerings of platforms and standalone solutions (e.g. apps) which supported service delivery and patient self-management.

Inform future personalised care module development

Conduct market engagement and explore the adoption of similar technologies in other parts of the health system, ensuring proposed solutions were fit for purpose.

Project approach

Project brief
Project brief defined with SELCA

Define inclusion criteria
Inclusion criteria agreed and used to define parameters of scope for the research carried out.

Desktop research
Desktop research carried out, identifying solutions which met the majority of the inclusion criteria set.

Engagement with NHS/AHSN system
Engagement with researchers/NHS providers active in this area of work to gain relevant insights on transferable practice and solutions currently in use. London Cancer Alliances were asked to submit a list of solutions they had knowledge of and were interested to gain further information on.

Shortlist suppliers against inclusion criteria
Suppliers were shortlisted against the inclusion criteria based on information found online and through engagement with the SELCA team to understand priorities (setting information provision as the key criteria)

Explore and review solutions
Functionality and appropriateness were explored through interviews with suppliers as well as follow-up emails for clarifications.

Market overview

Infographic showing summary of main recommendations

Summary of recommendations

Recommendations have been categorised into provider, system, and patient perspectives to provide insights specific to these key stakeholders. The main recommendations from each perspective are as follows:

Providers: The evidence for use of personalised care support platforms in cancer services is currently limited, and therefore health care organisations should look to pilot solutions at a local level to understand the benefits. Benefits realisation will be particularly useful to identify the impact the solutions are able to provide for local populations, and the demographics and digital capabilities therein – providing understanding as to the types of patients who benefit from these platforms and the digital capabilities that people need to have to access and benefit from them. Providers should look to negotiate pilot contracts at subsidised cost with suppliers before procuring any solution. There are multiple interoperability factors to take into consideration, and solutions that can integrate with multiple clinical and patient facing platforms and devices (such as wearables, Macmillan’s eHNA) would be favourable.

System: Procurement of this type of solution helps systems to deliver against elements of the NHS Long Term Plan including: offering digital access to all patients; providing every person with cancer access to health and wellbeing support and information before, during, and after their treatment; and supporting self-management, (which is one of NHS England’s six core components of personalised care). Sharing costs or running joint procurements across organisations such as cancer alliances or Integrated Care Boards (ICBs) could deliver savings through economies of scale. A population based commercial model offers the opportunity to spread a common solution for all patients and staff within a system. Adoption of these solutions in their early stage of maturity presents an opportunity for systems to define for suppliers what is needed to ensure their products provide optimum experience and outcomes.

Patients: Given the premise of personalised care, apps that are developed with patient input are highly favoured. A patient led approach to piloting and adopting a solution could be taken at both a provider and system level. Training for patients should be offered to optimise compliance and use of these solutions.

“The HIN’s Digital Transformation and Technology team were easy to work with, taking a collaborative approach to shape the project, set objectives and realise our vision for the market review. They were able to engage the market and build relationships to draw out an indepth analysis of the individual products. They utilised their expert knowledge to produce a clear evaluation which will be useful in our work going forward. They remained communicative throughout the project so that we felt involved every step of the way, and have helped us to make connections with companies to explore future beneficial partnerships”
Samantha Tordesillas, Programme Manager for Personalised Cancer Care, South East London Cancer Alliance

Need support with a market review?

The HIN’s Digital Transformation and Technology team have extensive experience in producing market reviews for the healthcare sector, including public health, secondary and primary care.

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London Mental Health Crisis Hubs Evaluation Summary

In the first wave of the Covid-19 pandemic, London NHS mental health trusts put in place mental health crisis hubs to provide safe access to mental health crisis care without having to attend an accident and emergency (A&E) department.

A mental health crisis hub is a service for people who are experiencing mental health crisis, who would otherwise have to go to A&E. Mental health crisis hubs are not designed for people who need urgent care for physical medical conditions. People who need urgent physical healthcare will usually have to go to A&E to be treated initially.

Each mental health crisis hub was set up in a different way. This is due to the different population needs in each location.

In February 2022, NHS England and Improvement (NHSEI) London asked the Health Innovation Network to complete an evaluation with three aims.

To better understand the different mental health crisis hub models and their impact at a service user, carer, medical professional, and service-level across London.
To find out what factors affect the roll out and sustainability of NHS mental health crisis hubs.
Find out the core requirements for mental health crisis hubs to be effective for Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs) to use as an alternative to Accident & Emergency (A&E).

Evaluation design

The structure of the evaluation was based on the London Mental Health Crisis Hub Assessment Framework. This framework was developed in 2020, alongside an organisation called UCLPartners (an Academic Health Science Network like the HIN) and NHSEI London. It was developed for mental health crisis hubs in London to provide safe and efficient models of care for people experiencing a mental health crisis. The framework is informed by the Institute of Medicine’s (IoMs) definition of six key healthcare quality domains:

Safe
Timely
Effective
Efficient
Equitable
Patient Centred

A steering group was set up by the HIN to advise and guide the evaluation. It included three experts by experience (two service users and one carer), representatives from all nine London mental health trusts, the London Ambulance Service (LAS), Metropolitan Police (Met Police), A&E, London ICB representatives and NHSEI London.

The evaluation gathered different types of data, including numerical data provided by the Trusts and information from service users and staff surveys. Interviews were also conducted with service users and staff members from the London mental health crisis hubs, A&E, LAS, Met Police and the ICBs / ICSs.

Mental health crisis models

At the time of this evaluation there were three different types of mental health crisis hubs still running in London. They were all included in the evaluation.

Hubs offering direct access (not via A&E)

Mental Health Crisis Hub at Goodmayes Hospital – North East London NHS Foundation Trust (NELFT)
Mental Health Crisis Hub at St Pancras Hospital – Camden and Islington NHS Foundation Trust (CANDI)

Both CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) crisis hubs allows direct access to people who are in mental health crisis and their carers through self-referral, signposting from community services or via the emergency services (LAS and / or Met Police).

Hubs offering access via A&E

Mental Health Crisis Hub at Queen Elizabeth Hospital – Oxleas NHS Foundation Trust (Oxleas)

People in crisis would need to attend A&E at Queen Elizabeth Hospital to then be referred to the crisis hub. Oxleas (Queen Elizabeth Hospital) represents hubs that provide this type of model in London in this evaluation.

Services provided at A&E

As well as the three models listed above, an A&E service (also known as psychiatric-liaison service) was included in the evaluation. Including the A&E model allowed for comparison between a business as usual model, which has been running for many years, and the more recently set up crisis hubs. The A&E model used in this evaluation is known throughout the report as business as usual model and represents A&E models across London. The A&E model used in this evaluation is King’s College Hospital Psychiatric-liaison service at A&E. This service is provided by South London and Maudsley NHS Foundation Trust (SLaM).

Each service included in the evaluation provide a service 365 days a year, 24 hours a day.

Key terms

Heath Innovation Network (HIN): The Academic Health Science Network (AHSN) for south London. It is one of 15 AHSNs across England. An AHSN connects NHS and academic organisations, local authorities and third sector and industry, in order to increase innovations across large populations quickly.

Home Treatment Teams / Crisis Teams: Community-based service to help people experiencing mental health issues and who are in crisis.

Integrated Care Boards (ICBs): An NHS organisation responsible for developing a plan for meeting health needs in a certain area.

Integrated Care System (ICS): A partnership which joins together health and care organisations to improve services for people in their area.

NHS England and Improvement (NHSEI): Provides national leadership and support for the NHS.

Patient and Carer Equality Framework (PCREF): A framework which sets out the standard of care which patients and carers should expect. It is designed to ensure racial equality in the provision of services.

UCLPartners (UCLP): AHSN for North London to the Essex coast. It is another one of the 15 AHSNs across England (like the HIN).

Evaluation findings

Although it is relatively early in the lifetime of the two hubs that allow direct access (CANDI – St Pancras Hospital and NELFT – Goodmayes Hospital, which were set up around the Covid-19 pandemic two years ago), the evaluation shows that both hubs are providing a timely service that enables service users and carers to be seen on arrival by a mental health professional.

These hubs are seeing more people going directly to the hub themselves, rather than being referred by other services. The majority of service users who provided feedback said that they felt safe, had privacy, and were treated with kindness and respect by staff who had a good understanding of mental health. However, service users, staff, carers and stakeholders also gave their opinions on how the crisis hubs could be improved.

Key findings

Where possible and relevant, we have compared mental health crisis hubs to hospitals providing support via the traditional A&E route (the business as usual, or BAU, model).

Crisis hub set-up

Camden and Islington (CANDI – St Pancras Hospital) and North East London NHS Foundation Trust (NELFT – Goodmayes Hospital) offered direct access to crisis care for service users and carers
Oxleas (Queen Elizabeth Hospital) provided a model where service users were referred to the crisis hub via A&E
South London and Maudsley (SLaM – BAU site, King’s College Hospital) has a psychiatric-liaison service within A&E at King’s College Hospital

Staffing

Only CANDI (St Pancras Hospital) employed senior nurses within in their associated A&Es to help and direct service users to the crisis hub if that is the best place for them to receive support and treatment.
CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) crisis hub staff included those with physical health training, as well as mental health training.

Distance between hubs and A&E

Distance and ease of transport varied between all mental health crisis hubs and A&Es.

Safe

The majority of service users, carers and staff said they felt safe at the mental health crisis hubs.
The emergency services had positive views on the direct access to the CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) hubs. This included a reduction in service users leaving before receiving care.
There were concerns around the staffing levels at each hub and the impact that has on service user and carer safety.

Timely

At CANDI’s Hub (St Pancras Hospital), most of the service users were seen within four hours.
The length of stay was lower for NELFT (Goodmayes Hospital) and CANDI (St Pancras Hospital) hubs compared to the BAU model.
Service users who stayed in the hub longer than expected due to a lack of mental health trust beds were unhappy with the timeliness of the care.

Effective

Discharge

Service users experienced different discharge outcomes. The CANDI crisis hub (St Pancras Hospital) had a higher number of attendances that were discharged back to their General Practitioner (GP).
NELFT (Goodmayes Hospital) had a higher number of service users being discharged to a Home Treatment Team (HTT) or a Crisis Team.
NELFT (Goodmayes Hospital) had slightly higher rates of mental health inpatient admissions compared to the SLaM BAU site at King’s College London.
Oxleas (Queen Elizabeth Hospital) had higher numbers of referrals to mental health inpatient beds compared to the SLaM BAU site (King’s College Hospital).

Repeat attendance

Service users that re-visited CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) hubs, were significantly more likely to go direct to the hub themselves, rather than go to A&E.

Workplace satisfaction

Most of the staff were happy with their workplace, training and senior leadership.
Most of the staff felt they were treated with dignity and respect by their colleagues and would recommend their service to friends and family.

Efficient

Service users are being referred to the CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) crisis hubs through various sources, not just A&E.
Higher proportion of self-referrals at CANDI (St Pancras Hospital) and NELFT (Goodmayes Hospital) hubs compared with the BAU model.
High proportion of referrals via the police and Home Treatment Team (HTT) / Crisis Team at NELFT (Goodmayes Hospital).
Small proportions of crisis hub attendances were redirected to A&E.
The majority of service users felt they had received the treatment and care required.

Equitable

Age and gender

Age and gender of service users were well recorded at all sites and is similar between the hubs and the BAU site.

Race

One Trust recorded race well. This was NELFT (Goodmayes Hospital).
The BAU site had a higher number of black service users than all other crisis hubs.
NELFT crisis hub (Goodmayes Hospital) had a higher number of Asian service users than the BAU site.

Sexual orientation

One Trust had relatively well recorded sexual orientation compared to the other sites. This Trust was NELFT (Goodmayes Hospital).

Existing mental health conditions

A lower number of attendees at CANDIs crisis hub (St Pancras Hospital) had an existing mental health condition known to the Trust, compared with the BAU site.

Person centred

126 service users and carers completed a survey and nine were interviewed to inform this evaluation.
Most service users said they felt safe, and were treated with kindness, respect and dignity. They also felt they had privacy, that the staff had a good understanding of mental health, and felt listened to by staff.
Most service users who attended A&E reported they had to explain their story more than once and that their legal rights were not explained to them.

Recommendations

The recommendations below are intended to inform the key factors of an effective mental health crisis hub. A full list of 22 recommendations is available in Section 8 of the full report.

Mental health trusts should continually improve services using the London Mental Health Crisis Hubs Assessment Framework with the six key quality areas – Safe, Timely, Effective, Efficient, Equitable and Person Centred.

Safe

Mental health trusts need to collect and report safety data.

Timely

Mental health trusts should make sure mental health crisis hubs are easy to reach and are accessible.

Effective

Mental health trusts should consider having staff trained in physical health, alongside mental health professionals within the hub.
Mental health trusts should understand what happens following discharge to improve care for service users and their carers within the community.
Mental health trusts should gather regular feedback from mental health crisis hub staff for continued improvement.

Efficient

Integrated Care Boards should communicate to the public, service users, carers and service providers on how to be referred and access the mental health crisis hubs directly. They should communicate this through a variety of methods, eg posters, leaflets, email, texts and websites and should include why a person may be transferred from A&E to a mental health crisis hub.
Mental health trusts should consider developing a direct access route to mental health crisis hubs so people do not need to go to A&E first.

Equitable

ICBs to engage with the local community to ensure equal access to mental health crisis hubs for all.
ICBs to have culturally relevant discharge support services.
Mental health trusts to improve recording of service users’ ethnicity and sexual orientation.
Mental health trusts to give service users of all races and ethnicities the chance to feedback (in line with the Patient and Carer Equality Framework).

Person Centred

Mental health trusts should apply effective methods for regular feedback from service users and carers on their mental health crisis hub experience to drive continual improvement.
Mental health trusts should continually train staff to improve patient care. Where possible they should involve service users and community services in the design and delivery of this training.

Read the full report

This page was co-created with experts by experience – people with real-life experience of health and care services – to help make the report findings accessible to all.

Improving Diabetes Care in Inpatient Mental Health Settings

Diabetes is two to three times more common among those with serious mental illness than in the general population, which is why improving diabetes care across Mental Health Trusts is a priority.

Until recently Acute Trusts have been auditing diabetes inpatient care using the National Diabetes Inpatient Audit (NaDIA), in order to assess local practice, identify best practice and recognise improvements. However, despite the prevalence of diabetes among those living with serious mental illness, diabetes inpatient care is not currently audited within mental health inpatient settings.

Following a test pilot in Southern Healthcare NHS Foundation Trust (2017) and South London and Maudsley NHS Foundation Trust (SLaM) (2014), the London Physical Health Leads Network created an audit to assess diabetes inpatient care across all London NHS Mental Health Trusts.

The London Physical Health Leads Network is a partnership between the HIN, UCLPartners (UCLP) and King’s Health Partners (KHP) Mind and Body Programme.

A friendly smiling nurse talking to a patient who is in a hospital bed.

The audit found:

Eight out of nine Trusts do not have access to their own diabetes specialist resource.
Appetite among staff for more diabetes education for both staff and patients.
All Trusts need to ensure existing diabetes policies are fully implemented.
Trusts could do more to reduce errors, harms and identify additional health conditions that require medical attention.
Patient satisfaction was 3.63 out of five, however more can be done to improve patient centred care, especially in diabetes.

Findings have already been shared with the nine London NHS Mental Health Trusts, and many are already taking action to improve diabetes care including:

Launching a weekly physical health forum to discuss improvements eg management of hypoglycaemia.
Secured funding to introduce diabetes training for staff and patients.
Recruitment of staff to undertake Quality Improvement projects based on various outcomes from the audit.

Download the full report

“Good healthcare can significantly improve outcomes for people with diabetes, yet those with serious mental illness are more likely to miss out on this care. Despite great local initiatives there is no accepted standard for care of mental health inpatients who have diabetes. The London Physical Health Leads Network believes that this needs to change and we are delighted to present this audit as the first step.”
Dr Ed Beveridge, Dr Kate Corlett – Co-chairs, Pan-London Physical Health Leads’ Network

Report Summary

Improving the diabetes care of people with serious mental illness (SMI) is a priority for the London Physical Health Leads Network, a network hosted by UCLP, the HIN, KHP Mind and Body Programme and the Physical Health Leads from across the nine London NHS Mental Health Trusts.

In comparison to acute inpatient settings that have had the benefit of the national diabetes inpatient audit (NaDIA) tool, there is currently no standard national audit for diabetes care in mental health settings. Following a test pilot in Southern Healthcare NHS Foundation Trust and SLaM, the HIN collaborated with SLaM, KCH and the London Diabetes Clinical Network to create an audit, based on the NaDIA, to assess diabetes care in inpatient mental health settings.

The newly created audit was piloted on seven inpatient wards at SLaM. The audit findings were then analysed and retested to inform adjustments to the template before it was rolled out the remaining eight London NHS Mental Health Trusts completing the audit.

A wide range of inpatient clinical wards were represented in the audit, including:

Acute Adult Ward (Mixed)
Forensic
Acute Adult (Male)
Older Adult
Mixed Psychiatric Intensive Care Unit (PICU)
Acute Adult (Female)
Rehabilitation
Female PICU
Children and Young Person
Male PICU
Forensic (Female)
Triage
Learning Disability
Perinatal

Participating patients who stated they were involved in their diabetes care during their stay

66 %
Wards with a self-management policy for diabetes

17 /28

Patient satisfaction

3.63 /5

The report makes 23 recommendations

Integrated Care Systems (ICSs) / Trusts to consider:
- The provision of diabetes specialist roles for mental health inpatient settings;
- How to ensure diabetes specialist pharmacists form part of the Mental Health Trust pharmacy teams, educating ward staff to support safe insulin usage.
- Mental Health Trusts to communicate with their wards:
- Who their Physical Health Champion is, their role and how to contact them;
- How to access diabetes specialist clinicians;
- What out of hours services are available and how to access them;
- How to contact diabetic emergency services.

Mental Health Trusts to consider:
- Types of education they currently offer to staff, patients and carers;
- Provision of training in various languages and inclusion of cultural variances to ensure every population is included;
- Ensuring patient education is holistic;
- Introducing the Diabetes Know Your Risk Tool to wards that do not currently screen for diabetes on admission or consider alternative systems to flag if a patient has a diabetes diagnosis on admission;
- Offering patients the option to be involved in their diabetes care during their inpatient stay;
- Ensuring appropriate information to support self-management is available for inpatients;
- Having a diabetes self-management policy which is communicated with all wards;
- Seeking dietician support for wards that are not currently working with a specialist or non-specialist dietician;
- Providing patients with the opportunity to give weekly feedback on their meals;
- Where Trusts do not have access to care plans for patients with diabetes, consider liaising with the wider system to understand if this is available for them or creating a shared care platform;
- Ensuring multidisciplinary team members understand if a patient with diabetes has a care plan and how to access it;
- Having an effective electronic patient prescribing system for detecting, recording, and avoiding errors in insulin and oral hypoglycaemic agent (OHA) prescribing errors;
- Ensuring Web-linked blood glucose and ketone meters are actively used to alert diabetes specialists across the Mental Health Trusts and at ward level;
- Accelerating the roll out of digital systems and associated apps to support patients living with diabetes;
- Introducing a risk scoring system for all hospital admissions;
- How each ward accesses diabetes specialists, Multidisciplinary Diabetes Foot Teams (MDFTs) and Tissue Viability Nurses;
- Using the Malnutrition Universal Screening Tool (MUST) and reviewing MUST scores weekly as advised.

A co-designed approach to scoping and evaluating the digital health technology getUBetter

Project overview

getUBetter provides digital self-management for individuals with musculoskeletal (MSK) conditions.

During 2019, the HIN led work to map the getUBetter app against the NICE evidence framework for Digital Health Technologies. Following this, an evaluation was scoped and conducted between 2019 and 2021 the HIN worked with a range of partners to explore the effectiveness of getUBetter.

We summarise the key findings including how easy people found getUBetter to use and the impact it had on the treatment for their condition.

A collaborative approach to real-world evaluation

Co-production with stakeholders has been a core principle throughout the evaluation with getUBetter. The HIN led a collaborative partnership to scope, design and deliver the digital health technology (DHT) evaluation, working with getUBetter, St George’s University Hospitals NHS Foundation Trust, the University of West of England, Wandsworth Clinical Commissioning Group (CCG) patient and public involvement (PPI) lead and Digital Health.London (DH.L). A novel aspect has been operationalising the NICE Evidence Standards Framework for DHTs so that these underpin the evaluation.

The first phase was to develop an approach that allowed us to use the standards framework to map the existing evidence-base for getUBetter against each tier. The outputs from the mapping were presented and validated at a stakeholder workshop with specialists in MSK conditions and digital evidence generation. This group then worked together to design an evaluation to ensure it addressed evidence gaps that aligned with the requirements set out in the evidence standards framework (ie behaviour change techniques and effectiveness). Colleagues at the University of the West of England undertook work to develop the evidence-base around behaviour change techniques and the HIN worked in partnership with getUBetter and provider organisations to evaluate aspects of effectiveness.

The evaluation plan

A detailed mapping exercise determined the getUBetter app met evidence standards for Tier A, B and C DHT.

These corresponded to previously named tiers 1, 2, 3a and 3b.

