CRADLE Scale up South London

CRADLE Scale up South London

CRADLE VSA at-a-glance

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

Shock Index device introduced to save lives in maternity wards

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

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

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

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

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

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

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

Find out more about our work in maternity and patient safety

Innovator Spotlight

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

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

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

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Creating a toolkit for effective implementation of the QUiPP app

Creating a toolkit for effective implementation of the QUiPP app

QUiPP at-a-glance

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

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

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

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

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

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

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

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

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

Find out more about our work in maternity

Innovator Spotlight

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

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

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

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

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

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

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

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

Visible queuing: a game changer in hospital emergency departments

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

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

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

The idea for the new system came from junior doctor Dr Lindsey Bezzina who worked in the Emergency Department for a year and witnessed the problems reception teams and other staff encounter first-hand when it comes to waiting times queries. Currently, a whiteboard behind the reception desk is used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This leads to repeated queries to reception staff about the waiting time and these queries are not always easy to answer due to the complexity of queues. As well as frustration for patients, these queries can occasionally result in aggressive and abusive behaviours which put additional pressure on staff.

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

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

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

Find out more about our work in patient experience

Innovator Spotlight

Dr Lindsey Bezzina, Junior Clinical Fellow, Emergency Medicine, St George’s University Hospitals NHS Foundation Trust said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.

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

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

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

Virtual reality on the wards at-a-glance

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

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

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

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

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

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

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

Find out more about our work in mental health

Innovator Spotlight

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

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

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

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

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

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

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Simulation Lab for Health Technology Development and Adoption: Discovery project

Simulation lab for health technology development and adoption

Tech simulation labs at-a-glance

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

Mobile simulation labs for health technology

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

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

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

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

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

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

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

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

Find out more about our work in mental health

Innovator Spotlight

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

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

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

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

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

Stroke-busting health checks at-a-glance

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

Stroke-busting health checks for Wandsworth 

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

This co-produced, community-led scheme will see the NHS partner closely with faith and community groups, led by Wandsworth Community Empowerment Network, to use mobile ECG devices to test people for irregular heart rhythms (a warning sign for stroke) and offer wider health advice. The health checks will include Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index. They will be an opportunity to talk about the risk of smoking, including the direct link to stroke.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic (BAME) communities at substantially higher risk of poor health and early death, including due to stroke. Traditional NHS approaches aren’t working well enough – these communities are less likely to attend NHS health checks, despite being the most at risk. Therefore, this team is going to work in an innovative new way to go to these communities and work alongside local leaders to engage people.
In total, the project aims to perform at least 1,000 “Stroke Busting Health Checks” in hard-to-reach communities at high risk of stroke. It will use healthcare assistants from local GP practices to offer regular checks through a hub and spoke model of engagement in high volume places of worship and association, including temples, mosques and churches.
To support the checks and help engage the community in this work, the team will also produce a bespoke film, distributed through social media, featuring local faith and community leaders with a call to action to take part in the checks. This culturally specific content can support other health projects elsewhere in the borough and beyond.

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

Find out more about our work in stroke prevention

Innovator Spotlight

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

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

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

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

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

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Lewisham Primary Care Recovery College Pilot Project

Lewisham primary care recovery college pilot project

Recovery College Pilot at-a-glance

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

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

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

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

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

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

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

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

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

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

Find out more about our work in mental health

Innovator Spotlight

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

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

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

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Transforming delivery of antenatal care in gestational diabetes

Transforming delivery of antenatal care in gestational diabetes

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

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

New innovations to improve care for women with diabetes in pregnancy 

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

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

There are three main aspects to the pilot:

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

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

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

Find out more about our work in diabetes

Innovator Spotlight

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

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

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

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Diabetes prevention decathlon

Diabetes prevention decathlon

Diabetes Decathlon at-a-glance

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

Diabetes Prevention Decathlon to increase choice and prevent diabetes

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

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

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

The Diabetes Prevention Decathlon will:

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

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

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

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

Find out more about our work in diabetes

Innovator Spotlight

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

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

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Engage Consult – Digital Self-Referral for MSK

Engage Consult – Digital Self-Referral for MSK

Digital self referral at-a-glance

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

Digital self-referral for people with musculoskeletal problems and pain  

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

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

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

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

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

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

Find out more about our work in MSK

Innovator Spotlight

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

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

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

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Top Tips for innovators


Top Tips for Innovators

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

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

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

Target the right people

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

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

Tailor your message

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

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

Get clinician approval first

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

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

Learn about procurement

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

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

Refine your pitch

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

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

Show how your innovation works

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

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

Be persistent, but polite

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

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

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

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

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