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.
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)
Acute Adult (Male)
Mixed Psychiatric Intensive Care Unit (PICU)
Acute Adult (Female)
Children and Young Person
Participating patients who stated they were involved in their diabetes care during their stay
Wards with a self-management policy for diabetes
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
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.
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.
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 )
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.
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.
80 per cent of patients had not used a health app before
Three quarters of patient respondents rated the app as ‘very good’, ‘good’, or ‘acceptable’.
55 per cent of patients reported using the getUBetter app in the past week
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
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.
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.
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
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  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.
*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
Be My Eyes
Local vs national implementation
Local (national across Norway by the Norwegian Cancer Society)
Tasks geographically ‘local’ to the volunteer and recipient (within a few miles)
No (tasks delivered via video)
Yes (except telephone ‘Check in and Chat’ service where recipients / volunteers matched at a national level)
Task benefits an individual recipient
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)
Volunteer and recipient have direct contact (e.g., face to face, phone, electronic)
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)
The ‘presentation of opportunities’ to volunteers (‘pull’ or ‘push’ models)
Push and Pull. Requests are pushed as alerts via the app and volunteers can also search a list of requests.
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)
Tasks can be booked and/or converted into a repeat or regular task
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 – system records activity of task, when and who carried out the request
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. 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.
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.
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
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.
Volunteers who put themselves ‘on duty’
% of tasks completed
Avg. monthly completed tasks
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.
 Team Kinetic data was extracted for all activity from 6th April 2020 to 26th January 2021
[11 Based on data trimmed to include whole months only from 1st April-31st 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).
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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. 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
 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.
Remote Consultations in Mental Health: Learning from Evaluation Report
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.
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.
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.
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 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
 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.”
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.
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.
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).
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
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.
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.
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 13th July 2020 and 1st September 2020 and was briefly electronically reopened on 11th 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 5th October 2020 – 15th 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).
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.
Workstream two: Summary of findings from the Trust patient and staff surveys
Patient experience of remote appointments can be summarised as follows:
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.
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.
Environment and privacy.
Openness during consultations.
Limitations compared to face-to-face.
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.
“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”
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.
Visualisation of data for improvement
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.
Workstream three: Summary of findings from the E-survey
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.
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:
Iaptus Virtual Consultation
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.
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.
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.
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.
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.
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.
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.
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. 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).
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.
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.
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.
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.
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
Dr Cecilia Casetta
Dr Jacqueline Philips Owen
Professor Peter Fonagy
Dr Kia-Chong Chua
Dr Juliana Onwumere
Dr Sarah Markham
Dr Barbara Grey
Dr James Woollard
Dr Gabriella Wojewodka
Dr Justin Earl
Dr Stuart Adams
Dr Sarah Cope
Dr Phoebe Barnett
Dr Rebecca Appleton
Professor Sonia Johnson
Appendix one: The south London e-survey (workstream three):
Evaluations on remote working in mental health services in South London What is the project about? Our trust is working to understand the impact of remote working during COVID-19 on staff and patients. We want to map the different evaluations (and research projects or surveys) taking place about any aspects of remote working (both client-facing and interprofessional). By combining this information, we can better learn and plan for COVID-19 recovery. This information will be collated across South London mental health trusts who are working in partnership supported by the Health Innovation Network, NIHR Applied Research Collaboration South London and King’s Improvement Science. This will allow rapid action learning back to improve patient care. What am I being asked to do? Please let us know about any evaluations (past, current or planned) that are looking at different ways of working with patients, carers, families or colleagues, since the beginning of the pandemic.
The aim is not to interrupt/change what you are doing, it is simply to map what is going on. Please also share any documentation (e.g. survey questions, topic guides, protocols) that can provide more detail about the evaluation. This can be emailed to Dr Lucy Goulding, Programme Manager at King’s Improvement Science on email@example.com. The survey should take approx 15 min to complete and closes on 21st August. How will personal data be used? All data will be managed in full compliance with the Data Protection Act 2018 and General Data Protection Regulations (GDPR) 2016. All information you share will be stored on a secure server, will only be seen by the core project team from the partners organisations, and only used for the purposes of the mapping exercise. Non-personal data will be analysed and anonymised findings may be shared within and potentially outside the trusts and may be published e.g. in an academic journal. All personal data will be deleted/destroyed once the project has completed. If you have any questions about the survey, or would like to find out more about this project please email Alison White, Senior Project Manager at the Health Innovation Network on Alison.firstname.lastname@example.org
The south London e-survey
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.
Organisation and services involved
Summary of project (aims and methods)
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.
Patients’ feedback after Attend Anywhere consultation. Survey of patients.
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.
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.
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.
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.
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.
SWLSTG Single-site, Fircroft Trust mental health and learning disabilities
The Fircroft Trust: supporting our clients during COVID-19 Unstructured telephone interviews.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Oxleas Older people’s services
Patient experience of remote consultations in the older adults mental health service. Telephone survey of service users.
Oxleas Specialist children’s services in Bromley, Bexley and Greenwich
Staff experience of working during the COVID 19 pandemic. Survey of staff.
East London NHS Foundation Trust
Trust wide service evaluation of remote consultation platforms. Survey of clinical staff’s experiences and feedback.
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.
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.
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.
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.
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.
Ongoing service evaluation of parent counselling services taking place across England, Wales and Scotland. Interviews of service users.
Ongoing service evaluation of young people, parents, carers and teachers using the service in England and Scotland. Survey of service users.
Service evaluation of young person’s remote access to CAMHs services. Survey of service users.
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
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
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
Survey and some qual interviews
online survey (open for 8 weeks)
survey, different questions based on the type of service
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
545 responses from staff (n=474), service users (n=47) and carers (n=24).
unknown but 160 consultants within the Trust
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
Community setting and inpatient/liaison services
Table 2: Summary of each Trust survey
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)
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
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
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
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
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.
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
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
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 wellbeing5,6. 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.
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.
“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.”
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.
Participating patients who stated they were involved in their diabetes care during their stay
Wards with a self-management policy for diabetes
“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].”
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.