Tier 1 (System Impact) evidence for effectiveness standards: met
Tier 2 (Understanding and Communicating) evidence for effectiveness standards: met
Tier 3a (Interventions) evidence for effectiveness standards – use of appropriate behaviour change techniques: met (best practice standard)
Tier 3b (Interventions) evidence for effectiveness standards – demonstrating effectiveness: partially met (minimum standard)

Caption: DHTs classified by function and stratified into evidence tiers (source: NICE evidence standards framework for digital health technologies [1])

A mixed-methods evaluation was co-produced involving getUBetter, Wandsworth Clinical Commissioning Group (CCG), St George’s University Hospitals NHS Foundation Trust, DH.L, the University of West of England, and the HIN.

The aim was to explore several aspects of the ‘demonstrating effectiveness’ category for condition-related outcomes, behaviour change outcomes, user satisfaction and health utilisation. Due to the ongoing Covid-19 pandemic, the evaluation was re-scoped to ensure activities could be completed within the Small Business Research Initiative (SBRI) programme funding timeline in 2021. The revised evaluation approach involved:

An online survey sent to getUBetter users to capture respondents’ demographic profile and app usage; experiences and satisfaction; condition-related outcomes; and changes in self-management and understanding of their condition.
An online survey of clinicians to explore awareness, use and value of getUBetter.
Health utilisation analysis to determine resource use from primary care data comparing patients with lower back pain with non-users in a sample of 10 GP practices.

Key findings

Health utilisation

Health utilisation analysis found that 835 patients were prescribed getUBetter for lower back pain, 50 per cent of whom activated their account. Compared to non-users, getUBetter users required four times fewer GP appointments, 20 per cent fewer physiotherapy referrals and over 50 per cent fewer prescriptions.

Patient survey findings

80 per cent of patients had not used a health app before

80 %
Three quarters of patient respondents rated the app as ‘very good’, ‘good’, or ‘acceptable’.

75 %
55 per cent of patients reported using the getUBetter app in the past week

55 %

Most liked aspects of the app as reported by patients

Easy to use the app
Helps me develop skills to manage my injury/condition
Provides relevant information according to my stage of recovery
It gives me reassurance

It was easy to register on getUBetter (given the apps needs information to ensure I get the right advice and to keep me safe; n=151)

Caption: Patient respondents reported it was easy to register on the getUBetter app

‘the app is a good reminder of what a healthcare professional has said in consultation when there is little time and a lot of information to digest’
getUBetter user

Patient respondents reported that during Covid-19, the app provided a good alternative to help manage their condition. When patients were not able to get face-to-face appointments or physiotherapy, they were happy to use the getUbetter app. Patients appreciated being able to recover independently without having to see a healthcare professional.

Impact of using getUBetter (n~159)

Caption: The majority of patients reported some benefit of using the getUBetter app.

Age group of respondents (n=204)

Caption: Adults across different age groups responded to the survey and reported the app easy to use

How often have you used the getUBetter app?

Overall rating of the getUBetter app

Caption: Despite most of the sample identifying as ‘white’ ethnicity, when comparing usage of the getUBetter app, there were small differences between ethnic groups. However, when comparing the overall rating of the getUBetter between ethnic groups, respondent ratings were very similar and positive across all groups.

Clinician survey findings

Most clinicians reported making referrals to the app

79 %
Most clinicians thought that the app supported patients with MSK conditions to self-manage

90 %

Outputs and contacts

An abstract was accepted for the Chartered Physiotherapy Society’s virtual conference 2021 which summarises the approach and results of the evaluation.

If you would like to learn more about the evaluation or getUBetter, please contact the team:

Get in touch

Digitally supported micro-volunteering – a report of an evaluation

Part One: Introduction

In August 2020, NHSx (in partnership with NHS England and NHS Improvement and the Ministry of Housing Communities and Local Government) asked the Health Innovation Network (HIN) to undertake an evaluation to better understand digitally supported micro-volunteering models operating in the field of health and social care. This report presents learning from the evaluation and is aimed at an audience of commissioners and policy makers to inform their strategies around micro-volunteering.

Background and context

Micro-volunteering is a form of volunteering that comprises short and discrete activities, that can be easily accessed and completed by volunteers in a way that is informal and convenient – usually via digital platforms¹. These characteristics distinguish it from traditional volunteering which typically involves the volunteer committing a regular block of time, over a longer period of months or even years. Micro-volunteering is a relatively new approach to volunteering². A 2019 survey by the National Council for Voluntary Organisations (NCVO) found that 23% of people exclusively volunteer as part of a one-off activity or dip in and out of activities³.

It has been suggested that micro-volunteering has the potential to increase volunteering activity, engage more volunteers, increase volunteer inclusivity, and provide a gateway into other volunteering roles. Consequently, it could increase capacity and meet the needs of a greater number of recipients. Emerging technology and societal changes, such as patterns of working, attitudes towards volunteering, and levels of community engagement, has increased demand for micro-volunteering, and there is growing recognition of its benefits⁴.

From March 2020, the coronavirus pandemic created severe disruption which interrupted the usual service delivery to broad sections of the population who require support with daily living. As large numbers of people were required to self-isolate due to symptoms or exposure to those with symptoms, and those most vulnerable to infection forced to shield, the pandemic created a greater need for support services, whilst concurrently constricting formal and informal networks through which those needs would usually be met⁵. The ELSA COVID-19 Sub-study conducted in June/July 2020 provides useful data around these patterns in people aged 50 and over who volunteer and/or provide care ⁶. The study found that of caregivers who looked after anyone once a week or more, inside or outside their household prior to the coronavirus outbreak, 35% either decreased or stopped the amount of care provided. It also found that almost 61% of those who had volunteered prior to the pandemic said that they either reduced (18%) or stopped (43%) taking part in voluntary work, with only 9% increasing their level of engagement, with the reduction most pronounced in those aged 70 or older.

The response to the COVID-19 pandemic through initiatives such as TechForce19 and the NHS Volunteer Responder scheme led to increased interest in the potential value of micro-volunteering across health and social care. In response to these opportunities, new products supporting micro-volunteering have been introduced to the market. Suppliers have developed micro-volunteering platforms that operate different models. Some are ‘pull-based’ models where tasks are pulled by volunteers from browsing available opportunities; whereas others are ‘push-based’ models where tasks are pushed to the ‘best match’ volunteer to accept or decline.

Digitally-supported-micro-volunteering-–-a-report-of-an-evaluation Download

Evaluation methods

The evaluation took a mixed methods approach gathering quantitative and qualitative data. It focuses on five platforms as case studies, exploring two in detail: the GoodSAM app which was integral to the NHS Volunteer Responders (NHSVR) programme and Team Kinetic; and three in less depth: Be My Eyes, Nyby and Tribe. Platform selection was informed by a rapid market review undertaken in August-September 2020.

This report draws on the findings from data gathered from multiple sources for the evaluation between October 2020 and February 2021:

Interviews with representatives from the five case study platform providers and their clients/commissioners
Interviews with NHSVR (n=17) and Team Kinetic (n=13) volunteers ⁷
Surveys of NHSVR (n=12,056) and Team Kinetic (n=144) volunteers⁸
NHSVR and Team Kinetic platform data about volunteer activity

References

1 The value of giving a little time: Understanding the potential of micro-volunteering (2013)

2 Jochum V and Paylor J (2013) New ways of giving time: opportunities and challenges in micro-volunteering: A literature review. Nesta, NCVO IVR. https://www.bl.uk/collection-items/new-ways-of-giving-time Accessed: 07/05/21

3 Time well spent: A national survey on the volunteer experience (2019)

4 Time well spent: A national survey on the volunteer experience (2019)

5 Lachance EL (2021) COVID-19 and its Impact on Volunteering: Moving Towards Virtual Volunteering, Leisure Sciences, 43:1-2, 104-110, DOI: 10.1080/01490400.2020.1773990 [1] Chatzi G, Di Gessa G, Nazroo J (2020) Changes in older people’s experiences of providing care and of volunteering during the COVID-19 pandemic https://www.elsa-project.ac.uk/covid-19-reports

6 The concept of a healthcare system collectively gathering information and synthesising knowledge about how well or otherwise service delivery is working then using this understanding to drive ongoing improvement can be described as a ‘learning healthcare system’. The Institute of Medicine defines a learning healthcare system as a system in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”

7 In December 2020 and January 2021, the HIN evaluation team interviewed 17 people who had registered as volunteers with the NHSVR Programme (I1-17) and thirteen people who had registered as volunteers with one of three organisations using the Team Kinetic (TK) platform to support micro-volunteering: Cardiff (n=2), Kenilworth (n=9) and St Helens (n=2).

8 The survey analysis and reporting address the large variation between the sample numbers for the NHSVR survey compared to the Team Kinetic survey by first analysing differences in responses between the two sample and only presenting the aggregated response where there are no statistically significant differences between the two.

Part Two: Description of the platforms, their development and implementation

Five organisations supplying a digital platform that supports micro-volunteering in the field of health and social care were selected as case studies for the evaluation. The five platforms share common features, but also have unique distinguishing features which led to their selection as case studies during the scoping phase.

Platform core features

The five models all allow discrete, one-off task-based volunteering activities that put the volunteer directly in contact with the individual recipient to provide support for needs related to their health and social wellbeing. Table 1 provides a summary of the core features of each micro-volunteering model.*

GoodSAM** was commissioned by NHS England and NHS Improvement to adapt its existing Emergency Responder technology to deliver the NHS Volunteer Responders (NHSVR) programme as a national COVID–19 pandemic response (https://nhsvolunteerresponders.org.uk/). The NHSVR programme was designed to provide a safety net to meet community needs in areas where voluntary sector infrastructure was inadequate to meet demand during the pandemic. It is commissioned by NHS England and NHS Improvement and delivered by Royal Voluntary Service (volunteer management) and GoodSAM (platform provider). Volunteers currently deliver seven roles: shopping for food and essentials and collecting and delivering prescriptions for someone who is isolating or shielding (Community Response and Community Response Plus), telephone support (Check in and Chat and Check in and Chat Plus), Patient Transport, NHS Transport and COVID vaccination centre stewards.

Team Kinetic (https://teamkinetic.co.uk/) is a software development company offering volunteer management services, originally as a commission by Manchester local authority to meet the volunteer needs of the 2012 Olympics. The micro-volunteering functionality was developed to support their volunteer organisation clients changing needs in responding to the COVID-19 pandemic. Team Kinetic worked in partnership with existing clients to develop a ‘community task’ feature to facilitate micro-volunteering activities. The product development was also supported by the TechForce19 innovation grant. Volunteers deliver four categories of activities: collecting shopping and prescriptions, making wellbeing telephone calls, acting as a chaperone, and ‘other’ (befriending, technical support with setting up IT and undertaking odd jobs).

Be My Eyes (https://www.bemyeyes.com/) is a video call service supporting people with visual impairment with everyday tasks such as reading labels when shopping or cooking or choosing the right clothes for work. The app connects volunteers with people needing support, allowing requests for help to be met within seconds. People with a sight impairment register their request for support on the app and the notification is then pushed out to volunteers. A direct video contact is then established between the person requesting support and the first volunteer to accept the support request undertakes the task. As well as this ‘first volunteer’ type of task, the app also enables people to request ‘specialised support’ that links them to organisations, such as the RNIB.

Nyby (https://Nyby.com/about-Nyby) is a platform that facilitates task sharing across the health and care sector. Nyby enables professionals in the sector to obtain support from volunteers and other health and care personnel in meeting the needs of clients that would otherwise go unmet. Staff post requests for support via the platform and these are picked up by volunteers or, where relevant, other personnel. Volunteers, who are qualified by the organisation they belong to, undertake activities such as running errands, providing practical assistance (e.g., changing light bulbs), acting as medical escorts, and helping clients to exercise and socialise. Volunteers can register to offer specific roles and recruitment campaigns can be created for specific target groups; they are sourced via voluntary organisations who are using the platform and as individuals unattached to any particular organisation. Nyby is a Cloud based Software as a Service (SaaS) platform based on peer-to-peer technologies that match needs and resources through digital platforms. A Norwegian initiative, Nyby is currently developing its first UK site. The platform was created through forming research and development partnerships to identify and then address fragmentation in public service provision. The company additionally supports partners in identifying service gaps that can be closed by connecting local authorities, health services, volunteers and the third sector to match resources and services using digital technology.

Tribe (https://tribeproject.org/provider/) is a digital platform that connects people with a wide range of local support, including volunteers, community groups and approved paid support providers. Tribe enables volunteers to support people in their local community socially through chats as well as with practical tasks, including shopping and collecting prescriptions. Tribe aims to work in partnership with volunteering organisations to mobilise and upskill volunteers via digital training in order to tackle gaps in provision – ‘care dark patches’. Unmet community support needs are identified by mapping data from multiple sources using artificial intelligence and machine learning. The platform is now also being used for social prescribing to map community service provision. Tribe was selected as one of UKRI’s Healthy Ageing Trailblazers, as part of this the project will receive significant funding to further develop the paid ‘home care’ support functionality.

Notes

*The core features table (Table 1) is specifically focused on the use of GoodSAM in relation to the NHSVR app and does not mention GoodSAM functionality that was not built into the NHSVR app. GoodSAM built the NHSVR platform to NHSE specification and GoodSAM has other functionality that was not incorporated eg an inbuilt video system, a rewards system, and a feedback and a notes system.

**Throughout the report, the GoodSAM/Royal Voluntary Service platform is referred to as NHSVR to reflect the focus specifically on the way that GoodSAM facilitated that specific NHS programme in partnership with RVS.

Table 1 Core features of micro-volunteering models

Feature	Be My Eyes	Nyby	Tribe Project	NHSVR*	Team Kinetic
Local vs national implementation	International	Local (national across Norway by the Norwegian Cancer Society)	Local	National	Local
Free to download app	Yes	Yes	Yes	Yes	Yes
Mobile phone app	Yes	Yes	Yes	Yes	Yes
Platform can be accessed without a smart phone?	No	Yes	Yes	No	Yes
Allows discrete /one-off task-based volunteering activities	Yes	Yes	Yes	Yes	Yes
Tasks geographically ‘local’ to the volunteer and recipient (within a few miles)	No (tasks delivered via video)	Yes	Yes	Yes (except telephone ‘Check in and Chat’ service where recipients / volunteers matched at a national level)	Yes
Task benefits an individual recipient	Yes	Yes	Yes	Yes (except NHS Transport role which supports an organisation e.g assisting GP practice moving equipment between NHS sites; and Vaccination Steward role which supports the vaccination centre)	Yes
Volunteer and recipient have direct contact (e.g., face to face, phone, electronic)	Yes	Yes	Yes	Yes	Yes
Operating in UK	Yes, national coverage	No, but pilots are in planning phase	Yes, currently operational in various UK regions	Yes, commissioned for England	Yes, currently operational in four areas across UK
Supports volunteering activities within health and care sector(s)	Yes (though health support needs met by organisational partners)	Yes	Yes	Yes	Yes
The ‘presentation of opportunities’ to volunteers (‘pull’ or ‘push’ models)	Push	Push and Pull. Requests are pushed as alerts via the app and volunteers can also search a list of requests.	Push	Push Pull functionality is used to enable vaccination centre volunteers to find shifts.	Pull via searchable ‘public’ list of tasks open to volunteers within a given proximity. Push notifications also sent via email. For Android users notifications can be pushed directly to the phone. Tasks also pushed to specific volunteers carrying out a ‘Street Champion’ role.
The setting of ‘preferences / constraints’ by a volunteer (e.g., for particular tasks, localities etc)	Yes (though limited to language spoken)	Yes	Yes	Yes	Yes
Tasks can be booked and/or converted into a repeat or regular task	No	No – but function is in the ‘roadmap’ for development	Yes – integral	Yes – referrers can set a task as repeating but these cannot be carried out by the same volunteer more than twice in a month (except Check in and Chat Plus and Community Response Plus roles which allow ongoing support to be provided by the same DBS-checked volunteer).	Yes – allows volunteer to repeat/rebook tasks without need for administrative approval. All re-bookings are listed as new tasks so there is an audit trail, and they are picked up in the public bucket if not fulfilled.
Within app recording of tasks	Yes	Yes – system records activity of task, when and who carried out the request	Yes	Yes – volunteer asked to confirm task completed and referrer informed complete	Yes – volunteer asked to confirm task completed
Within app activity record available to volunteers	No. Volunteers can only access account creation details. Activity record is available on request from Be My Eyes.	Yes	Yes. Volunteers can access number hours logged into app and log of completed tasks.	Yes. Volunteers can access number of hours on call, 2-month log of alerts and completed tasks.	Yes. Volunteers can access completed or pending tasks (including type and date completed). Volunteers can export record and share this.
Within app screening and verification of a volunteer’s identity	Yes. 2 stage authentication during registration on the app.	No. Verification and screening is carried out manually by the commissioning organisation where required for a role.	Yes. Some checks can be completed through the app or website. Volunteers can upload ID/DBS documents via the app, but checks are carried out manually by the commissioning organisation.	No. Volunteers can upload ID/DBS documents via the app but checks are carried out manually by the organisation. Volunteers must complete a form and provide evidence of DBS accreditation for certain roles. An ID check is carried out on all volunteers as part of the application process.	No. Volunteers can upload ID/DBS documents via the app but checks are carried out manually by the commissioning organisation. Results of the checks recorded on the app. Next app iteration has a fully integrated DBS service with ID verification. Parental consent can be requested for younger volunteers as required.
Volunteer recruitment	Media (including social media) campaigns	Handled by the partner commissioning organisation. The platform includes the ability to generate bespoke registration webpages to aid recruitment.	Organisations form a team on the Tribe platform and register existing volunteers. Can invite individuals registered as a “regular joe” Tribe volunteers to join the team and promote the team via social media channels.	National / local call directing to website for online registration.	Four TK micro-volunteering projects recruited volunteers locally: direct email to existing volunteers, adverts in local papers, Facebook and flyers posted in public settings.
Volunteer registration	Within app registration system	Sign up via website or app – only a name and phone number are needed, excluding any further documentation requirements set by partner organisations.	Within system application process	Direct registration on the website.	In-app registration by the volunteer or client and bulk registration by Team Kinetic from client list. In-app registration collects name, address, age which TK verify to client specification. Uses single sign-on so volunteers can use Google or Facebook to login and confirm their email address. In four TK micro-volunteering projects, volunteers registered initially on another website or Facebook and delivery organisation created TK accounts on behalf of volunteers following completion of ID and security checks. Volunteers were then asked to download the app.
Training and induction (on- or off-line)	Yes – via online training resources available through Be My Eyes website and app.	Locally determined based on need (i.e., by working with local partners). Dedicated Customer Success Managers help with training local teams and resources (including video content) is available for supporting professional care staff and volunteers.	Yes – via online training resources available through Tribe website and app. Volunteers register for training via the app/website and it is delivered via the platform. In-person training will resume when feasible. Tribe will then work with training providers to upload records to volunteer profiles Upskilling volunteers to meet community demand is integral to the Tribe Project. Training is developed and delivered in collaboration with voluntary/community sector, and commissioner partners and supported by industry partners such as Skills for Care.	Yes – via online training resources available through NHSVR website. RVS deliver all training which takes the form of volunteer ‘guides’, pre-recorded webinars, live webinars, links to external websites/training providers.	Yes – via online training resources available through TK website with API and Zapier integration to external resources. Admin users can build specific induction and onboarding for specific roles. Client may also offer training outside of system. Volunteers and Admin users can upload documents to individual training profiles and to opportunities. TK have offered providers bespoke training sessions over Zoom.
Support for volunteers	Support provided via the Be My Eyes customer support team (by email and through the app).	There is an assigned project manager within the local organisation who acts as support for their volunteers. Nyby provide technical support with regard to the system.	Tips and instructions are shown within the app. Tribe deliver on-boarding training for new voluntary organisations/areas, targeting less digitally savvy users. The wider support offer for volunteers is still being shaped through co-production with stakeholders.	A RVS call centre offers volunteer support seven days a week, 08:00-20:00. Specialist teams (e.g., Safeguarding) are available to escalate callers to if their requirements cannot be met by the general Support Team.	Team Kinetic support the Admin level users (clients) to enable them to support their users directly. Issues can be escalated via support tickets and support chat to a Team Kinetic support operative.
Creation of tasks	Support needs are posted directly by recipients	Anyone in a group with permission can create a task	Tasks created by partner organisation representatives	Any professional can request support for a recipient via webpage or phone, and system extended to include self-referral	Volunteer managers triage and create tasks

Table 1 Core features of micro-volunteering models

Implementation

The geographical scale and boundaries of the models vary between (inter)national and local communities.

• Be My Eyes largely works outside of geographical boundaries – volunteers can support recipients located anywhere in the world.
• NHSVR is a national programme coordinated in partnership between NHS England, Royal Voluntary Service and GoodSAM. Demand for support is directly matched with volunteer supply, at a local level, apart from the ‘Check in and Chat’ function which was revised to match recipients with volunteers living in any area. Initially referrals could be made by any front-line provider with an NHS or local authority email, but the referrer set-up broadened as the scheme developed to include Social Prescribing Link Workers, VCSE organisations, MPs, Police, Fire Service, Community Pharmacy, NHS 111, and Ambulance Service amongst others. Some local authorities have built it into their triage system as one of the potential referral routes.
NHSE and RVS have worked with referring organisations to help ensure the programme supports and remains relevant to local needs.
• Team Kinetic, Tribe and Nyby support models that operate at a very local level, through community-based voluntary groups, community partnership and local authorities/municipalities. The technology is licensed to a local organisation as a client with support provided by the company i.e. as a licensed and supported software application. Therefore, the client and local partners need to implement and operate the technology as part of their local volunteering model or pathway. For example, Team Kinetic work with their clients to tailor the technology and support local implementation, but it is the client organisations that use the system to manage local volunteer activities, including managing on-boarding the volunteers, verifying ID checks, and inputting volunteer requests.

A co-production approach is at the core of how Nyby and Tribe implement their models. This involves working with local community groups to map local need and tailor the technology based on local contextual factors. Nyby work with local communities to map local needs and only expand based on pre-defined success criteria. Local partners working with Nyby often appoint a Project Manager who works closely with a Nyby Solution Specialist to ensure that any necessary training is completed and there is a rigorous implementation and roll-out plan. Nyby also enables and promotes experience sharing across its 50 government and charity partners across Norway, Sweden, Denmark, Germany and soon, the UK. Tribe work with local stakeholders to use local data to develop a ‘community needs matrix’ displaying projected need versus current provision. Tribe expect a minimum of a two-year commitment from commissioning organisations recognising the time it takes to bring new community provision online.

Part Three: Learning from volunteers about facilitating micro-volunteering using digital platforms

This section of the report explores the learning from data about the activity, experiences and perceptions of volunteers with the NHSVR and Team Kinetic platforms. It draws on platform system data, and feedback from volunteers via surveys and interviews.

Volunteer activity with the micro-volunteering platforms

There is considerable appetite for volunteering with digital platforms that support micro-volunteering.

Data extracted from the NHSVR and TK platforms (Table 2) shows that up to January 2021 just under 800,000 people had registered with the two platforms, from the point early in the pandemic (March/April 2020) when the micro-volunteering platforms were launched.

Activity unit	NHSVR⁹	Team Kinetic¹⁰
Approved volunteers	647,405	155,322
Volunteers who put themselves ‘on duty’	397,940
Created tasks	1,766,210	4,710
Completed tasks	1,446,681	4,615
% of tasks completed	81.9%	98.0%
Avg. monthly completed tasks[11]	144,981	506

Table 2 Summary of platform activity to January 2021

Volunteers’ motivation for signing up with the platforms needs to be seen in the context of the COVID-19 pandemic

As shown in Figure 1, the main reasons reported by NHSVR and TK survey respondents for registering to volunteer with the platforms were related to a desire to help during the COVID-19 pandemic. Responses to this question need to be understood in the context of the platforms’ development. The NHSVR and Team Kinetic platforms were both developed specifically as a solution to problems created by the COVID-19 pandemic. The NHSVR programme recruited volunteers through a very prominent national media campaign with messaging around creating an ‘army’ of NHS volunteers to support the NHS through a crisis. In contrast, Team Kinetic worked with local organisations to develop locally relevant responses to mobilise volunteers to provide support during the crisis.

*Figure 1 Top seven motivations to register, split by platform (n=11,904)*

References

[9] NHSVR data was extracted from the Future NHS NHSVR project site for all activity from 30^th March 2020 to 25th January 2021. ‘Approved’ and ‘on duty’ figures were taken from: https://www.royalvoluntaryservice.org.uk/Uploads/Documents/Our%20impact/NHSVR_Working_Paper_Four_Patient_Findings.pdf

[10] Team Kinetic data was extracted for all activity from 6^th April 2020 to 26^th January 2021

[11 Based on data trimmed to include whole months only from 1^stApril-31^st December 2020.

Qualitative data from interviews with NHSVR and TK volunteers provides additional insights. Most NHSVR interviewees first heard about the initiative from the national media campaign. In contrast, recruitment to the TK platform was very much implemented at a local level. Kenilworth interviewees received an invitation to sign up to Team Kinetic from the local Covid-19 Facebook group they joined early in the pandemic. Cardiff and St Helens interviewees responded to adverts in their local papers, Facebook and flyers posted in public settings, and to information received from the local volunteer centre. One interviewee had first used the Team Kinetic platform in 2012 when it was rolled out for volunteers attending sporting events to replace communication with the volunteer force by email, though she had not used the app previously.

In addition to wanting to help out in the crisis, being in a position to help was a key theme in interviewees’ motivations. Interviewees talked of having more time for a range of reasons related to activities being restricted during the pandemic. Decreased work commitments were mentioned frequently, including working from home, and other volunteering work being paused or moving online. Interviewees also reported feeling they had relevant skills to help.

Platforms that facilitate micro-volunteering have the potential to provide a significant level of support during a crisis.

Whilst not all those who registered with the NHSVR and TK platforms were approved to volunteer or went on to download the apps and then complete tasks, the platform data indicates that over 100,000 individuals carried out over 1.5 million tasks between March/April 2020 and January 2021 (Table 2). The majority of these tasks were either delivery of shopping, prescriptions, and other essentials or telephone support (Figure 2 and Figure 3).

*Figure 3 Team Kinetic task by category*

Digital platforms that support micro-volunteering have the potential to engage a broad demographic

As illustrated in Figure 4, NHSVR and TK platform data shows that around 80% of registered volunteers were of working age (20 to 59).

69% (268) of Team Kinetic volunteers were female and 31% (123) were male. No other platform data was available on volunteer demographics, but data from the NHSVR and Team Kinetic volunteer surveys shows: 64% of respondents were female; 6% were from an ethnic minority community (EMC) group (indicating an ethnic group other than ‘White UK’); 63% stated a religion; heterosexual and 4% identified their sexuality as LGBT+ (as opposed to heterosexual). As shown in Figure 5, 25% of respondents were working full time and another 16% were working part time; 9% were furloughed and 5% were unemployed.

*Figure 5 Work status of volunteers (n=10,640)*

The NHSVR programme recruited volunteers through a very prominent national media campaign with messaging around creating an ‘army’ of NHS volunteers to support the NHS through a crisis. The messaging may have attracted a younger cohort of volunteers than the TK micro-volunteering platforms with their very local focus.

Digital platforms that support micro-volunteering have the potential to engage people who have not previously volunteered.

As illustrated in Figure 6, the NHSVR and Team Kinetic volunteer surveys found that around a quarter of respondents who were working or furloughed had never volunteered before. A similar pattern was seen in the qualitative interviews with volunteers from the two platforms. Interviewees who had not volunteered in the past were asked why and their reasons included not knowing how and a lack of time when working full time was the main reason. The micro-volunteering apps addressed these issues because people were able to find and complete tasks at the time allocated to volunteer.

*Figure 6 Percentage of respondents who had or had not volunteered before, split by occupation (n=10,481)*

In addition to quantitative data from surveys of NHSVR and Team Kinetic volunteers, rich material from interviews with volunteers from those platforms help us understand the way in which micro-volunteering engages people – both those who would not traditionally volunteer, as well as those who are already active volunteers. Table 3 compares what we learned from NHSVR and TK volunteers with the findings from the 2019 ‘Time Well Spent’ national survey on volunteer experience.

Table 3 What micro-volunteering offers for those who are traditionally less likely to volunteer

	What the evidence tells us about….
	Volunteers with a micro-volunteering platform (from this evaluation)	Traditional volunteers (from Time Well Spent: A National survey on volunteer experience. 2019)	The opportunities micro-volunteering (MV) offers for those who are less likely to volunteer due to this characteristic
Characteristic
Age	From Team Kinetic and NHSVR platform data we know around 80% of volunteers with both platforms are of working age (20 to 59). 77% of respondents to the NHSVR survey were aged 16-64; 23% were aged 65 or older.	People aged 65 and over were the most likely to have volunteered recently: 45% saying they had volunteered in the last year. People in this age group were most likely to volunteer frequently (35%). The proportion of those who had volunteered in the last 12 months was lowest among 25–34-year-olds (31%) and generally lower for people aged 25 to 54.	The speed with which MV tasks can be accessed and carried out addresses barriers to involvement in traditional volunteering in working age people. Specifically, it allows activity around work/family commitments, and leisure/lifestyle choices.
Gender	From Team Kinetic platform data, we know 69% (268) of volunteers were female. 64% of respondents to the NHSVR survey were female. Our volunteers’ surveys found: 1. The NHSVR and TK platforms were good at engaging men who had not previously volunteered: 25% said they had never volunteered before Covid-19 compared to 17% of women (Q1). 2. Men tended to sign up for different activities than women (Q6): they were more likely to sign up for community support (e.g., shopping), patient transport, or other transport; and less likely to sign up for telephone support (32% compared to 66% of women signed up for this). 3. Men were likely to have completed fewer tasks (Q8b): 42% had completed no tasks and 18% had completed over ten tasks (compared to 34% and 15% of women respectively). This may be a function of the type of activities they signed up for as compared to women they were more likely to say, ‘I haven’t yet been given a task to do despite switching the app ‘on-duty’’ and less likely to say, ‘I was given a task but unable to accept’ (Q9). 4. When asked to indicate reasons why they would continue to volunteer with the platform in the future (Q16), men were more likely to select ‘a sense of duty or obligation’ (43% compared to 22% of women).	Women are more likely to volunteer. Men were more likely to say they have never volunteered (34% vs 29% of women). Men who have volunteered were more likely to say they have been hardly involved throughout their life (23% vs 19% of women).	MV can provide access to opportunities to carry out tasks that may be of interest / relevant to skills and experience.
Ethnicity	Our volunteers’ surveys found: 1. 6% of respondents were from an ethnic minority community (EMC) (compared to 15% in the general population according to the 2011 Census). As previously discussed, this could just reflect what we know to be lower response rates amongst EMCs. 2. EMC respondents were as likely as those of a white ethnicity to have volunteered in the past (Q1): 80%. 3. As reported above, compared to those from a white group, EMC respondents were likely to indicate different reasons for being motivated to volunteer with the platform (Q5), and to report differently in terms of their experience of volunteering with the platform, particularly in terms of the benefits and rewards (Q13). Overall, they seemed more likely to be satisfied with the experience.	Rates of recent volunteering in people from ethnic minority communities (EMC) are similar to people who were white (36% compared to 38% respectively).	MV can provide access to opportunities in a way that seems to meet the expectations of people from EMC groups.
Working status	Our volunteers’ surveys found: 1. 25% of respondents were working full time and 16% part time; 8% were furloughed and 5% were unemployed. 2. 26% of respondents working full-time, and 25% of those who were furloughed from work or unemployed had never volunteered before (Q1) (compared to 16% of the retired); interestingly, 20% of those who were permanently sick or disabled had never volunteered before.	Unemployed people and those not working are least likely to have ever volunteered. People working full time were less likely to have volunteered in the last year (35%) than those working part time for 8–29 hours a week (41%) or fewer than eight hours a week (53%). They were also less likely to volunteer than retired people (44%) or full-time students (42%).	The speed with which MV tasks can be accessed and carried out addresses barriers to involvement in traditional volunteering in working age people. Specifically, it allows activity around work/family commitments, and leisure/lifestyle choices.

Table 3 What micro-volunteering offers for those who are traditionally less likely to volunteer

Digital platforms that support micro-volunteering offer volunteering activities that are complimentary to those offered by more traditional forms

Asked how their previous experience of volunteering compared to experience with the platform, interviewees said it was difficult to compare them. For example, one said it was a different type of volunteering in that her governor roles are regimented by attending meetings, whereas the app allowed unplanned support to individual needs. Another said that compared to her trustee and teaching voluntary work, the difference is that she can choose to do one off activities. There was recognition of the specific context in which the micro-volunteering platforms were operating: the situation was different, and the app worked well in organising people and getting them mobilised to help out in the crisis.

Interviewees saw advantages and disadvantages of micro-volunteering compared to their more formal volunteering activities. They described how although they liked the freedom of not making a commitment offered by the platform, they preferred their other volunteering work as it offered routine and certainty. However, the also talked of the benefits these features brought in terms of planning activity around other commitments. It was suggested that the more formalised commitments associated with traditional forms of volunteering guarded against the experience through the platforms of offering help but not being called upon. One volunteer also described traditional volunteering as a preference due to the wider variety of tasks usually on offer. Others contrasted the social contact and teamwork in their roles outside the platform with the absence of a team with the volunteering model offered by the platform.

In the qualitative interviews with NHSVR and Team Kinetic volunteers, those with considerable experience of traditional models of volunteering were notably more critical of various aspects of these micro-volunteering platforms. This finding is supported by evidence from the surveys as shown in Figure 7.

*Figure 7 Percentage of respondents who were satisfied or dissatisfied with their experience of the micro volunteering platform, split by whether they had volunteered before (n=11,339)*

Digital platforms that support micro-volunteering have the potential to engage volunteers beyond the pandemic

72% of NHSVR and Team Kinetic survey respondents indicated they would be ‘likely’ to volunteer with the platform in the following twelve months. A similar pattern was seen in the qualitative interviews. Some of those who said they would continue to volunteer with the platforms beyond the pandemic added the proviso that the amount of time they could offer might reduce, for example because of changing work commitments.

Reasons given in the interviews for continuing to volunteer with these micro-volunteering platforms included the flexibility – being able to switch the app on and off, and that it was undemanding, and fit with their availability, and met their interest in short activities involving no commitment; and the ease of using the app.

Most interviewees also said they might look for new opportunities for volunteering, outside of their activity with the platform.

Frequency of volunteering is linked to an individual’s availability

In qualitative interviews, NHSVR and TK volunteers indicated that the frequency with which they volunteered with the platforms was dependent on their availability and the ability to fit tasks in with personal circumstances (e.g., health), other commitments (particularly work – both paid and unpaid, including family care, but also education), and lifestyle (e.g., social and leisure pursuits). Changes in the extent of activity of volunteers with the NHSVR and TK platforms during the COVID-19 pandemic highlights how availability alters over time. The timeline graphs with activity mapped against the pandemic milestones (Figure 8 and Figure 9) shows there were more uncompleted tasks as the lockdown eased. In interviews, volunteers described how the number of tasks they undertook rose/fell over time as the demands of their work (paid and unpaid) decreased/increased. Some had reduced their volunteering activities during the summer months when COVID lockdown restrictions eased, and they were able to do more socially.

*Figure 8 NHSVR volunteer activity between 30th March 2020 and 24th January 2021*

Figure 9 Team Kinetic volunteer activity between 13th April 2020 and 18th January 2021

Volunteers experiences with the micro-volunteering platforms

On the whole, NHSVR and TK interviewees were positive about their experience of volunteering with their respective platforms.

A cross-cutting positive theme in the qualitative interviews with NHSVR and TK volunteers was the simplicity of the approach in general and specifically of the apps and the tasks they supported. People liked the online system and the accessibility offered by a phone-based app. In terms of the broader approach, interviewees liked its flexibility which allowed task selection to fit with availability and being able to choose tasks. Feedback from NHSVR and TK volunteers in both the surveys and interviews was broadly positive about registration and using the app to find tasks.

As shown Figure 10, the NHSVR and TK volunteer surveys indicate that 83% of respondents found the process of getting involved ‘easy and straightforward’. A similar pattern to that found in the volunteer surveys was seen in the qualitative interviews, with one NHSVR interviewee indicating it took twenty minutes to register.

*Figure 10 The extent to which volunteers (dis)agreed that platform registration was easy and straightforward (n=11,730*

Both NHSVR and Team Kinetic interviewees generally found the respective apps easy to use, though some had experienced difficulties initially before gaining familiarity, and/or knew of others who had been unable to use it.

Dissatisfaction was largely associated with low activity

In the qualitative interviews with NHSVR and TK volunteers, dissatisfaction was largely associated with low activity, caused by receiving no or too few alerts and Figure 11 illustrates how the survey findings support this observation. Interviewees who had completed no or few tasks reported disappointment, and feelings of having wasted time.

*Figure 11 Level of (dis)satisfaction and number of tasks completed*

There were variations between ethnic groups in responses to questions in the volunteer surveys which suggest that, compared to those from white ethnic groups, ethnic minority communities had particularly positive experiences

Analysis of data from the surveys of NHSVR and TK volunteers found a statistically significant difference in responses given by respondents from ethnic minority communities (EMCs) compared to those from a white ethnic group on a number of questions. A detailed breakdown of the difference between white and EMC responses to a set of questions about experience with the platforms is given in Figure 12.

Additionally, 64% of EMC respondents agreed with the statement ‘I have benefited from gaining new skills and knowledge through the guidance’ compared to 45% of those from a white ethnic group. 74% of EMC respondents agreed experience with the platform ‘gives me new skills and experience’, 72% agreed ‘it gives me more confidence’, and 54% agreed ‘it improves my employment prospects’. The respective figures for white respondents were 50%, 45%, and 27%.

EMC respondents were also more likely to say they would be ‘likely’ to continue to volunteer through the platform over the next twelve months: 84% compared to 72% of respondents from a white ethnic group.

*Figure 12 Respondent experiences with micro-volunteering platforms – White/Ethnic minority communities (EMC) comparison*

Volunteers’ tips for implementing a micro-volunteering platform

In the qualitative interviews, NHSVR and Team Kinetic volunteers made suggestions for improvements to the platforms which are presented here.

General improvements

Volunteers indicated that ensuring the frequency of activity matched their expectations would enhance their experience of volunteering with these micro-volunteering platforms, as would minimising time between registering and approval and commencement of volunteering activities. They suggested that providing clear role descriptions at registration would help volunteers select roles, and that clear guidance around carrying out roles would be beneficial, such as arrangements for handling payment for shopping, and where to access support where needed to carry out roles. Simple mechanisms for claiming reimbursement of volunteer costs was also indicated.

Interviewees noted that being able to view locally relevant communication, as opposed to receiving blanket information, would be helpful, increase the user experience and create a team feel. It was suggested that building a volunteer network, both locally or on a wider scale, would be beneficial for building rapport among volunteers and improving peer-supported learning. The use of online forums such as Facebook were seen as a way to achieve this, with interactive training materials to support peer-learning and increasing skills. Having access to local and/or regional support networks of delivery managers was also identified as having potential benefits for the volunteer experience.

There were perceptions that both platforms could be expanded to capture a wider variety of tasks and allow tasks for individual clients to be repeated. It was suggested that notifications should be redesigned to give clearer and more localised messaging. For example, using a push model if there is little demand in one area, to notify volunteers that they may not be needed and keep people informed. Alternatively, using a pull model where specific tasks can be grouped and completed by a small number of individuals or to increase continuity.

Finally, there was a perceived need to connect to a wide source of ‘referrers’ such as community services, social services and GPs, to reducing the burden on these service providers.

Improvements to the technology

Volunteer suggestions to improve the technical aspect of the apps mainly related to the presentation of tasks. Providing additional details regarding the task, including detailed description and estimated time for completion, would enable volunteers to make a more informed choice about accepting or declining a task. Inclusion of information about the client within the alert/notification was suggested to enable the volunteer to tailor their response to the individual client e.g., information about the age of the client, if they have a hearing impairment or dementia, or having difficulties communicating in English. TK volunteers suggested grouping tasks within a small locality would help volunteers identify opportunities in their locality. Suggestions for modifications to the NHSVR alert system included changing the tone and volume of notifications and introducing the ability to restrict the number of alerts.

NHSVR volunteers felt the app reporting could be improved by allowing volunteers and clients to enter feedback on tasks completed, providing an audit trail which could be accessed by both, as well as ensuring that unnecessary alerts being issued for clients who no longer needed the service. In-built metrics such as ‘hours spent available via app’ are not as useful to volunteers who wish to track number of tasks completed for example. Availability of record of activity in a format which could be exported and shared on CV to support employment search was identified as beneficial.

There were also suggestions to improve external communication via the app. Firstly, linking the chat feature to a specific task rather than showing continuous chat data. Secondly, allowing the app to integrate with Zoom/ virtual video calling platforms for use during ‘check in and chat’ tasks which would allow for a more personal experience for both volunteers and clients. Thirdly, a mechanism to escalate a task to a help centre after several failed attempts to contact a client.

Both NHSVR and Team Kinetic volunteers suggested a need for more support regarding navigating the app for individuals who are perhaps less technologically trained. This could be achieved through tutorials or user guides within the apps themselves.

Techniques for providing rewards like virtual badges

The Team Kinetic task-app already incorporates a reward system which includes virtual badges of achievement. In contrast, the NHSVR app has no virtual reward recognition system built in. Views across volunteers were mixed in terms of the utility of virtual rewards. Both volunteer groups acknowledged that virtual rewards such as badges could be motivational for some individuals.

Team Kinetic volunteers noted having a wider variety of milestones than currently available may be useful, such as recognition when reaching a certain number of service users or incorporating a tiered system which volunteers climb as they complete tasks (e.g. bronze, silver, gold). There was also recognition that receiving an accolade in the form of virtual ‘thumbs-up’ from a volunteer coordinator had been a boost during their volunteering experience, as had receiving a thank you letter from a local mayor. NHSVR volunteers acknowledged that a reward system could be a nice addition to the current app and that a competitive element may motivate some individuals, in particular, it may be rewarding for completer-finisher type personalities. NHSVR volunteers had fewer practical ideas about what the reward system should measure, perhaps due to the fact they had not experienced this during their usage of the app.

Some volunteers across Team Kinetic and NHSVR expressed concern over the reward system stating that volunteering should not be used as a means to gain rewards, and those wanting to help would not likely be interested in such rewards. This type of system may also lead to a focus on quantity rather than quality. Despite this, it was acknowledged that a reward system could still help engagement with volunteering and for individuals wanting to use this information on their CV.

Improving opportunities for volunteers to take part in micro-volunteering

Both Team Kinetic and NHSVR volunteers noted a need for increased awareness of the micro-volunteering model. Suggestions were made to invest in marketing such as TV advertisements and local media opportunities and that volunteer-led campaigns may be beneficial in recruitment. NHSVR volunteers noted that general communications had been too corporate to date and did not focus enough of the communities being served and stated there is a need to provide regionally relevant feedback to local groups volunteering. Practical suggestions such as expanding the types of tasks available and capitalising on the local expertise could improve opportunities for volunteers and clients alike. Additionally, obtaining feedback from both volunteers and service users was mentioned as a means to improve the current system.

Team Kinetic volunteers noted a need for clearer governance structures to ensure public safety and the benefits of sharing good practice across volunteer organisations to avoid potential mistakes. Similarly, to NHSVR, Team Kinetic volunteers also suggested a way to capture and organise disparate groups during emergencies (e.g. floods) could be beneficial and potentially easy to integrate into the TK system.

Volunteer perceptions of micro-volunteering

There was consensus across interviewees from both platforms that most of the different key features of micro-volunteering were important to them

In the qualitative interviews, NHSVR and TK volunteers’ perceptions of different aspects of micro-volunteering were explored. Interviewees wanted to be able to volunteer in a way that involved ‘small actions that are clearly defined, can be completed quickly, and have a clear beginning and end’, and to be able ‘to choose an action and complete it when it is convenient’. The main reason they gave was the flexibility this provided to complete tasks within the time allowed by other commitments. There was also consensus that an approach involving ‘actions that can be completed at home or close to home’ was important, most often because of accessibility.

Views about the importance of volunteering involving ‘no commitment from the volunteer to complete the action more than once – involvement can be just a one-off or volunteers can dip in and out’ were more divergent. Whilst this brought benefits for some, once again, largely around ‘flexibility’, others saw advantages for both clients and volunteers in repeating tasks – to build trust, establish rapport and improve understanding of how the volunteer can help.

There were also diverging views around the recruitment process and training. Interviewees wanted a ‘simple process of identifying an opportunity for volunteering without a complicated recruitment process’, because it saved time which could be used to volunteer, whereas complicated processes could put people off. However, adequate governance and training were regarded as important. This suggested the need for a balance between simplicity and ensuring that the service was delivered safely, perhaps though an approach that was more tailored to the task and the volunteer.

Volunteers like the accessibility and flexibility of micro-volunteering

Volunteers like the accessibility of micro-volunteering – tasks can be easily identified and quickly completed at a convenient time. They also like the flexibility it offers – to choose the extent of commitment, over a time-limited period, in a way that fits with their lifestyle. People liked that they could decline a task, knowing that someone else would pick it up – people in need would not be left without. People like being able to choose and carry out different types of tasks offered by the platforms. Micro-volunteering was described as a good way to get volunteer experience, and a good entry point for people who did not know how to volunteer.

The micro-volunteering concept underpinning the NHSVR and Team Kinetic programmes did not suit all interviewees

Some NHSVR volunteers said they would prefer a mechanism that enables them to establish a relationship with a client over time, to improve rapport and understanding of the client’s needs and one said they would prefer to sign up for a specific shift and receive a list of shopping tasks to undertake during that shift. Team Kinetic interviewees mentioned features that were specific to the way the app was used locally that addressed these areas of dissatisfaction expressed by volunteers with the NHSVR Programme. Notably, they talked about the ‘street champion’ role with multiple tasks grouped at a street level; and being able to book to repeat tasks which could build rapport with clients.

There was a perception that micro-volunteering is a good way to mobilise people into volunteering, especially during the current crisis. However, some experienced volunteers personally preferred the more structured commitment of traditional volunteering models.

Push vs pull models of micro-volunteering suit different people at different points in time

Interviewees were asked for their views of push and pull models of micro-volunteering platforms. Responses to this question revealed some key differences between the NHSVR and Team Kinetic platforms.

NHSVR interviewees agreed that the platform was a ‘push’ model of micro-volunteering. Their perceptions of the ‘pull’ model in comparison to their experience of working with the ‘push’ model were mixed. There was, however, a clear preference for the ‘push’ model amongst most interviewees at the current time: either in the short term because it suited their current circumstances, particularly work commitments, or in the longer term because it suited their attitudes to volunteering. NHSVR interviewees indicated they, and others, would have volunteered less if they had to actively search for opportunities, that the ‘push’ model made volunteering easier, and that people are more willing to help if asked. Just four people said the pull model would work better for them at present, including two who reiterated points made throughout the interview that they preferred to develop a relationship with a recipient over time.

Team Kinetic volunteers commonly thought that the platform involved both pull and push approaches. ‘Pull’ in that they could search for opportunities directly on the app. ‘Push’ in that delivery organisations sometimes sent them notifications outside of the app – by text, email, WhatsApp or from the Facebook group – that tasks were listed on the app for completion. Mixed views were expressed about preferences for ‘pull’ or ‘push’ models of micro-volunteering. Largely people liked the model they experienced, including those who liked the mix of the two approaches. One interviewee said that they liked receiving notifications, another said it would be helpful to receive notification that jobs are available by phone, as a reminder to look at the app, particularly when they returned to work full time.

Part Four: Sustainability

Supporting and promoting volunteer capacity

There is some concern amongst platform providers and their clients about volunteer fatigue and a consequent perceived need to build the voluntary sector infrastructure and continue to raise the profile of volunteering. However, the various platforms were seen as a good way to promote new models for volunteering and expand and sustain volunteering capacity. This was also a strong theme in the interviews with volunteers, many of whom pointed to the need to increase public awareness of the opportunities presented by micro-volunteering platforms. Across the board, volunteers highlighted how micro-volunteering has huge potential to support local communities and health economies in a number of ways, and that this has been largely due to a cultural shift observed since the pandemic.

The NHSVR and Team Kinetic volunteers interviewed particularly liked the flexibility and simplicity of the approach in general, and specifically the app. They saw both platforms as a way into volunteering for those without previous experience. Similarly, Be My Eyes reported volunteers liked the flexibility and simplicity of app, which leads to high retention and the sustainability of the model.

For Nyby and Tribe, the underlying rationale for their model of volunteering is to build and sustain volunteer and community capacity to address local need. Their approach uses co-production to embed a locally tailored model of volunteering within community partnerships by harnessing the power of technology and community action. Team Kinetic was used by local voluntary sector organisations and volunteers described some mechanisms that supported community development, such as the ‘street champion’ role, and local co-ordinators. There was a theme in interviews with NHSVR volunteers however, that the platform lacked sustainability because it was not embedded within existing local voluntary sector infrastructure, and therefore failed to develop social capital. Interviewees suggested this could be addressed creating local or regional structures, including mechanisms for teamwork and expert and peer support.

Volunteer passports

Platform providers and their clients highlighted the role digital platforms could play in expanding the development and roll out of volunteer passports. For example, if a volunteer registers with a platform, completes ID and DBS checks, this could potentially simplify and expedite the process of them registering and volunteering via another voluntary organisation/platform. In addition, it could provide volunteers with a digital ‘CV’ of their volunteering skills and experience.

Variation in model implementation

The flexibility in how the model and underpinning technology are implemented is an important factor in determining sustainability, because it allows clients and users to tailor the approach into local settings and ways of working (e.g., systems, processes, practices). Preventing the adaptation of a technology to local contextual factors is known to result in implementation failure^[1]. However, local variation in how the model is implemented may result in the model being used less effectively or optimally. For example, there could be issues when platforms were seen as an adjunct to, rather than an integrated component of, the local volunteering pathway. This could be due to local organisations being unwilling or unable to change internal systems and process to achieve better integration. Examples of not fully utilising the platforms included, only putting a sub-set of pre-existing volunteering activity onto the system rather than using it to recruit, register and manage new volunteers; and using process to advertise tasks to volunteers outside of the platform (such as through a direct email) rather than using functionality within the system to alert volunteers to opportunities. It is important here to recognise that two of the platforms were developed specifically as a response to the COVID-19 pandemic is response context and that this has determined the way they have evolved. It is clear that these platforms will need to adapt to be relevant as a way of supporting micro-volunteering outside of an emergency.

Standards for micro-volunteering

There was a perceived place for standards in terms of increasing the confidence of commissioners regarding the quality of provision. Tribe are working with TSA (https://www.tsa-voice.org.uk/) as part of a steering group for digital care standards and are participating in Helpforce work on standards in volunteering (https://helpforce.community/about). However, BME expressed concerns that standards would introduce complexity in the system which would detract from the benefits of simplicity offered in their app. GoodSAM, the providers of the technology supporting the NHSVR model, expressed a similar note of caution regarding the responsibility of organisations in terms of supporting volunteers and enabling

References

[12] Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (Greenhalgh et al 2019)

Part Five: Conclusions and Recommendations

This evaluation provided good evidence that micro-volunteering works as a way of engaging a willing volunteer force in meeting unmet community need. The micro-volunteering platforms engaged very high numbers of volunteers during the COVID-19 pandemic.

The platforms were not necessarily able to capitalise on the willing volunteer force that stepped forward and expressed an interest. There was clearly a very large number of people who saw their willingness convert into no activity at all, and another large group who undertook very little activity. This is potentially a missed opportunity to build volunteer capacity. Low activity was the feature most frequently associated with dissatisfaction amongst volunteers. Despite this, the evidence indicates this group are willing to engage with the micro-volunteering platforms in the future. Action should be taken as a matter of urgency to ensure that this ‘low activity’ group are engaged, and that their disappointing experience does not lead to them being lost to volunteering in the longer term.

The micro-volunteering platforms were good at engaging people who traditionally are less likely to volunteer – particularly those of working age. The combination of platform accessibility (especially the ease of using the app, the simplicity of the tasks and the flexibility of carrying out those tasks around other commitments), and changed personal circumstances during the pandemic (especially having more time because of reduced demands of work and/or restrictions on leisure opportunities) created the conditions for people to take on volunteering work – both those who were already very active volunteers, those who did a bit and those who were not volunteering prior to the pandemic. Volunteering strategies should take advantage of the opportunities for extending the pool of volunteers micro-volunteering offers.

In the conditions of a crisis like the COVID-19 pandemic, micro-volunteering platforms can act as a catalyst to engage people in additional voluntary work – including those who would not otherwise have volunteered. People learn that volunteering brings rewards – helping others, making a difference, learning new skills, all makes you feel good. They also learn that volunteering can be fitted in around work, family life and leisure. Volunteering strategies need to take account of these findings by communicating messages to the public about the opportunities offered by micro-volunteering that are clear and in a way that engages them.

Outside of the pandemic, effective messaging strategies could include clear articulation of the nature of the ask, such as the problem requiring their assistance, the nature of the commitment from the volunteer, and the rewards volunteering can bring.

Some people may be more motivated by meeting people and making new friends, others may be more interested in learning new skills that might be useful in their employment search. People who work and perceive lack of time as a barrier may be attracted by messages that micro-volunteering can be very quick and easy. Evidence from this evaluation suggests the messages will most effectively be tailored to suit specific segments of the population.

The types of tasks offered by micro-volunteering platforms could usefully be extended – both to reach a wider potential pool of volunteers – engage them and use that as a catalyst to increase their engagement.

There is also evidence that different segments of the population are interested in different types of activities. For example, from the data available more men than women selected roles which focused on driving, so increasing opportunities for these types of activities may better engage them.

The Be My Eyes platform could be regarded as an archetypal micro-volunteering model – an ultimately simple way of connecting volunteers with those who need their support. The approach could offer solutions to other providers as a way of extending reach of their apps to both service users and volunteers, and thus enhancing sustainability.

As demonstrated by the success of Be My Eyes, global infrastructure – both technology and community – can deliver highly effective solutions at the micro-level. Strategies for micro-volunteering could usefully draw on these lessons, including enabling agile solutions that can incorporate technological developments, and build on the possibilities offered by technologies such as 5G.

Interviews with volunteers also highlight that micro-volunteering does not work for all. Therefore, it needs to sit within a comprehensive package of opportunities that encompass a spectrum from archetypal micro-volunteering models such as Be My Eyes to very formal, traditional ways of volunteering, and a range of approaches in between.

The longer-term sustainability of national platforms supporting micro-volunteering could be enhanced by creating local or regional structures, including mechanisms for teamwork and expert and peer support.

NHSVR volunteers suggested expanding the app to capture a wider variety of tasks and allowing tasks for individual clients to be repeated. Feedback suggested that this may be happening informally outside of the app. Allowing this information to be captured and logged could be used to improve the reporting and increase impact of the volunteer programme as a whole.

Microvolunteering report

Download a PDF of the report

HIN Strategy 2021-26

Welcome

Back in 2013, the HIN was formed by an alliance of local organisations wanting to make a significant and lasting impact on health and care in south London.

As the Academic Health Science Network for south London, we occupy a unique position between health and care providers (and commissioners), industry, and academia, with the ability to both support early innovations and then work at a national scale to spread innovation in practice. Our early priorities were selected following a close consideration of community needs and priorities which enabled us to identify programmes that would drive goals for health outcomes, improve the experience of care, test and spread innovation and focus on wealth creation and industry engagement. Our local relationships and system understanding have strengthened over time, enabling us to respond to changes, evolving our programmes and suggesting innovative solutions as a trusted broker.

In the last eight years we believe we have made a valuable impact including:

Invested £200,000 directly in Innovation Grants to kickstart 15 innovative health and care projects in south London covering long-term conditions, mental health, emergency care and maternity care to name a few. One example is a mass screening project which delivered health checks to 441 people across six health clinics at local Black Caribbean and Black African Churches, a Tamil temple and two mosques in Wandsworth. It found:

Using the Diabetes UK ‘Know Your Risk’ tool, 61 per cent of participants had a high or moderate risk of Type 2 diabetes
27 per cent had a blood pressure of >140/90 indicating possible hypertension.

Enabled south London residents to receive cutting edge technology including:

35 patients suffering with severe cluster headaches, a relatively rare but most debilitating condition, benefitting from the life-changing and non-invasive Gammacore device
248 patients with suspected coronary artery disease benefited from Heartflow scan which avoids any invasive procedure

A 74 per cent increase for patients with high cholesterol benefitted from PCSK9I inhibitors, a new type of medicine for lowering cholesterol.

Led the London-wide collaboration to support the increased use of remote monitoring of care homes; this involved working with six companies to implement remote monitoring in nearly almost half the number of care homes in the capital (many of which did not even have wifi), supporting more than 22,000 residents.
Supported over 120 companies through our DigitalHealth.London Accelerator.
Supported 12,000 patients to access our structured education programme via the Diabetes book and learn service.
Spread the use of the award-winning ESCAPE-pain programme which helps people with arthritis self-manage their pain through exercise to more than 200 sites across the country.

To enable these changes, we rely on our staff who bring a wealth of experience from many sectors. We have developed a work culture that supports creativity, enables people to think differently, fosters bravery and strives to build a resilient, diverse, and joyful organisation.

We are excited about building new partnerships and collaboratives. This strategy is the outcome of the many conversations and listening events and our personal and collective learning over the last eight years.

Thank you for your continued involvement and support in speeding up the best of health and care, together.

Signed by the HIN Board

September 2021

Our Mission, Vision and Values

Our Mission

Speeding up the best of health and care, together.

Our Vision

We want a future where health and care innovation spreads fast. We’re building it by connecting people with great ideas, inspiring people to think differently and giving them practical support to do something new.

Our Values

BRAVE: We encourage our teams and others to be brave with their ideas and support them to try something new.
KIND: We care about each other, the people we work with and about the health and wellbeing of south Londoners.
OPEN: We’re open about what we do, and we share what we learn.
DIFFERENT: We think differently, and we are strong because of our diverse backgrounds, talents and experiences.
TOGETHER: We build communities and networks, we collaborate and we connect.

Introduction

We want a future where health and care innovation spreads fast.

To do this we will:

Ensure south London benefits from national innovation priorities and that these help address health inequalities.
Deliver health and care change programmes with a focus on long-term conditions and mental health to improve health outcomes.
Support innovators and the workforce in the health and care system to achieve faster adoption of innovations and drive economic growth – with a focus on digitally-enabled business models.
Evaluate the effectiveness of innovations in a real-world setting and generate evidence to identify which innovations should be adopted in health and care.

Build a sustainable, resilient, diverse, and joyful organisation.

How? By using our relationships as a membership organisation to spend time with people to understand their challenges and what will improve the health outcomes for south Londoners. We aim to support in five key areas:

Change: We improve health and care, utilising high standards of excellence and professionalism with a focus on patients and residents in line with the NHS values and support the NHS principles.
Connect: We are the part of the NHS bringing innovations to support patients and residents in south London. We understand the challenges for the NHS, social care and innovators and create connections across the system.
Collaborate: We work with public sector, academic institutions, private sector and third sector organisations to promote the needs of patients and residents of south London and share knowledge and learning.
Catalyse: We act as a catalyst for sustained improvement which provides the best value for taxpayers’ money. This includes seeking funding from outside the NHS and social care where it aligns to our values.
Create capabilities: As a NHS hosted organisation which works with industry, we provide a compelling offer to experienced public sector staff to develop entrepreneurship, commercial and change management skills. We also support non-NHS staff to understand the NHS values and culture.

A key part of our role is in supporting and connecting innovators with local health and social care organisations to work together. And our remit around wealth generation, means that we also explore ideas that will drive economic growth for south London and beyond and build upon the 500 new jobs we have already created.

Our strategy was developed following multiple internal and external conversations and will enable us to connect our members and partners with practical and sustainable innovations that make a real difference to people and communities.

In the next five years, we aim to deliver:

Innovation and Industry Partnerships – supporting innovators and the workforce in the health and care system to achieve faster adoption of innovations and drive economic growth – with a focus on digitally-enabled business models.

Innovation selection support – Helping members and other organisations to articulate their needs to be addressed by innovations, to select the best interventions / technologies to meet these needs and to design programmes to deliver improvement.

Health and Care Change Programmes – providing a balanced portfolio of programmes with a focus on long-term conditions, including mental health, and local priorities.

Evaluation services – providing support, directly and through partners, to evaluate the impact of new innovations in the real-world, plus the evidence base to choose interventions and to support spread and adoption.

Capability and community building – collaborating on major local programmes, connecting people, creating partnerships, and increasing capabilities of provider and commissioner organisations through a range of people development programmes.

In addition to our core offer, which is developed in partnership with other AHSNs, national commissioners and regional stakeholders, we will also provide a range of additional services which will be available on a fee-for-service basis as part of our enhanced offer. Part of our commitment to members is to offer high quality services at competitive rates to support them in innovation and improving services for our local south London population.

Local and national context

We are part of a vibrant but complex system of innovation nationwide and across London. We work in collaboration with strategic partners across south London to help the NHS and care system innovate and improve. Each part of our local network has distinct strengths when it comes to discovering and implementing innovation.

South London: Serving the population of south London is core to our mission and most of our members are based in south London and serve or represent our local population.

Map showing different stakeholders of the HIN

We act as an ambassador for south London achievements and take a lead role in sharing innovations developed locally, with our national partners.

London-wide: In many instances our innovation ecosystem extends beyond south London and increasingly we work with innovators and partners across London and beyond to develop and spread innovation. An example of the types of organisations involved in the development process is outlined here. The HIN as an AHSN is focused on developing innovations which may originate from academia or from London’s world-class start-up and digital ecosystem.

diagram showing other stakeholders involved in local health innovation

Further to this, we have collaborated with regional, national and international bodies to drive innovation including:

National commissioners such as NHS England and NHS improvement, NHSE London region, NHS Digital, NHSX, the Office for Life Sciences, Department for International Trade.
Other AHSNs to share our learning and to bring innovations, proven to work elsewhere, to our members and local population.
London-wide partners such as MedCity, Greater London Authority and the Mayor of London.
Industry partners including pharmaceutical companies and technology leaders
Research organisations including NIHR Applied Research Collaborations, King’s Health Partners, St. Georges University of London, Kingston University, London South Bank University .
Charities, patient organisations and third sector partners including National Voices, CW+, GSTT Charity, Versus Arthritis, Sport England, BEAT, Diabetes UK, Health Foundation, Zero Suicide Alliance, Mind, Alzheimer’s Society, local Healthwatch branches.

Through DigitalHealth.London, a partnership with other London organisations which we host, we have supported hundreds of private sector companies over the last five years which help to improve care, generate value to NHS, or create economic growth:

Image showing companies DigitalHealth.London have worked with

Over the next five year period we will seek funding to continue this effort and plan to develop partnerships with international accelerators to support developed companies to scale internationally and to bring the best innovations from abroad to support London providers.

Nation-wide: We seek to spread innovation nationally, and to learn from across the country. We are part of the national AHSN Network which gives us national reach and scale in specialised activities. Increasingly, we work with other AHSNs across London and the country to bring the best to south London, to avoid duplicating efforts and to ensure we have the greatest impact for the investment we make. Building on our experience through DH.L, the London digital ecosystem and our digital programmes, HIN leads the AHSN Network digital workstream and supports other AHSNs with digital issues.

Our role within the AHSN network: •Leading on key national project such as Early Intervention Eating Disorders.
•Leading on national themes such as digital innovation.
•Leading on regional programmes such as the London wide remote monitoring Innovation Collaboration.
•Sharing best practice and learning from south London.

Case study: The ESCAPE-pain programme

The ESCAPE-pain programme (Enabling Self-Management and Coping with Arthritic Pain using Exercise), developed in south London was implemented across the country as a major AHSN Network programme.

This group rehabilitation programme for people with chronic joint pain integrates educational self-management and coping strategies with an exercise regimen individualised for each participant.

Developed by Professor Mike Hurley, an NHS Innovation Accelerator fellow, in 2013 it was identified as a local innovation that was ready for adoption by HIN. Following the success of our local rollout, ESCAPE-pain became an AHSN Network national adoption and spread programme.

It was delivered in partnership with Versus Arthritis and Sport England and supported by the NHS Innovation Accelerator. In 2020 it was named ‘Musculoskeletal Initiative of the Year’ by the Health Service Journal.

At the end of the national programme, 12,781 people had completed ESCAPE-pain and sites adopting went from 51 to 280.

The longer-term future of the programme has now been secured through a partnership between HIN and national medical charity Orthopaedic Research UK.

Connecting people with great ideas

Innovation is a vibrant, exciting, and growing area in which we operate. The need to effect rapid change during the pandemic has accelerated the pace of innovation and exposed even more staff and patients to opportunities of innovative technology and alternatives to traditional ways of delivering care. During this period of change, we think it important to outline our principles for choosing what we work on and recognise that our portfolio will evolve over time (and that we can’t deliver every great idea immediately). We are informed by key principles:

These have led us to consider five key areas where we work in the period 2021-23:

	Objective	Commitments 2021-23
Innovation and Industry Partnerships	To drive economic growth by supporting innovators from academia and private sector to develop their products and services	•To advise and support 100 innovators to navigate the health and care system •To provide intensive support through the DH:L accelerator to 20 companies in cohort 6
Innovation Selection support	To support organisations to articulate their needs to be addressed by innovations, to select the best interventions / technologies to meet these needs and to design programmes to deliver improvement	•To support local SWL and SEL initiatives to select innovations •To extend this service to other partners as part of our enhanced offer
Health and Care Change Programmes	Deliver a balanced portfolio of national and local programmes which serve the population of south London	To deliver our targets in key commissioned programmes: •Long-term conditions (Diabetes and cardiovascular disease) •Mental health •Patient Safety and experience
Evaluation services	Providing support, directly and through partners, to evaluate the impact of new innovations in the real-world and to provide the evidence base to choose interventions and to support spread and adoption	Develop services to: •Evaluate rapidly the effectiveness of innovations in the real-world •Independently evaluate the impact on inequalities of innovations
Capability and community building	Collaborating on major local programmes, connecting people, creating partnerships, and increasing capabilities of provider and commissioner organisations through a range of people development programmes	•Provide programmes to develop staff to be ready to adopt innovations across settings of care including care homes •Develop additional programmes working with people initiatives in south London and with Health Education England

Health and Care Change Programmes

Our portfolio of programmes re-doubles our focus on long-term conditions, including mental health, where we add value coordinating programmes across organisational boundaries and in varied settings of care. These included projects that have started locally, based on south London priorities and national innovation programmes that we support nationally as part of the AHSN Network.

From the time we were established, we have picked themes and programmes based on the population health need across south London such as diabetes and cardiovascular disease. These cross-cutting themes have worked well as they have allowed us to have multiple initiatives within the scope of the overarching programme.

All changes to programmes have been timely responses to the local system, demonstrating how we have the capacity to flex to local needs. For example mental health was added as a programme as all our local stakeholders had mental health as a priority.

This is a tradition we continue with, co-designing with HIN members and other stakeholders, from initial idea, through design to implementation and spread, with our local system including community groups, VCSE organisations.

Innovation and Industry Partnerships

We are the first port of call for commercial innovators wanting to reach the south London market, through advice, guidance, and making connections:

Supporting innovators to identify the steps required to further develop their innovation and demonstrate its clinical and financial effectiveness.

Opening doors by providing guidance on understanding the NHS and social care, helping navigate the culture and practices and how to maximise the opportunities where an innovation has the potential to provide a solution to a health or care challenge.

HIN is a national lead for digital innovation and will continue to work with key partners to understand opportunities for investment, ways to stimulate economic growth with a focus on technology, life-sciences and health.

Case Study: DigitalHealth.London

We are a founding member of DigitalHealth.London, a pan-London organisation that connects NHS staff, digital health companies and academics, and equips them to improve the NHS and social care in London through digital technology.

We signpost innovators onto relevant opportunities such as our business support programmes, relevant networks or masterclasses, for example:

DigitalHealth.London Accelerator Programme, which is uniquely positioned to provide in-depth knowledge of the NHS and care sector to a cohort of high potential small and medium sized businesses (SMEs).
DigitalHealth.London Launchpad programme for early stage London-based innovative companies that are looking to launch products in the NHS and care sector.
NHS Innovation Accelerator, working collaboratively with NHS England and the other AHSNs, to support innovators and evidence-based innovations scale in the NHS and care sector.

Direct Support to HIN Members

We provide a wide range of support and opportunity to our members such as:

Spread and Adoption Support for the implementation of innovative solutions developed by our members: defining the benefits of a programme, evaluation, help to build its national profile and support for joint award applications.

Commercial Support to develop partnerships and contracts including procurement support and guidance.

Collaborating and Connecting – a varied range of HIN networks and communities of practice, including patients, stakeholders from public, private, academic and VCSE sector, including seldom heard groups across a range of themes. HIN colleagues can join and work alongside partner networks to offer expertise and knowledge and make connections.

Evaluation Support – advice on how to conduct the most appropriate evaluation for a service development, change programme or innovation implementation, plus introductions to trusted partners for ongoing work as appropriate.

Horizon Scanning, identifying the latest innovations and the best of national and regional innovation pipeline of companies and programmes. Vetted introductions to trusted innovators identified by our Innovation and Industry Partnerships work.

Programme Management Support for when additional capacity is needed in the system, including scoping. Often this involves extensive partnership working to form and run joint initiatives.

Academic Interface,as lead for the Involvement and Implementation team in the ARC , we link academics to those looking to research and evaluate innovations and implement research-generated evidence into our local system.

Access to NHS Graduate Digital Data and Technology Scheme which helps recruit IT and data graduates into hard to fill NHS roles.

Funding Opportunities, including how to access pathway transformation funding and procure nationally recognised rapid uptake products, and apply for our annual £100k Innovation Grants Scheme.

Access to the HIN Academy which offer a range of development opportunities and workshops.

Attendance at our events – including training, collaboration sessions, roundtables, and online forums. In addition, we can also support with the organisation, facilitation and reporting for member events as part of our HIN Consult offer (see below).

Case Study: You & Type 2 Diabetes programme

A dynamic partnership was needed to co-create this new digital pathway for people with diabetes type 2. Thus HIN helped South-West London Clinical Commissioning Group (CCG) develop the diabetes “You & Type 2” programme, from inception, including support for the selection of industry and evaluation partners and spread of the pathway in Southeast London.

HIN worked with GP practices across Lewisham, Lambeth, and Southwark, providing project management support and access to digital resources involved in the pathway.

The practices committed the time of their staff to training in personalised care and support planning, process mapping workshops, and the rearrangement of their ways of working to incorporate the You & Type 2 pathway.

The CCG had an important role in recruiting practices and leading the governance of the project, particularly the information governance around the new technologies being introduced.

HIN supported innovators from the design stage to delivery and worked collaboratively to ensure that their products worked in a seamless pathway.

Our enhanced offer

Our varied and extensive experience allows us to offer enhanced support through consulting services in five key areas.

Innovation selection: We can help organisations and teams to prioritise and select the most appropriate innovation and support with strengthening the evidence base and implementation. Through our networks we are able to apply learning about what has been successful elsewhere.

Improvement programme design and management: Co-design is our starting point for our support offer for system-wide improvement and change programmes. Our stakeholder engagement services provide access to the right people and organisations who together can solve challenges.

Capacity and capability building: We identify local leaders and provide a programme of support and development to enable them to champion innovation and improvement in their organisations. Examples include the Care Home pioneers, Digital Pioneers, QI Training, and Communities of Practice Leadership Programmes.

Evaluation and informatics: We deliver high quality independent evaluations and informatics support designed to build the evidence base for spread and adoption of health and social care innovations such as a new product, service or pathway. This includes evaluation design and support, capability building / training, mixed methods evaluations (e.g. qualitative, quantitative, surveys), digital health technology real world evaluations, data analytics and insight reporting. Our experience is that 6-10% of innovation project resources should be focused on evaluation.

Grant administration, communications, and event management:

Our support ranges from administering grant programmes and competitions, providing communications support and running targeted campaigns to raise awareness of innovations, to organising or hosting events designed to stimulate a better understanding of innovation. This work makes use of our experience in developing communities of practice and our links across a variety of key stakeholders.

How we fund our work

Some of our work is funded through national commissioners including NHS England, the Office of Life Sciences, Patient Safety Commission. We work with the AHSN network to develop most of these programmes and ensure consistency across the country in deploying proven outcomes-based interventions.

We are also supported by our members through direct contributions and are committed to delivering valuable services to them and providing our enhanced offers at competitive prices and a significant discount to commercial rates.

We also undertake additional commercial work that supports our values, priorities, and positively impacts the lives of south Londoners.

Our aim for commissioned work is to ensure that it contributes to the sustainability of our organisation and helps us to continue to provide services in the future. Most of our work aims to generate a surplus in the medium term and any significant investments made by us must be approved by our Board, which is made up of representative organisations from our membership base.

Demonstrating value

We are passionate about demonstrating impact and value on all our projects through understanding the inputs, outputs and outcome measures each step of the way.

Commissioners increasingly recognise the importance of independent evidence for effectiveness, not just of interventions but of the programmes to implement them in the real world. The range of projects we support mean it is imperative that our evaluation and informatics team is a crucial part of our offer and one we intend to further develop over the next 1-2 years.

This has included looking at the effect on patient measures and social return on investment such as in our Joint Pain Advice programme, the number of companies we have assisted and new innovations we have evaluated, the number of patients gaining access to NICE approved innovations via our Rapid Uptake Products programme & Diabetes Book & Learn.

We are also committed to supporting the development of an evidence base around societal impact of our programmes including the impact on inclusion, environmental sustainability and health inequalities.

HIN as an organisation

To deliver our ambition, we need the best people, from a variety of diverse backgrounds, who bring rich experience. This is why we choose to invest in recruiting brilliant people to work with us and in creating a place to work that enables everyone to thrive and develop skills they need to work with each other and the variety of stakeholders in our programmes.

Our priority is to build a sustainable, resilient and joyful organisation which offers staff the unique opportunity to work across sectors and different types of organisation and undergo training through our inhouse HIN Academy.

How we build a sustainable, resilient, diverse and joyful organisation

Graphic showing how HIN approaches staff wellbeing

Our co-designed wellbeing offer is central to this, and was ahead of its time. It culminated in the achievement of the Healthy Workplace Charter Excellence standard in November 2017. A wide range of developments have stemmed from this work, including:

training line managers in mental health awareness
identifying and training staff as Mental Health First Aiders
establishing a Health and Wellbeing working group
introducing a number of activities including physical (running club, walking challenge) and non-physical (book club).

Diversity

We are conscious that as the AHSN for south London we serve one of the most diverse populations in the country, part of a global diverse city. It is of prime importance that our work improves the health and care of the diverse populations within south London and reduces inequalities. In order to do this, we need our staff to understand and reflect this diversity. We deliver better outcomes because we are not all the same. Our belief in diversity in enshrined in our values, our commitment to be open, brave and to deliver our work together.

As a result, we are signed up to the AHSN Network’s three key diversity pledges which are reflected in our working practices:

We commit to implementing a recognised process to self-assess and improve equality performance in each of our organisations.
We commit to empowering and supporting our staff to be positive role models for equality and diversity.
We commit to understanding the impact of our work on all members of our communities and for our work to reflect the equality and diversity within these communities.

Those who work for us say that they value being part of the NHS with the opportunity to have an impact both locally and at a national scale, and with public and private sector partners. Those who work with us complement us on the skillset and attitude of our colleagues and their ability to deliver on impactful project tackling difficult challenges.

Our alumni

We recognise that our staff are talented and can contribute to improvement and innovation in many ways in a variety of roles and organisations. We develop our staff in their day-to-day roles, and most choose to stay with us for several years. We actively support career planning for individuals and succession planning within teams and offer a range of adaptable working opportunities to help staff broaden their experience during their time at the HIN. We also recognise the contribution of staff who choose to use the experience at the HIN in member organisations or the wider innovation ecosystem and celebrate their success. We are developing our support for alumni who have gone on to work in a range of organisations and roles including senior national NHS leadership roles, local NHS transformation teams, and industry organisations to include:

A formal network headed up by our previous chair Richard Barker.
Networking opportunities, both face to face and virtual.
Show and tell presentations to keep them updated with the HIN’s latest work.

Conclusion

We are proud of the achievements and impact we have had to date. In the next five years we will build on this further by focusing on our five key lines of business:

Innovation and Industry Partnerships
Innovation Selection Support
Health and Care Change Programmes
Evaluation services
Capability and community building

We will also continue to invest in our staff and the HIN as an organisation to ensure it remains an attractive place to work.

You will know we have achieved this because we will have:

Supported over 250 companies and innovators to increase economic growth for London, including the creation of new jobs.
Helped 35,000 south Londoners access new nationally approved drugs and medical devices.
Supported over three quarters of south London care homes to adopt remote monitoring tools.
Supported 30 projects to understand their impact on inequalities.

The next five years will undoubtedly be full of challenges and opportunities to improve the lives of those in south London and we are proud to be at the forefront of that, ensuring innovative breakthroughs reach those who will benefit from it first.

Remote Consultations in Mental Health: Learning from Evaluation Report

Introduction

COVID-19 turbo-charged the use of remote consultations in mental health, with many services having to switch to video or telephone appointments almost overnight. But what has this meant for service users and staff, and what lessons can we take for the future?

This report, published jointly with south London mental health providers, local system partners, academics and service users examines the evidence on the impact of the shift to remote consultations, shares learning and provides recommendations for future practice. This work is ongoing so please check back to the Remote consultations in Mental health resource page for updates and the latest published papers.

Executive Summary

Remote Consultations in Mental health – Learning from Evaluation Executive Summary

COVID-19 has meant significant changes in how mental health services have been delivered. Appointments that would normally have taken place face-to-face have had to be moved to video or telephone consultations.

These changes are likely to have had an impact on all the people involved in mental health care – from service users to clinicians and other mental health professionals. There may have been positive and negative effects, or unexpected consequences. Currently, however, there has been no comprehensive evaluation of these effects.

This project is led by the three south London NHS Mental Health Trusts, working in conjunction with service users and academia to develop the evidence base in this area and form a learning healthcare system.

Through conducting a robust evaluation of the current evidence and identifying any potential gaps, the project aims to guide ongoing research, disseminate best practice, and inform the delivery of services now and in the future.

This report details phase one of this project with the thematic analysis of the findings from the three workstreams- systematic evidence reviews; a synthesis of patient, carer and staff surveys and a survey of ongoing evaluations.

Executive-Summary-Read-only-1 Download

About the Project Partners

This work is produced jointly by the following organisations. The group have formed as the MOMENT (reMOte MENTal health group).

The Health Innovation Network
The Health Innovation Network (HIN) is the Academic Health Science Network (AHSN) for south London, one of 15 AHSNs across England. As the only bodies that connect NHS and academic organisations, local authorities, the third sector and industry, we are catalysts that create the right conditions to facilitate change across whole health and social care economies, with a clear focus on improving outcomes for patients. This means we are uniquely placed to identify and spread health innovation at pace and scale; driving the adoption and spread of innovative ideas and technologies across large populations.

The NIHR Applied Research Collaboration South London
The National Institute for Health Research (NIHR) Applied Research Collaboration South London are a research organisation that brings together researchers, health and social care practitioners, and local people to improve health and social care in south London.

Kings Improvement Science
King’s Improvement Science (KIS) comprises a small team of researchers and quality improvement experts. Their aim is to help improve health services in south-east London.

Expert by Experience group
A group of four Experts by Experience with a range of backgrounds including experience of using health and social care services and caring responsibilities were recruited by the KIS Patient and Public Involvement Coordinator through the KIS involvement bulletin. The group have been core team members throughout the programme from September 2020.

Mental Health Policy Research Unit
The aim of the Mental health Policy Research Unit is to help the Department of Health and others involved in making nationwide plans for mental health services to make decisions based on good evidence. They make expert views and evidence available to policymakers in a timely way and carry out research that is directly useful for policy.

South West London and St George’s Mental Health NHS Trust
South West London and St George’s (SWLSTGs) serves 1.1 million people across the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth and employ more than 2,000 staff who provide care and treatment to about 20,000 people from south west London.

Oxleas NHS Foundation Trust
Oxleas provide a wide range of health and social care services to people living in south east London and parts of Kent. This includes physical health, community services and mental health care such as psychiatry, nursing and therapies. Oxleas have 4,000 members of staff working in many different settings, such as hospitals, clinics, prisons, children’s centres, schools and people’s homes.

South London and Maudsley NHS Foundation Trust
South London and Maudsley NHS Foundation Trust (SLaM) provides the widest range of NHS mental health services in the UK. They also provide substance misuse services for people who are addicted to drugs and alcohol. Their staff serve a local population of nearly two million people. They have more than 230 services including inpatient wards, outpatient and community services. They provide inpatient care for over 5,000 people each year and treat more than 45,000 patients in the community in Lambeth, Southwark, Lewisham and Croydon. They also provide more than 50 specialist services for children and adults across the UK and beyond.

South London and Maudsley Quality Centre
The SLaM Quality Centre Improves mental health care for the populations they serve using data, evidence-based planning, care process models and a shared methodology. The Quality Centre defines, tests, implements and continuously improves the work of the Trust, so that service users, carers and staff can clearly see what is expected at each part of a journey through the system. This is being achieved through the collaboration of our clinical, academic, lived experience (service user and carer), quality improvement, operational, governance and commissioning leads.

Foreword

The new coronavirus SARS-CoV2 was first identified in late 2019 with the first cases of COVID-19 infection reported in the United Kingdom at the end of January 2020. From mid-March 2020 onwards, social distancing measures were introduced to reduce the spread of the virus and health services rapidly increased their adoption of remote consultations. This included inter-professional, service user and carer facing interactions using the internet, telephone, video conferencing and text messaging. Video conferencing software called ‘Attend Anywhere’ was made freely available to secondary care from 31 March 2020.

In response to this rapid change, a number of partners across south London mental health service providers, service users, service and innovation connectors and academic evaluators came together with the ambition of forming a learning health care system^[1] to evaluate experiences, implementation, and effectiveness of remote consultations in the context of existing and emerging evidence to inform and improve service delivery, during the pandemic and beyond.

Our interested organisations joined in June 2020 as an informal partnership across south London. Together we identified and agreed on a programme as part of COVID-19 response work. Phase one saw the delivery of a survey of ongoing evaluations being conducted in south London; a synthesis of patient, carer and staff surveys; and systematic evidence reviews.

Phases two and three were centred around the dissemination of our findings and establishing a ‘Learning Healthcare System’ on remote consultations in mental health settings.

This local-level learning has the potential to be captured, synthesised and shared across organisations; to identify evidence gaps, create positive change within services and improve experiences and outcomes for patients, carers and staff. This report shares our methods, findings and tools developed and highlights the gaps in evidence and future research opportunities. Please stay up to date with our work develops via our webpage and use the contact form to get in touch with the team.

Professor Fiona Gaughran – Lead Consultant Psychiatrist, National Psychosis Service, Director of Research and Development SLAM, Reader in Psychopharmacology and Physical Health Kings College London, Applied informatics research lead NIHR ARC South London

[1] The concept of a healthcare system collectively gathering information and synthesising knowledge about how well or otherwise service delivery is working then using this understanding to drive ongoing improvement can be described as a ‘learning healthcare system’. The Institute of Medicine defines a learning healthcare system as a system in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”

Background

Service changes were introduced extremely rapidly across the NHS in response to the COVID-19 pandemic, including in mental health. These included a shift from face to face service delivery to a model where most outpatient contacts were conducted remotely, either on the telephone or by video consultation. These service changes may have significant advantages for many staff and patients, such as convenience, safety, time savings; they may also have disadvantages, drawbacks, or unintended consequences, and may exclude some key populations.

Our partnership sought to understand the impact of such service changes, what has worked and what has been less successful, and for whom, in order to either embed or adapt, new and emerging models going forward, to ensure the greatest benefits for patients, carers and staff. This report also provides case studies that describe the implementation processes that supported the introduction of these novel models of care in the first phase of the COVID-19 pandemic.

The project is set mostly in south London and includes the three mental health Trusts – South London and Maudsley NHS Foundation Trust (SLaM), South West London and St George’s Mental Health NHS Trust (SWLSTG) and Oxleas NHS Foundation Trust (Oxleas), working closely with the Health Innovation Network (HIN), Kings Improvement Science (KIS), NIHR ARC South London and the SLaM Quality Centre (a collaboration between the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at Kings College London (KCL) and Kings Health Partners (KHP) along with the Mental Health Policy Research Unit. University College Health Partners (UCLP) were also involved in the partnership contributing to the core group and sharing the e-survey across their mental health providers in north east and north central London.

Figure 1:

Increase in Microsoft teams call at South London and Maudsley NHS Foundation Trust March 2020 – May 2020.

Figure 2:

Project over-arching objectives: a South London approach to establishing a ‘learning healthcare system’ across health and care

Aims

To bring together the findings from the three workstreams to inform clinical practice and to determine ongoing gaps in knowledge. The workstreams are listed below.

Systematic literature reviews of the evidence on remote consultations pre and during the COVID-19 pandemic
Thematic synthesis of Trust-wide surveys on remote consultations
E-survey of projects on remote consultations across south London mental health NHS Trusts

The specific objective of this work was to identify commonalities and areas of difference; highlight gaps in the evidence base around remote consultations in mental health services that may need to be addressed in future research, and inform future information gathering approaches. The evidence gathered supports mental health services and service users to learn what is already known about remote consultations.

Figure 3:

Methodology

Partnership development

Our interested organisations joined in June 2020 as an informal partnership across south London. Together we identified and agreed on a programme of work as part of COVID-19 response work. The group have formed as the MOMENT (reMOte MENTal health group).

Programme methodology

A project group was established with resources, timelines, and a governance structure across the multiple partners. A project plan and data capture process were established and a forum (the core group) that allowed sharing of tools and approaches. A dissemination plan and engagement strategy were written to connect with colleagues across London and help create a larger learning network. A group of four experts by experience with a range of backgrounds, including experience of using health and social care services and caring responsibilities, were recruited by the KIS Patient and Public Involvement (PPI) Coordinator through the KIS involvement bulletin. The project group used the learning health system as an organising framework and co-designed the work programme with providers, users, and evaluators.

Programme structure – The programme was split into three workstreams.

Workstream one – Evidence reviews

Two reviews were conducted. One ‘Umbrella Review’ on the evidence pre-COVID-19 and a systematic review of evidence during the pandemic

Umbrella review

We conducted an ‘umbrella review’, also known as a ‘review of reviews’, of research literature and evidence-based guidance on remote consultations in mental health, including both qualitative and quantitative literature, conducted and published prior to the COVID-19 pandemic. The aim was to identify the pre-COVID-19 literature on guidance, effectiveness, implementation and economic effectiveness of remote consultations in mental health. Nineteen reviews met our criteria, reporting on 239 studies and 20 guidance documents. The review included studies on telephone counselling, videoconferencing for diagnosis, therapy and education across a range of diagnoses.

Systematic review

We also conducted a systematic review of the evidence on remote consultations in mental health services during the COVID-19 pandemic. Our aims were to identify the adoption and impact of remote “telemental” mental health approaches and facilitators or barriers to optimal implementation. Seventy-seven relevant papers were synthesized.

Workstream two – Trustwide patient and staff surveys on remote consultations

A thematic analysis was conducted to synthesise the questions and findings across four organisation wide surveys that were carried out within the three south London mental health Trusts in the summer of 2020. This analysis included results from patient and carer surveys, one survey of Consultants and Specialty and Associate Specialty (SAS) doctors, and one survey that collected responses from patients, carers and staff (see table one). Please see here for copies of each individual survey report.

Table 1:

Workstream three – e-survey

An electronic-survey (e-survey) (Appendix one) was conducted to collect information about evaluation, research or quality improvement projects studying any aspect of remote consultations (both patient-facing and interprofessional) within mental health services. The survey was initially conducted within the three mental health Trusts in south London, though some of the projects described were in local voluntary sector organisations or had national / international reach. The survey was then carried out in north east and north central London following minor modifications.

The focus of the survey was to collate information about project aims and methods; we did not capture findings.

The south London e-survey was initially open to responses between 13^th July 2020 and 1^st September 2020 and was briefly electronically reopened on 11^th November 2020 to allow entry of five additional projects that became known to members of the project group. In north east and north central London the e-survey was open between 5^th October 2020 – 15^th November 2020.

Summary of findings

Triangulation of evidence and data: A thematic analysis of the findings from the three workstreams was undertaken by a multidisciplinary team of researchers and project managers, further scrutinised by a team of experts by experience, and by clinical and managerial members of the project group. An infographic summarising the findings from this analysis is being developed by the experts by experience (underway).

Workstream One: Evidence reviews

Umbrella review of pre-COVID-19 literature- Please see [https://www.jmir.org/2021/7/e26492] to access the paper.

This systematic review of systematic reviews revealed the following:

Remotely delivered mental health services can be as efficacious and acceptable to staff and patients as face-face formats, at least in the short-term.
There was little evidence on large scale implementation of remote consultations and effectiveness in ‘real-world’ (i.e. outside of a research study) settings.
Further, the findings of this umbrella review did not provide us with evidence relating to digital exclusion and how it can be overcome and was not able to provide conclusions on particular contexts, for example children and young people’s services or inpatient settings.

A systematic review of COVID-19 literature from during the pandemic– (link will be added to paper when available)

A synthesis of 77 relevant papers from 19 countries demonstrated that globally, many countries had been able to rapidly shift to remotely delivered mental health services during the pandemic. In general, these studies suggest that:

Telemental health has been reasonably well accepted, particularly where the alternative was no contact.
A mixture of telephone and video-based calls have been offered, with people expressing different preferences for these.
Concerns about remotely delivered services are raised in relation to new service users, physical healthcare, and privacy and confidentiality.
A small number of studies have formally investigated how telemental health may best be implemented, though suggestions made within this body of literature to support implementation include:
- Staff training, champions for telemental health, providing service users with access to technology and guidance on how to use it
- Providing staff with guidance on identifying whether a remote offer is appropriate in different situations / with different individuals.

Overall, the literature suggests that the delivery of telemental health has been largely successful within the context of a pandemic. Nonetheless, longer-term evaluation and better evidence is needed as restrictions on physical distancing between people evolve.

Figure 4:

Workstream two: Summary of findings from the Trust patient and staff surveys

Patient experience of remote appointments can be summarised as follows:

Oxleas:

90% of patients responded “Yes” or “Somewhat” when asked if they were happy with the care and treatment received in their remote appointment.
79% of patients responded “Yes” or “Maybe” when asked if they would like to be able to have remote appointments in future.

SWLSTGs:

97% of survey participants reported that they would either ‘definitely’ or ‘probably’ use the system again, were they to be offered the option, despite issues with video and audio quality reported in the survey.

Joint patient and staff survey at SLaM:

From responses to a question on experience and one on future intent, three profiles of virtual contact users was constructed.

• Resistant (n=84): those who reported that their virtual contact experience was “worse/ much worse” than that in face-to-face contact, and they are “somewhat/ very unlikely” to want it in the future

• Ambivalent (n=338): those who did not find virtual contact experience better than that in face-to-face contact, yet they showed no intention to reject it in future

• Receptive (n=123): those who found virtual contact “better/ much better” than face-to-face contact and are “somewhat/ very likely” to want it in future More detailed information on each of the surveys is included in table two in the appendix.

The themes produced were considered according to whether the survey responses had been collected from patients or staff.

The following themes were generated, a range of opinions were expressed in relation to each theme.

Convenience.
Environment and privacy.
Choice.
Openness during consultations.
Limitations compared to face-to-face.
Longer-term use.
Resources required for better implementation.

The analysis of themes across all the surveys is listed in table three in appendix two.

Important gaps in the information available following the thematic synthesis were identified.

There was a lack of demographic information about participants. Considering the information about respondents that was available and combining this with knowledge about the survey sampling and distribution methods, we are able to conclude that respondents are not representative of the population and as such the findings of the thematic analysis may not be generalisable
We also recognise that the surveys were designed to capture a snap-shot of perspectives at a particular point in time within the context of a pandemic and that view-points shift over time.

Convenience

“Would prefer to use this system rather than face to face. It is more convenient for me as I work full time and means I do not have to leave work early”
South West London & St George’s Mental Health NHS Trust

“Logistically more convenient, no travel expense and in an era of COVID-19, feels safer.”
“Benefits: less travelling time, more productive”
OXLEAS

Benefits: less travelling time, more productive

“Easier to manage work life balance, less tired as reduced travel”
South West London & St George’s Mental Health NHS Trust

Making best use of data – improvement analytics

In addition to the Trust surveys, both SWLSTG and SLaM rapidly developed dashboards to track access and productivity to remote consultations over video, in person and telephone. You can view a case study from SLaM here.

Improvement analytics supports delivery of a Trust Data Strategy where the Trusts aim to become a data-driven organisation, where all staff have the capacity and ability to use data to inform decision-making and improvements in order to improve outcomes for the patients and communities.

This includes:

Visualisation of data for improvement
Diagnostic data
Measurement plans
Power Business Intelligence dashboards
Data for improvement resources and coaching

These dashboards provide visualisation of data which is intended to be the foundations of a conversation starter.

Please see Figure five and six for snapshots of the dashboards. The SWLSTG dashboard shows the increase in telephone and video consultations from the point of the first lockdown. It also illustrates the time period of the patient survey described in workstream two.

Figure 5:

Figure 6:

Workstream three: Summary of findings from the E-survey

Responses

Responses from south London based mental health organisations described 22 projects. A further 10 projects being conducted in north east and north central London were captured by the survey. The findings describe all 32 projects (please see appendix two for more detail on each project).

Focus of projects

The majority of projects (29 out of 32) sought to assess patient and/or staff perspectives on experience and/or access via surveys or interviews.

Design and methods

There were 16 service evaluation projects; five quality improvement projects; five service evaluation and quality improvement projects; five research projects; and one strategy discussion.

The broad methodological approaches being used are: qualitative, e.g. interviews/focus groups (three projects); quantitative, e.g. analysis of routinely available data (one project); survey (20 projects); mixed methods (7 projects), unclear (1 project).

Patient and public involvement within the projects:

Just over a third of projects (11 out of 32) stated intention to involve their patients/public members within the project team, for example in aspects of project planning and delivery, as opposed to involving patients/service users/carers as participants in the project.

Service areas and patient groups:

A range of service areas and patient groups are included across the 32 projects.

Child, adolescent and young people [8 projects]
Community Mental Health Services [4 projects]
Education and training [1 project]
Forensic [1 project]
Gender services [1 project]
Integrated Psychological Therapy Team [1 project]
Aging/older people’s services [2 projects]
Learning disability [3 projects]
Memory services [1 project]
Parents and carers of young people using mental health services [1 project]
Personality disorder [1 project]
Psychosis [1 project]
Adult mental health services [1 project]

Some projects span multiple services, others are Trust (or organisation) wide.

Demographics:

Under a third (nine out of 32) demonstrated intention to collect demographic information from participants. This is potentially an important gap in terms of better understanding for whom remote consultations does and does not work well for.

Remote consultations technology: type, function and support

Many projects included the use of multiple types of phone or video-based technology within their questions / data collection. Technology solutions specified included:

Attend Anywhere
Cisco WebEx
FaceTime
Iaptus Virtual Consultation
Microsoft Teams
Skype
Telephone
Zoom

Microsoft Teams and Zoom were the most mentioned platforms.

Across the 32 projects, remote consultations was listed as being used to facilitate:

• Individual assessments

• Routine clinical appointments

• Individual psychological therapies

• Group psychological therapies

• Online arts psychotherapy

• A listening service

• Emergency appointments

• Patient reviews

• Interprofessional communication and administration including meetings

• Service evaluations & surveys

Respondents were asked whether support is offered for remote consultations to staff and/or patients (e.g. training, introductory video, or technical assistance). Some respondents left this question blank or indicated that no support is offered. Where it was indicated that support is available, this took the form of webinars; patient leaflet / instructions; informal training from staff (unclear whether this relates to staff-to-staff or staff-to-patient), support for staff from Attend Anywhere Team; and staff supporting patients to complete e-surveys.

Questions about preferences or comparisons between different remote consultations platforms are included within ten projects. In addition, nine projects will collect information about technical issues (e.g. hardware, connectivity, inter-operability) or anticipate that this may emerge within qualitative findings

Outcomes being studied:

A minority of projects (four out of 32) were set to assess the effectiveness of remote consultations on clinical outcomes or examine cost. None of the projects were assessing cost effectiveness.

Very few respondents gave clear details of service level outcomes (for example relating to numbers of patients supported or impact on team working) assessed within their projects, though one project will collect service level data on Did Not Attend (DNA) rates and travel.

Participants were asked what (if any) implementation outcomes (e.g. acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) are being studied and how these are being measured or assessed. Nine projects will assess one or more implementation outcomes via qualitative interviews or surveys with acceptability being mentioned most frequently (four projects). It is unclear whether any of these projects intend to use validated scales to assess implementation outcomes.

A minority of projects assess unintended outcomes (positive or negative) or inequities (for example characteristics of or number of people not accessing remote care).

Theories and frameworks:

The majority of respondents did not report applying a specific framework, theory or model to guide their reported project.

Potential gaps in research and evaluation:

Several topic areas are not well covered by the 32 projects and are potentially under-researched or evaluated:

Contextual details including numbers of patients in contact with services; the proportion of contacts delivered remotely versus face to face; the characteristics of patients who are (or aren’t) accessing services in different ways; and how each of these variables are changing over time
Digital exclusion / inequities and gaining an in-depth understanding of which groups of people are not well served by remote consultations
Patient and public involvement in designing and executing projects
Understanding impact on staff interprofessional working
Evaluating the support offered to facilitate remote consultations (e.g. training, webinars, patient leaflets)
Effectiveness studies looking at clinical outcomes
Cost effectiveness of remote consultations
Evaluating implementation of new pathways including hybrid/blended approaches to service delivery (a mix of face-to-face and remote delivery) and de-implementation of old ways of working
The use of implementation frameworks / theories / models to understand, contextualise and generalise project findings

However, it should be noted that many of the above topics are indeed touched upon or may emerge as areas of exploration or as findings within some of the projects, particularly within those projects that are collecting qualitative data from participants.

Limitations of the e-survey:

The e-survey provided a snapshot of projects planned or underway between July and November 2020. Many projects will have been instigated subsequently.

While every effort was made to disseminate the survey widely across the eligible mental health services, we are aware that some relevant projects already underway were missed.

While a small number of responses were received from charitable / voluntary sector organisations, there is likely to be a body of work being undertaken by such organisations that is not captured here.

The survey distribution method used by each organisation did not follow a uniform approach. It is possible that some distribution methods were more effective than others in reaching the relevant people and encouraging project leads to complete the survey. Direct email contact with individuals known to be engaged in relevant projects appeared to be the most successful way to encourage survey completion.

It would have been helpful to obtain more detail about the methods being used within each project, and any repeat surveys in the future should include questions that would elicit this information. For example, where it is indicated that the project involves a survey, we do not have detail about whether the survey was distributed in an electronic (e.g. email or text) or paper format and we often do not have information about the types of questions asked.

The questions on service outcomes, implementation outcomes and unintended consequences were frequently left blank by respondents, potentially indicating that participants did not understand what the question was asking or that they felt it was not relevant to their project. It would be useful to obtain feedback on the survey questions from staff members should the survey be repeated. Furthermore, in future iterations it may prove helpful to follow up each response via telephone interview, allowing exploration of questions where limited detail was initially offered.

It is possible that the methodological quality of future projects could be strengthened by providing team members with training or relevant resources on implementation.

The original aspiration was to embed patient and public involvement within this piece of work. The short timeline meant that it was not possible to involve public members within the development of the e-survey, however, the findings have been discussed in group meetings which include experts by experience.

Commonalities across workstreams and recommendations

The following themes emerged from the three workstreams and are inter-related.

Perspectives are not universal

Our collective findings across the workstreams clearly demonstrate that there are a variety of perspectives regarding remote consultations between staff and patients, and regarding remote consultations more broadly (including staff inter-professional working).

The remote delivery of mental health services works well for some people but not others and is appropriate in some situations or on some occasions but not others for many individuals. There is no ‘one size fits all’ and an individualised approach will always remain the gold standard. This breadth of experience holds true for patients, carers, and staff.

It follows that the effectiveness of remote consultations on a range of outcomes – for example clinical symptoms for patients, or wellbeing or productivity for staff – may not be universal either; this too remains to be established.

Recommendation: Further research is required to better understand under which circumstances remote consultations is beneficial, for whom, and why, in order to make evidence-informed offers regarding the mode of service delivery and to provide increased choice. This research should purposively seek to tap the views of under represented populations e.g. racial and ethnic minority groups, carers and do deep dives within clinical populations.

Acceptability

Findings from our thematic analysis of the organisation wide surveys mirror findings from our two literature reviews in terms of the acceptability of remote consultations to patients, carers and staff. Both workstreams suggest that while there are different opinions, and while face-to-face contact may be preferred, remote service delivery can be acceptable to patients, carers and staff, at least in the short-term, with many participants indicating that they are satisfied with this way of working. Levels of satisfaction may be higher when video calls are used as opposed to telephone calls. It is noteworthy that the pre-COVID-19 review indicates that these findings may apply outside of the context of a pandemic. Again, findings from the staff and patient surveys, in particular, illustrate the point that individuals may find remote working and/or remote consultations acceptable on some occasions / in some circumstances but not others. Furthermore, the likelihood of non-response bias (where people who take part in a study are systematically different to those who do not) is a key caveat here as participants across workstreams were firstly able and secondly motivated to engage in research and provide their feedback or data may not be representative of wider populations.

Recommendation: A set of questions to be routinely asked as part of future projects should be developed. As an example, questions should elicit participants’ demographic information in order to better understand whose perspectives and data are being captured or excluded. This would help us to understand whether there may be differences according to ethnicity or living in an area of relative deprivation/advantage, for example. This work has commenced by the project team please check for updates.

Recommendation: Future research and evaluation strategies should specifically target the groups who have been under-represented in the data sets analysed to date, including but not limited to: older adults, children and young people, people with learning disabilities, people with an autism spectrum disorder, inpatients, drug and alcohol clients, prison leavers, homeless people and carers.

Accessibility

For many people, for example, those with diverse communication needs, the widespread adoption of remote technologies at the start of the pandemic removed choice and reduced the ability to access mental health services. Findings from the staff and patient surveys demonstrated that some patients had received text messages inviting them to a video-based consultation and including a link to join the virtual meeting without any prior conversation about whether this format was appropriate for their needs. Similarly, some consultations were offered via telephone without assessment of whether this was an appropriate means of communication for individual patients and carers. There are also some good examples of services using innovative ways to engage service users in remote consultations – (Click here to see how the Recovery College at SWLSTGs have supported their students in accessing resources remotely and here to see how SWLSTGs have assisted their patients and carers in accessing Attend Anywhere via a step by step video guide) – and where guidance was produced to help clinicians with decision making tools for choosing between remote, in person or blended consultation.

Recommendation: Organisations and services should ensure that the NHS Mandatory Accessible Information Standards are adhered to when offering remote consultations or indeed when staff are engaged in remote work more broadly. We need to be asking service users and carers about their capabilities and confidence and addressing this.

Convenience

Three of the systematic reviews included within the pre-COVID-19 umbrella review assessed convenience, with most patients indicating that engaging with therapy sessions from home via remote interventions was convenient. Convenience was also a main theme arising from the thematic analysis of survey findings. Many respondents highlighted the convenience and time and/or money saving nature of remote consultations or remote work by virtue of not needing to travel. Further, some people felt that remote appointments could facilitate the attendance of more people from a multi-disciplinary team, though others suggested the opposite was true. Importantly, however, there was a consistent message that some people find remote consultations (or for staff remote work more broadly) inconvenient some or all of the time. Patients cited difficulties with computer literacy, having an appropriate private space, involving family members or carers in appointments where this was wanted, and poor virtual meeting etiquette (e.g. being left in ‘waiting rooms’ for lengthy periods). Staff also noted problems with meeting etiquette (e.g. meetings over-running), unsuitability of the environment for privacy and ergonomic reasons, and the tiring nature of virtual meetings.

Therapeutic alliance

Findings from both the staff and patient surveys and the evidence reviews suggested that for some people it is possible to develop a good therapeutic alliance remotely, although it is perceived that therapeutic alliance may be better when services are delivered face-to-face. In our pre-COVID-19 umbrella review, female older adults and veterans generally expressed a preference for talking to therapists in person. One of the studies included in the during-COVID-19 systematic review reported that 88% of clinicians found it more difficult to establish a therapeutic relationship with new clients when consultations were held remotely. Similarly, two systematic reviews within the umbrella review included findings demonstrating poorer clinician ratings of the therapeutic alliance during remote work. There was some suggestion that therapeutic alliance may develop more easily in consultations held using video-conferencing software as opposed to the telephone.

Technological challenges

Within our patient and staff survey findings, specific issues relating to the use of technology included: user confidence and knowledge around using technology, issues with Wi-Fi and connectivity, ability to access (and cost of) appropriate equipment and software subscriptions, and security/information governance challenges. Having access to technology and appropriate support to use this technology were identified as key barriers to uptake. These findings applied across patients, carers and staff. Within our umbrella review, three of the systematic reviews included mentioned technical difficulties as a challenge, however, none of these reviews implied that technical difficulties had been a severe barrier to implementation. However, issues were reported around mistrust in technology, low image resolution, and connectivity problems.

Exclusion

Findings across workstreams raise the possibility that many people may have been excluded from accessing mental health services with an impact on their wellbeing and their families, or have had their access reduced, as a result of the rapid shift to remotely delivered services. This is mirrored by the presumed exclusion of people who are not routinely using remote technologies from much of the research and evaluation data that have been analysed to date. However, we do not have systematically collected data to demonstrate the extent of digital exclusion or to draw conclusions about which groups of people are most adversely affected. There are a small number of projects (that we obtained details of via the e-survey) that are seeking to understand the perspectives of some of those groups who are more likely to be digitally excluded (for example people with learning disabilities and older adults). Within our staff and patient survey synthesis, it was recognised that the perspectives of older adults are mostly unknown. While the umbrella review included data relating to some groups who are thought more likely to be digitally excluded (e.g. older adults) there was a lack of evidence for other groups including children and young people and inpatients, and overall, as outlined above, a lack of demographic information about people who had participated in the research studies (which was also a key limitation within the e-survey and evidence reviews).

Recommendation: The co-creation of research/evaluation and service delivery strategies to help understand and address digital exclusion and inequities will be vital and careful consideration will need to be given to assess how best to involve those who are under-represented and/or digitally excluded within the development of these strategies. Engagement from a variety of services, for example, assessment centres, food banks, probation services, supported accommodation and community charities may be needed to reach those who are under-represented. It is acknowledged that this work would be challenging, but it will be essential for services where digital is the primary route to care.

Guidelines

Responses to staff surveys synthesised indicated that staff would appreciate clear guidelines on how and when to offer remote consultations as opposed to face-to-face. This was echoed in the during-COVID-19 literature review. Our umbrella review included one systematic review of guidelines for video-conferencing based mental health treatments[1]. This review encapsulates guidance on decisions about the appropriateness of remotely delivered mental health services; ensuring competence of mental health professionals; legal and regulatory issues; confidentiality; professional boundaries; and crisis intervention.

Recommendation: It may be beneficial for those who are developing new guidance on video-based consultations within mental health services to draw upon the recommendations made within the systematic review by Sansom-Daly et al. (2016).

[2] Sansom-Daly UM, Wakefield CE, McGill BC, Wilson HL, Patterson P. Consensus among international ethical guidelines for the provision of videoconferencing-based mental health treatments. JMIR mental health. 2016;3(2):e1

Case studies

See all the case studies

Remaining research and evaluation gaps

Reaching those who are least able to engage in remote consultations

All three workstreams likely under-represent the voices of those who are least likely and able to engage remotely which represents a significant and worrying gap in the available evidence. Data collection mechanisms to date have been overly reliant on electronic means – for example surveys administered by email. Innovative methodologies will be required to proactively reach digitally excluded people and enable their participation in both developments of a research strategy and in the research itself, especially under the restrictions in movement and socialisation placed upon the population during the acute phase of the COVID-19 pandemic.

Uptake

Some of the data considered within this project suggest that the offer and uptake of remote consultations varies according to service. Further work could be done to understand the reasons underpinning choices made by services and differences in uptake amongst different patient groups. The routine collection of data relating to the mode of service delivery over time in each clinical pathway would likely form an important next step in the development of a ‘learning healthcare system’ that collectively gathers information and syntheses knowledge about how well or otherwise service delivery is working then uses this understanding to drive ongoing improvement.

Change over time

We are currently unable to draw conclusions about whether perceptions in relation to remote consultations are changing over time nor whether viewpoints will evolve as we move beyond the acute phase of the COVID-19 pandemic and towards a situation where face-to-face contact poses less risk of spreading infection. Longitudinal data are needed to inform future choices and investments. The most rigorous way to assess change in perceptions and experiences over time is to ask the same set of people the same questions repeatedly. This requires each participant to have a unique anonymous identifier assigned to their survey responses in order to track change over time. This methodology is often more time and resource intensive to set up, and the attrition rate (where people drop out / don’t complete surveys) may be high. Further, people who are motivated to participate in completing a series of surveys may have different characteristics or perceptions compared to people who do not participate.

Blended models of service delivery

We currently know very little about models of delivery, experiences and effectiveness of mental health services that are delivered through a combination of remote and face-to-face consultations.

Recommendation: Research is needed to evaluate the implementation of new pathways including hybrid/blended approaches to service delivery (a mix of face-to-face and remote delivery) and de-implementation of old ways of working.

Effectiveness

While the pre-COVID-19 umbrella review demonstrated that remotely delivered services can be as good as face-to-face appointments in improving clinical outcomes in some circumstances, we cannot say with certainty whether this finding holds true in the case of fast and widespread implementation due to the pandemic, as there was a lack of high quality quantitative evidence within our during-COVID-19 literature review .

Recommendation: It is important that future work addresses questions of clinical effectiveness and better ascertains for which groups of people and which clinical pathways remote consultations are and are not effective before being routinely offered as the norm post-pandemic.

Cost and cost effectiveness

Given the relative dearth of evidence on the effectiveness within the pandemic context, it follows that little is known about the cost effectiveness of remotely delivered mental health services. Within our umbrella review, two systematic reviews examining either costs or cost effectiveness met our inclusion criteria. One systematic review concluded that tele-psychiatry can be cost effective compared to face-to-face interventions, particularly in rural areas where the number of consultations required before telepsychiatry becomes more cost effective (combatting initial equipment costs) is lower. In the second systematic review which looked at costs, 60% of included studies reported that telepsychiatry programmes were less expensive than in person care, due to savings such as travel time and reduced need for patients and their families to take time off work. However, eight studies in this review concluded that telepsychiatry programmes were more expensive, particularly due to videoconferencing equipment costs. A final study included in the review found no difference in costs.

Recommendation: Further research regarding costs and cost effectiveness is needed, particularly as video-conferencing software is now more widely and cheaply available.

Implementation effectiveness and support

Our COVID-19 specific literature review had a focus on exploring barriers and facilitators to optimal implementation of remote consultations and the emerging evidence on this is summarised. the pandemic led to remote consultations and remote work being implemented urgently as a matter of need and not choice. This presented little chance to study implementation effectiveness in real-time, thus work remains to be done to establish best practices in terms of implementing remote consultations. Such studies are now feasible as remote options are likely to be offered long-term in some settings. The existing implementation science literature may be helpful in designing better implementation support going forward. Furthermore, we may be able to apply frameworks retrospectively in order to generate additional learning from implementation efforts undertaken within the context of a crisis.

Next steps

The programme has achieved a great deal since June 2020 and the work continues using the Learning Healthcare system model as our guiding principle.

Evaluating remote consultations is a priority for the London Healthcare system. Research resource is being established for this for the NIHR Applied Research Collaborations (NIHR ARCs) that we hope will continue to inform our work.

Acknowledgements

A big thank you the Mental health Trusts and to everyone working on this project

Professor Fiona Gaughran
Professor Nick Sevdalis
Dr Julie Williams
Dr Lucy Goulding
Zoe Lelliott
Noushig Nahabedian
Dr Cecilia Casetta
Dr Jacqueline Philips Owen
Professor Peter Fonagy
Dr Kia-Chong Chua
Dr Juliana Onwumere
Lana Samuels
Melanie Getty
Paul Lennon
Dr Sarah Markham
Alison White
Harriet Jordan
Len Demetriou
Alex Lloyd
Elizabeth Graham
Dr Barbara Grey
Aileen Jackson
Dr James Woollard
Dr Gabriella Wojewodka
Dr Justin Earl
Aisha Abdullah
Dr Stuart Adams
Dr Sarah Cope
Dr Phoebe Barnett
Dr Rebecca Appleton
Professor Sonia Johnson
Nina Pearson
Lydia Davies

Appendix two : Summary of the projects identified in the e-survey (workstream three)

Projects have been assigned an identification (ID) number within the table for the purpose of describing findings within this report. Project ID numbers are presented in square brackets [] alongside descriptions of the findings.

Project ID	Organisation and services involved	Summary of project (aims and methods)
1	SWLSTG 2-3 Child and Adolescent Mental Health Services (CAMHS) and 2-3 adult services	Service user and staff experiences and perceptions of individual virtual video consultations carried out using the Attend Anywhere virtual consultation platform. Qualitative interviews with service users and staff.
2	SWLSTG Trust-wide	Patients’ feedback after Attend Anywhere consultation. Survey of patients.
3	SWLSTG Community mental health and psychological services across 8 sites	Feedback from people using outpatient mental health and psychological services on the experience of accessing care via digital systems. Survey of outpatients.
4	SWLSTG Sutton Mental Health Foundation	Sutton Mental Health Foundation telephone service evaluation: was the telephone support service (weekly phone calls) meeting support needs of service users and those receiving intentional peer support. Survey of service users.
5	SWLSTG Sutton Mental Health Foundation	Sutton Mental Health Foundation access to IT: what access do service users and volunteers have to the digital world and how can this be improved? Survey of service users.
6	SWLSTG Orchid Mental Health Emergency Service	Performance of the Orchid Mental Health Emergency Service (a service for patients of all ages with mental health problems who would otherwise have had to go to Accident and Emergency) since opening and impact on wider systems. Mixed methods – monitor performance against KPIs, service user experience, impact on local emergency departments and liaison psychiatry services.
7	SWLSTG CAMHS, Forensic and National Specialist services; Community; Acute and Urgent (Inpatient and Liaison services); Cognition and Mental Health Ageing service lines	Examine what impact changes in work practices (including shift to remote working) have had on experiences, wellbeing and productivity of psychiatrists and specialty and associate specialist (SAS) doctors Survey of consultants and SAS doctors.
8	SWLSTG Single-site, Fircroft Trust mental health and learning disabilities	The Fircroft Trust: supporting our clients during COVID-19 Unstructured telephone interviews.
9	SLaM Psychological Interventions Clinic for outpatients with Psychosis (PICuP) team	What proportion of service users have sufficient access to remote consultation technology in order to access remote psychological therapy? What are attitudes to PPE in return to face to face therapy? How to best provide therapy for people with psychosis in the context of covid-19. Survey of service users.
10	SLaM Promoting Recovery Teams and complex care services in Southwark (6 teams)	Gather data on the preferences service users have in relation to how they receive psychological therapy during the COVID-19 pandemic. Survey of service users.
11	SLaM National & Specialist CAMHS Obsessive Compulsive Disorder/Body Dismorphic Disorder team	A quality improvement project to improve staff and service user experience of remote assessments and treatment – a QI project. Mixed methods – qualitative and quantitative surveys during PDSA cycles.
12	SLaM Lewisham Memory Service, Croydon Memory Service, Southwark and Lambeth Memory Service	Evaluation of alternative neuropsychological assessments at SLaM memory services: what are patient and clinician experiences of alternative neuropsychological assessments? Are there any differences in satisfaction/ease of administration between 1) remote assessment, 2) socially distanced home assessment, 3) socially distanced clinic assessment? Survey of patients and staff.
13	SLaM Croydon Personality Disorder Service staff and service users	Working Remotely in the Sun Project: The experience of participating in our crisis and coping skills development group online – what works well online and what are the difficulties of working online? Qualitative.
14	SLaM Mental health community teams in Southwark, Lewisham, Lambeth and Croydon	Health Champions Study: A pilot hybrid effectiveness-implementation Randomised Controlled Trial of a volunteer Health Champion intervention to support people with severe mental illness to improve their physical health. Mixed methods.
15	Kent and Medway NHS and Social Care Partnership; Oxleas; SWLSTG Multiple sites, learning disability services	How are people with Learning Disabilities and their caregivers accessing ICT during the COVID-19 pandemic and what are the implications for their access to digital healthcare? Within the population of service users with LD and their caregivers are there sub- groups facing greater exclusion from ICT use? Implications during the COVID-19 pandemic and beyond. Mixed methods.
16	National Multi-site / potentially international	Evaluating the experience of mental health care providers delivering psychological therapy online during a pandemic. Survey of providers of psychological therapies.
17	SLaM Main focus on Southwark and Lambeth Integrated Psychological Therapy Teams to date	What is the experience of virtual mental healthcare amongst patients and clinicians? (Mental healthcare includes mentalisation based therapy, group work, systemic therapy and psychodynamic therapy) Qualitative interviews.
18	SLaM All clinical services	Analysis of electronic health record data to assess the rates of remote consultation and psychiatric medication prescribing before and after the COVID-19 pandemic. Quantitative analysis of routinely available data.
19	Oxleas All services	Assessment of how Oxleas NHS patients and service users feel about the shift from face to face to remote consultations. Survey of service users.
20	Oxleas Adult Learning Disability Team in Bexley, Bromley and Greenwich	Patient experience of remote consultations in the Oxleas Adult Learning Disability team. Survey of service users.
21	Oxleas Older people’s services	Patient experience of remote consultations in the older adults mental health service. Telephone survey of service users.
22	Oxleas Specialist children’s services in Bromley, Bexley and Greenwich	Staff experience of working during the COVID 19 pandemic. Survey of staff.
23	East London NHS Foundation Trust	Trust wide service evaluation of remote consultation platforms. Survey of clinical staff’s experiences and feedback.
24	East London NHS Foundation Trust	Arts therapy department survey of staff, service users and carer’s experience using online platforms to deliver arts psychotherapy. Survey of clinical staff, service users and carers.
25	North East London NHS Foundation Trust	Trust wide quality improvement project to evaluate roll out of video consultations in services, identify functional requirements, staff support and training needs. Survey of staff across the Trust.
26	Camden and Islington NHS Foundation Trust	Trust wide quality improvement project and service evaluation of staff and service users to inform service development and resource allocation. Surveys and qualitative interviews with service users and staff.
27	Barnet, Enfield and Haringey Mental Health NHS Trust	Service evaluation and quality improvement project of patient experience of remote consultations in community services. Survey of service users.
28	Tavistock and Portman NHS Foundation Trust	Quality improvement project to evaluate remote working in CAMHS, gender services, adult mental health services, education and training. Qualitative interviews and focus groups of staff, service users and carers, surveys and environmental impact assessments.
29	Place2Be	Ongoing service evaluation of parent counselling services taking place across England, Wales and Scotland. Interviews of service users.
30	Place2Be	Ongoing service evaluation of young people, parents, carers and teachers using the service in England and Scotland. Survey of service users.
31	YoungMinds	Service evaluation of young person’s remote access to CAMHs services. Survey of service users.
32	Mental Health Innovations	Strategy discussion to inform suture use of remote consultation in mental health services. Strategy discussion involving senior management staff and clinicians.

Summary of the patient and staff surveys included in workstream 2

	Oxleas- patient survey	SWLSTG-1 – Patient survey	SLaM -patient, carer and staff	SWLSTG-2 Staff survey of consultant psychiatrists and SAS doctors
purpose	To survey patient’s views on remote consultations	Evaluation of Attend Anywhere video consultation platform. Focus on financial and environmental benefit and overall satisfaction with the platform	Experience of virtual appointments/ meetings survey report (virtual means either by telephone or video)	To better understand how staff had adapted to the changes and the impact these had on productivity and wellbeing
population	Patients and service users	All users of the Attend Anywhere platform. General stats provided for all types of consultations within the time frame: total 65,878	Staff, patients, and carers	consultant psychiatrists and SAS doctors
method	survey	Survey and some qual interviews	online survey (open for 8 weeks)	survey, different questions based on the type of service
delivery	by SMS or email using SmartSurvey, for older adults or people with LD this was done by telephone, timing of survey was considered in relation to other Patient Experience surveys being sent out (4 week gap between this survey and usual patient experience survey for a specific clinic)	Survey sent immediately post video consultation, this was embedded within the platform	link sent – unclear how (email, SMS?) had to be actioned by someone, not automatic. For phone consultations, someone had to ask the person the questions over the phone	survey designed on Survey Monkey
responses	5,054	929	545 responses from staff (n=474), service users (n=47) and carers (n=24).	80
surveys sent	35,933	7,589	unknown	unknown but 160 consultants within the Trust
response rate	14%	12%	unknown	50%
services targeted	Adult Mental Health (AMH), Adult Community Health (ACH), Children and Young People (CYP), Older Adults Mental Health (OPMH), Adult Learning Disability (ALD)	All services with Attend Anywhere uptake	unknown	Community setting and inpatient/liaison services

Table 2: Summary of each Trust survey

Patients/Service users		Staff
Convenience
Reduction in travel (helpful when caring for children, disabilities)		Reduction in commuting
No need to take time off work		Can invite more professionals to MDTs (e.g. GPs)
Home setting/no waiting in reception with others		Consultants and SAS doctors: some said it reduced stress
Comfort in home setting		Consultants and SAS doctors: Increased productivity – can complete work in the time normally used for commuting, meaning better work/life balance
Less chance of missing appointments if forgotten about (can be called to start appointment or called and reminded to log into video call)
Inconvenience
Difficult when not computer literate		Home working environment lacking proper set-up (causing physical pains)
Some platforms have a waiting room where patients were left waiting without being seen (Attend Anywhere)		Lack of boundaries between home and work life
Might be difficult to involve family members in virtual MDTs		Virtual meetings seem longer, less urgency to finish on time
		Virtual meetings take more energy, feeling tired/drained after
Effect on symptoms
Reduction in anxiety about travel/leaving the house/faced with others in waiting room		Some staff felt patients were more open
Easier to open up when not faced with someone		Some staff felt patients were more withdrawn
For child services, some young children may not respond to video very well
Gaps when not meeting face-to-face
Physical examinations missed		Missing the informal interactions with team members where issues could be solved quickly without emails or meetings
Body language is difficult to translate over video, and less over phone. Some felt they had to compensate for this which was a burden		Team check-ins are more formal
Assessments with children is difficult when they don’t respond to video		Less down time or breaks in between meetings/consultations.
Building rapport with people who have difficulties with social cues, or attention issues can be more challenging
Some interventions are not possible to do remotely
Short-term vs long term
Continuity of care during pandemic, safer		Continuity of professional responsibilities (consultants supporting their team)
Might be open to continuing in the long-term for certain appointments		Some would like flexibility to continue to WFH at least a portion of the week
		Question about compensation if paying for own utilities and Wi-Fi
Choice
Patients would like to be given the option of face-to-face or virtual/remote consultations		SLaM survey: acceptance of virtual working is also higher when staff perceives they have a choice
Uptake of virtual consultations is better when patients are given the choice		Staff would like more guidelines for staff on how and when to offer the different options (this is also stated in the improvements theme)
Choice of telephone vs video, and if using a video platform, choice to keep the camera off
Improvements needed
More help to assist people who are not as tech savvy		Staff need better guides to offer patients, particularly for certain groups (older adults, forensic services, learning disability services)
Access to better equipment and high speed broadband is needed, particularly in more deprived areas		Better IT support for staff, better guidance for when to offer virtual sessions
		Hospital Wi-Fi is not good enough for virtual video consultations
		Changes to platforms might help, more features, better connectivity, sharing files
Privacy
Some patients feel staying at home is more private		Having the right location to minimise interruptions or ensure patient confidentiality is an issue for staff
Depending on the home situation, patients might be less able to speak freely or disclose risk (e.g. domestic abuse)

Table 3: Analysis of themes from all the Trust surveys

Joint Pain Advice in the workplace

Work and Health Challenge Fund Project

About

The Joint Pain Advice (JPA) model was developed by the Health Innovation Network (HIN) as a result of an identified need for accessible, personalised, understandable information and practical advice and support about how to self-manage the impact of chronic pain. Pilot studies have demonstrated that JPA supports participants with chronic knee, hip and back pain to reduce their pain and symptoms, increase their physical activity levels and improve their physical function and mental wellbeing in both clinical and community settings.

HIN and the Bone and Joint Research Group (part of Royal Cornwall Hospitals NHS Trust) were awarded funding from the Work and Health Challenge Fund to test the JPA model delivered in the workplace to employees.

The evaluation of this service improvement project aims to understand the effectiveness of JPA as a workplace intervention. It explores the clinical effectiveness of JPA and the acceptability and feasibility of the programme for participants (employees), JPA Advisors and workplaces, delivered in a ‘real world’ workplace setting.

Authors

Professor Mike Hurley, Clinical Director, Health Innovation Network

Andrea Carter, Health Innovation Network

Amber Gibney, Health Innovation Network

Sally Irwin, Health Innovation Network

Dr Rachel Hallett, St George’s University of London and Kingston University

Dr Jo Erwin, Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust

Professor Tony Woolf, Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust

Acknowledgements

Work and Health Challenge Fund (Department for Work and Pensions and the Department for Health and Social Care)
Guy’s and St Thomas’ NHS Foundation Trust
St George’s University Hospitals NHS Foundation Trust
Richmond and Wandsworth Borough Councils
King’s College Hospital NHS Foundation Trust
Healthy Workplace Team, Healthy Cornwall, Cornwall Council
Sunflower Training & Consultancy

Executive Summary

Overview

In the UK over 8.75 million people have osteoarthritis (OA) and around 10 million people have chronic low back pain. These problems impact an individual’s personal, social and working lives, affecting physical and mental health and wellbeing¹. They also have a wide socioeconomic impact through substantial health and social care expenditure and lost productivity². Although National Institute for Health and Care Excellence (NICE) guidelines core recommendations for the management of OA³ and low back pain⁴ are to provide information and advice to improve understanding of the condition and management strategies and to encourage increased physical activity and support weight loss (where appropriate) as effective ways of managing the condition and its impact, in reality, few people receive this advice.

Joint Pain Advice (JPA) supports people to self-manage their chronic hip, knee and/or back pain, based on NICE guidelines. Within the JPA model, participants are invited to up to four face-to-face appointments over six months. This intervention has been successfully piloted in primary care and community settings with c600 participants who reported improvements in pain, physical function, physical activity and mental wellbeing^5,6. It was also shown to reduce follow-up appointments with a GP⁵. A social return on investment evaluation found that the JPA intervention offered a social return on investment of between £2 and £4 for every £1 invested⁷.

JPA in the workplace was one of 19 initiatives across the UK selected to receive funding from the Work and Health Challenge Fund. As part of this project, JPA was offered to employees across four large organisations in London and 16 organisations in Cornwall, including several small and medium enterprises (SMEs). Two different models of delivering JPA were tested:
In London, existing members of staff of the larger organisations were trained to deliver JPA to their organisation’s employees. They are referred to in this report as ‘in-house’ Advisors.
In Cornwall, JPA Advisors were trained and travelled around from workplace to workplace to deliver JPA to employees of several organisations, including small and medium enterprises (SMEs). They are referred to in this report as ‘peripatetic’ Advisors.

Challenge-Fund-JPA-Workplace-Report-V4-1 Download

Psychologically Informed Collaborative Conversations
(PIC-C)

Pain is common in the general population, affecting between one-third and one-half of UK adults. The connection between pain and psychological wellbeing is reciprocal – with increased awareness that when pain persists it often leads to increased psychological distress and high levels of psychological distress can increase the likelihood that painful musculoskeletal conditions will either persist or develop.

Helping clinicians implement psychologically informed treatment strategies and techniques offers the promise of improving patient care for people living with pain.

In 2020, The Health Innovation Network AHSN, in partnership with St George’s Hospital NHS Foundation Trust, Kingston Hospital NHS Foundation Trust, the Physiotherapy Pain Association and Duke University, USA secured funding from Q Improvement Lab, a Health Foundation Initiative, to test innovative ideas to improve care and services for people living with pain. An evaluation report of this project – Psychologically Informed Collaborative Conversations (PIC-C) – now available to download.

Download the full report

“PIC-C training has changed my practice quite a lot. I’m much more happy to sit and listen to the patient. Give them more time, get the whole story, take more time on the subjective and include more of the biopsychosocial [components], rather than just looking at the physio and the exercises.”
Course participant

Report summary

PIC-C is an evidence based online training and supervision programme to help physiotherapists increase their confidence in delivering psychologically informed care and support to patients presenting with pain. The design is based on four key themes:

building a therapeutic alliance;
reducing perceived threat of pain;
reconceptualising pain beliefs and somatic experience; and
fostering self-efficacy for pain control.

PIC-C was co-created with patients who were equal members of the project team, involved in reviewing, critiquing and contributing to content.

PIC-C was tested with 38 physiotherapists. Evaluation two weeks after completing the course showed a number of significant benefits of the training.

Graph showing reported improvements in compassion, confidence, resilience, work related fatigue and work satisfaction — Graph indicating the impact of PIC-C training on participant attitudes and feelings (n=38)

100 %
of participants reporting increased resilience following the training
96 %
of participants reporting that the training had increased their compassion for others
50 %
reporting that the training had reduced their work-related fatigue

“I definitely feel more confident now, in seeing this particular group of patients. Talking through other people’s experiences and my own has definitely made me feel more confident with the idea of [psychologically informed practice].”
Course participant

PIC-C was tested with 38 physiotherapists. Evaluation showed: A reduction in physiotherapist anxiety and increased confidence with 100 per cent of respondents stating PIC-C had a positive impact on their confidence in delivering psychologically informed consultations.

A change in practice in using psychologically informed strategies and techniques with patients as participants progressed through the training. The biggest change being that Physiotherapists attended more to the therapeutic alliance. Pre-PIC-C, 19 per cent of participants stated that they focused on ‘developing a therapeutic alliance’ as a standard part of their practice. Post-PIC-C, this increased to 81 per cent of participants.

Participants valued the supervision element of the programme, with participants recognising this was a unique benefit of the course offer. Having protected time to discuss the practical application of techniques learned including complex cases helped embed learning and strengthened relationships with colleagues.

PIC-C influenced a change in practice, evidencing a shift in confidence in adopting psychologically informed approaches. PIC-C provides benefits to practitioners themselves and the organisations in which they work.

The PIC-C training course is relevant to all physiotherapists and health professionals and therefore will be of interest locally, nationally and internationally. Supervision post teaching sessions was identified as a ‘missing link’ by physiotherapists in the literature and our exploratory focus groups, and its inclusion sets this training apart from other packages.

Presently, there is no similar learning programme available to physiotherapists in the UK. We therefore recommend PIC-C is made available to health professionals as a stand-alone programme or incorporated into wider educational learning packages e.g. postgraduate courses. We also recommend securing accreditation to satisfy quality control and continuing professional development requirements and recognition for Advanced Clinical Practice.

Additional resources

What is Person-Centered Care and why is it important?

What is person-centered care?

Person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs. This means putting people and their families at the centre of decisions and seeing them as experts, working alongside professionals to get the best outcome.

Person-centred care is not just about giving people whatever they want or providing information. It is about considering people’s desires, values, family situations, social circumstances and lifestyles; seeing the person as an individual, and working together to develop appropriate solutions.^1,2,3 Being compassionate, thinking about things from the person’s point of view and being respectful are all important. This might be shown through sharing decisions with patients and helping people manage their health, but person-centred care is not just about activities. It is as much about the way professionals and patients think about care and their relationships as the actual services available.

In the past, people were expected to fit in with the routines and practices that health and social services felt were most appropriate.⁴ But in order to be person-centred, services need to change to be more flexible to meet people’s needs in a manner that is best for them. This involves working with people and their families to find the best way to provide their care. This partnership working can occur on a one-to-one basis, where individual people take part in decisions about their health and care, or on a collective group basis whereby the public or patient groups are involved in decisions about the design and delivery of services. The underlying philosophy is the same: it is about doing things with people, rather than ‘to’ them.

There is no one definition of person-centred care.^5,6 People might also use terms such as patient-centred, family-centred, user-centred, individualised or personalised.^7,8,9,10Regardless of the terms used, a lot of research has looked into what matters to patients and how to provide person-centred care to make sure people have a good experience.^{11,12,13,14,,15,16,17,18} There are many different aspects of person-centred care, including:¹⁹

respecting people’s values and putting people at the centre of care
taking into account people’s preferences and expressed needs
coordinating and integrating care
working together to make sure there is good communication, information and education
making sure people are physically comfortable and safe
emotional support
involving family and friends
making sure there is continuity between and within services
and making sure people have access to appropriate care when they need it

Why is person-centred care important?

Person-centred care is a high priority

Making sure that people are involved in and central to their care is now recognised as a key component of developing high quality healthcare.^20,21,22,23

There is much work to be done to help health and social services be more person-centred and this has become more of a priority over the past decade.^24,25 This is because it is hoped that putting people at the centre of their care will:

improve the quality of the services available
help people get the care they need when they need it
help people be more active in looking after themselves
and reduce some of the pressure on health and social services

In the UK there is increasing demand for health services and there are limited resources. People are living longer and may often have many health conditions as they age.^26,27Research has found that person-centred care can help to improve people’s health and reduce the burden on health services,^28,29,30 so government policy is emphasising strengthening the voice of patients^31,32,33,34 and moving away from a paternalistic model where professionals ‘do things to’ people.^35,36,37 The NHS constitution in England has person- centred care as one of its seven core principles. This philosophy is also built into National Service Frameworks, monitoring requirements and legislation in all four countries of the UK.

Person-centred care can improve quality

Research has found that person-centred care can have a big impact on the quality of care. It can_^38,39

improve the experience people have of care and help them feel more satisfied
encourage people to lead a more healthy lifestyle, such as exercising or eating healthily
encourage people to be more involved in decisions about their care so they get services and support that are appropriate for their needs
impact on people’s health outcomes, such as their blood pressure
reduce how often people use services. This may in turn reduce the overall cost of care, but there is not as much evidence about this
improve how confident and satisfied professionals themselves feel about the care provided

Reviews of research about this topic found that offering care in a more person-centred way usually improves outcomes.⁴⁰ Some of the most common ways that have been researched to improve person-centred care include helping people learn more about their conditions, prompting people to be more engaged in health consultations and training professionals to facilitate care that empowers people to take part.^41,42

Offering care in a more person-centred way can even improve outcomes for professionals. A review of seven studies about professionals delivering person-centred care in nursing homes found that this approach improved job satisfaction, reduced emotional exhaustion and increased the sense of accomplishment amongst professionals.⁴³

Research has found that some components or underlying principles of person-centred care may be most important for affecting outcomes, including:^{44,45,46,,47,48,49,50,51,52,53,54,55,56,57}

getting to know the patient as a person and recognising their individuality
seeing the patient as an expert about their own health and care
sharing power and responsibility
taking a holistic approach to assessing people’s needs and providing care
including families where appropriate
making sure that services are accessible, flexible and easy to navigate
looking at people’s whole experience of care to promote coordination and continuity
making sure that the physical, cultural and psychosocial environment of health services supports person-centred care
making sure that staff are supportive, well trained in communication and striving to put people at the centre of their care

While the evidence is mounting that person-centred care can make a difference, there are not that many studies about outcomes yet and some research has mixed findings.^58, Person- centred care means different things to different people and this might be why there are mixed findings. This makes it even more important to think about how to measure and put person-centred care into practice, so that health services can better understand the benefits of this approach.

Towards person-centred care in South London

In order to be more person-centred, health services need to know what is most important to people. Person-centred care can focus on people’s individual health needs, but it is also about involving people in planning and evaluating services. Words such as ‘co-production’ and ‘co-design’ have been used to describe involving people in developing services and assessing their quality.

Based on all of the available evidence and feedback from patients and professionals, the Health Innovation Network – South London believes that beginning with a person-centred approach will lead to positive outcomes for patients and carers. Finding out what is important to patients and carers and making improvements in these areas will improve people’s experience of care and help them be more independent. For this reason, The Health Innovation Network is developing ways to measure the experience of health services in one of its key clinical priority areas: dementia. A Delphi technique is being used to get opinions from people with dementia, carers, patient and carer representative organisations, professionals and other stakeholders. People will be invited to rate the importance of various aspects of the quality of dementia care. Their responses will be summarised and circulated for discussion in repeated rounds until consensus is reached. This will help to make sure that the things being measured and improved upon are important to the people using services.

This is an innovative approach because although the concept of person-centred care puts patients at the heart of their care, few approaches to measurement have been driven by patients or build on aspects that patients and carers identify as most crucial.⁵⁹ However, it is important not just to focus on people’s preferences because these can change over time and people generally prioritise the things they are currently doing rather than the potential way things could be.⁶⁰ One of the challenges that the Health Innovation Network is tackling is how to define what services are fundamentally trying to achieve, and this is being done in partnership with patients and carers.

References

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Dijkstra RF, Niessen LW, Braspenning JC, Adang E, Grol RT. Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis. Diabet Med 2006;23(2):164-170.
Lawton J, Rankin D, Elliott J. Is consulting patients about their health service preferences a useful exercise? Qual Health Res 2013;23(7):876-886.

What is important to people with dementia?

Statements to help assess healthcare on empirical research

Scope

The Health Innovation Network is the Academic Health Science Network (AHSN) for South
London, collaborating with partners from the NHS, universities, local government, industry,
the third sector and service users and the public to promote innovation and best practice.
Improving dementia care is one of the key clinical priorities for the Health Innovation
Network.

The term ‘dementia’ is used to describe a collection of symptoms including loss of memory,
mood changes, feeling sad, angry or frightened, communication problems and a gradual loss
of the skills needed to carry out daily activities. These symptoms are caused by structural
and chemical changes in the brain as a result of physical diseases. Dementia is a
progressive condition and symptoms become more severe over time. Each person’s
experience of dementia will vary depending on the type of dementia, their physical make up,
their emotional resilience and the support available to them. There is not currently a cure for
dementia although medication can reduce symptoms and slow progression in some people.
A range of support may improve people’s quality of life.¹

The Health Innovation Network is developing ways to measure the experience of health
services among people with dementia and their carers. The process of developing the
metrics is as important as the final outcome so people with dementia, carers, patient and
carer representative organisations, professionals and other stakeholders are being engaged
using a Delphi technique to elicit opinions. People will be asked questions and invited to rate
the importance of various things. Their responses will be summarised and circulated for
discussion in repeated rounds until consensus is reached. The Health Innovation Network
wanted to ensure that the statements used in the Delphi process were based on research
evidence so this document presents statements about what matters to people with
dementia and their carers that could be used as part of quality measurement standards or
indicators. The statements are drawn from empirical literature, specific to dementia.

Much work has been done about what matters to patients generally.² There are a number of
frameworks for considering important aspects. For instance, building on the six-item US
Institute of Medicine framework for person-centred care,³ the Picker Institute framework includes eight domains: respect for patient-centred values, preferences and expressed needs; coordination and integration of care; information, communication and education; physical comfort; emotional support; involvement of family and friends; transition and continuity; and access to care.⁴ A meta-synthesis of different frameworks and proposed sets of domains of patient-centred care found that most contained similar concepts.⁵ The Kings Fund reviewed literature about ‘what matters’ to patients and undertook case studies and analyses of survey data.⁶ There have also been many thousands of studies published about improving patient experience^7,8 and measuring patient experience.^9,10,11 This document differs in that it draws on empirical evidence about dementia care to cross-check whether the things that people with dementia and their carers say are important to them match with more general characterisations about what is important for person-centred care.

Compelling Evidence

To compile a list of statements that could be used to test what matters most to patients, an
independent team examined all documents compiled by the Health Innovation Network as a
starting point to draw out important topic areas. Most of this material was not empirical
literature relating to people’s experiences of dementia care or what people and families
wanted from dementia care. The material was largely descriptive, such as examples of small
improvement projects, opinion pieces, editorials or material that did not relate to
measurement.

After reviewing background materials, general frameworks about what is important in patient
experience were examined followed by a search for empirical research specifically about
patient experience in dementia.

Three bibliographic databases were searched for research published up until April 2014.
Studies were eligible for inclusion if they focused on the experiences of people with
dementia or their carers. This included studies asking people what was important to them as
well as studies asking people to reflect on the quality of care received. Search terms
included dementia, experience, carers, person-centred and Alzheimer’s disease. There were
no geographic or temporal restrictions.

In total, 2,971 studies were screened. From these, 162 relevant studies were identified and
the full text reviewed. All of this material was drawn together into a list of statements
reflecting key themes in what is important to people with dementia in terms of health and
social care. The review was not focused on describing the findings of individual studies, but
rather of creating a checklist of statements that people with dementia might make when
commenting on the quality of services.

Quality statements

The result of the review was a list of statements that people with dementia and their carers have made when assessing the quality of healthcare. The statements focus on:

What care is provided
How care is provided
And how people feel as a result of the care provided

The statements can be divided into six domains:

learning about dementia
using services
dignity and empathy
involvement
ongoing support
and support to maintain some independence

The quality statements are listed in Box 1. Citations are provided by each statement to illustrate the empirical evidence base from which they have been adapted. Only empirical evidence is listed in the citations, though there are many other supporting documents such as the National Dementia Strategy and NICE quality standards.^12,13,14,15

The statements are all worded positively, to highlight aspects that people with dementia and their carers think are important. However, in studies themselves, the concepts were equally likely to have been expressed as negative statements such as ‘I have not been given enough information’ or ‘there is a lack of partnership working.’ The statements should not be taken as verbatim comments or reflections of how people see current levels of care, but rather an extraction of what people would like to see or thought was important.

It is acknowledged that people with dementia may not always be able to respond to questions about their experience of care, especially in the later stages. It is also true that the statements in Box 1 are not necessarily worded in the most appropriate manner for speaking with someone with dementia or their carers. The quality statements are not meant to be used as presented without modification, but rather are a way of summarising the types of comments people have made in the empirical literature about what is important to them.

Box 1: Statements made by people with dementia and their carers in the empirical literature about the quality of health services

Topic 1: What care is provided

1.1. Learning about dementia

My family and I were told I had dementia in a sensitive way.^16,17,18,19
It was quick to be diagnosed with dementia.^{20,21,22,23,24,25,26,27,28,29,30,31,32,33}
Professionals have been open with me about my dementia and my care.^34,35,36
I have been given clear information about dementia.^37,38,39,40
Professionals use language that is easy to understand.⁴¹
I have been given enough information about dementia.^{42,43,44,45,46,47}
I have been given enough information to plan for the future.^48,49,50
I have been given a chance to ask questions.⁵¹
I have been told about the risks and benefits of treatment in a way I can understand.⁵²
I have had an opportunity to meet other people with dementia and their families.^53,54,55,56

1.2. Using services

I get the treatment and support that is best for me and my life.^57,58,59
I can easily get services when I need to.^60,61
I do not have to wait too long when I need care.⁶²
I get a check-up regularly without asking for it.⁶³
I have enough help from health and social services.⁶⁴
My family or other important people have enough help from health and social services.^{65, 66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83}
I only go to hospital when I really need to.⁸⁴
I have all the equipment, furniture and privacy I need to be comfortable.^{85,86,87,88,89,90,91}
Health services tell me about other services in the community that could help me or my family.^92,93,94,95

Topic 2: How care is provided

2.1 Dignity and empathy

I am treated as a person, not a number.^{96,97,98,99,100}
Health and social services are designed around my needs.^{101,102,103,104}
Services take account of my age, ethnicity, religion, sexuality and other things that are important to me.^{105,106,107,108,109,110,111}
Services treat me with dignity and respect.^{112,113,114,115,116}
Staff try to put themselves in my shoes and understand what things are like for me.117,118
Professionals are usually friendly and kind.^{119,120,121,122}
I feel supported and understood.^{123,124,125,126}

2.2 Involvement

I feel listened to by professionals.^{127,128,129,130}
I can be involved in decisions about my care if I want to.^{131,132,133,134,135}
My care is a partnership between me, my family and professionals.^{136,137,138,139}
My family or other important people have been involved as much as I would like.^{140,141,142,143,144,145}
I know what I can do to help look after myself.^146,147
My family and I have been involved in planning what will happen in later life.^{148,149,150,151,152,153,154,155,156}

2.3 Ongoing support

I trust the health and social services teams that support me.¹⁵⁷
There is good continuity in the care I receive over time.^158,159,160
There are good links between services so one service knows what another is doing.^161,162
There are smooth transitions between services.¹⁶³

Topic 3: How people feel as a result of care

3.1 Support to maintain some independence

We are supported so I don’t feel like a burden to my family.^{164,165,166,167,168,169,170,171,172,173,174,175,176}
I am supported so I don’t feel lonely.^{177,178,179,180}
I am supported so I feel part of a community.^{181,182,183,184,185,186,187,188,189,190}
I am supported to keep my identity and continue activities I enjoy.^{191,192,193,194,195,196,197,198,199,200,201}
I am supported so I don’t usually feel depressed or anxious.^{202,203,204,205,206,207,208,209,210}
I have practical support with things like nutrition, sleep and hygiene.^{211,212,213,214,215,216,217,218}
My family have been helped with grief and coping. ^{219,220,221,222,223,224,225,226,227,228,229,230,231,232, 233,234,235,236,237,238,239,240,241,242,243,244,245,246,247,248,249,250,251,252}

Things to bear in mind

The quality statements in Box 1 include both functional aspects of the quality of care (what is
provided) and relational aspects (how people experience care). There are likely to be too
many statements to act as quality indicators because research suggests that people prefer
short and simple statements when rating the quality of care. The purpose of this review of
empirical literature was to amass a wide range of statements, and these will be further
refined and prioritised via the Delphi process.

It is important to note that much of the research from which these statements are drawn
relates to the caregivers of people with dementia rather than statements made by people
with dementia themselves. Furthermore, the majority of research is based on qualitative
interviews with small samples of people. Despite these caveats, the compilation does
provide an empirically-based starting point to begin testing the most important domains to
measure.

The statements broadly map to the Picker Institute framework of person-centred care, but
there are some differences specific to dementia care. Table 1 illustrates how the literature
about what is important to people with dementia maps to the eight domains in the Picker
Institute framework.

Domains identified in research	Domains in the Picker Institute framework
1.1 – Learning about dementia	Communication and education
1.2 – Using services	Access to care Physical comfort
2.1 – Dignity and empathy	Respect for patient-centred values, preferences and expressed needs Emotional support
2.2 – Involvement	Involvement of family and friends
2.3 – Ongoing support	Coordination and integration of care Transition and continuity
3.1 – Support to maintain some independence

Table 1: Mapping statements from people with dementia onto the Picker Institute framework

The empirical evidence provides few examples of people with dementia and their families
focusing on physical comfort (such as food and noise) or integration. Statements about
involvement, dignity and empathy are more common. This is not to suggest that some
aspects are more important to people with dementia than others. Such comments could only
be made following empirical testing. Rather, this observation is made to highlight that there
are some differences in the priorities expressed in published studies about dementia
care compared to generic frameworks about patient experience. Whilst the broad principles
may be similar, the extent of prioritisation may differ. An example is statements about
maintaining independence. Dementia research sometimes prioritises services that help to
reduce isolation, loneliness and carer burden, whereas these concepts are not always
included in more generic frameworks about person-centred experience.

In the US, a ‘Person-Centred Dementia Care Framework’ has been developed based on a
literature review about dementia care and input from a wide range of experts.²⁵³The
framework contains four levels as illustrated in Figure 1:

The person living with dementia and their family is at the centre of care. The innermost ring signifies the network of people who care about the person.
The next level focuses on the core values and philosophy underpinning personcentred care and this is linked to the domain of relationships and community.
The next level focuses on structural domains deemed to be important for personcentred dementia care. These include a meaningful life, accountability, governance, leadership, workforce, services and the environment.
Radiating from these domains are specific operational and individualised practices to support person-centred care.

The ‘quality statements’ identified from the current review for the Health Innovation Network span the four levels of this framework, though there is most emphasis on the core values (dignity, involvement, independence) and on the way these are operationalised in services rather than the structural elements. As with the mapping onto the Picker Institute framework, this again reinforces that empirical research with people with dementia and their carers has emphasised relational aspects of care rather than environmental or functional issues.

*Figure 1: Person-centred dementia care framework developed in the US_²⁵⁴*

The next phase of the Health Innovation Network’s project is to test the quality statements
with people with dementia, their carers and stakeholder organisations in order to narrow
down the list into those most useful and appropriate for measuring the quality of dementia
care.

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