Volunteer Support for Care Homes and Care Home Staff now available

Volunteer Support for Care Homes and Care Home Staff now available

A new organisation of volunteer health and care students has offered support to care homes and care home staff through a HIN pilot scheme.

HealthSHIP (Health Students Helping in Pandemics) are mostly health students (i.e. nursing, physio, occupational therapy, medical) with valid DBS certificates, and free time on their hands who are keen to support NHS and social care staff with everyday needs (errands, childcare, pet care, grocery shopping, admin, non-clinical tasks, etc). The scheme is nationwide – it’s free, quick and easy, representing 87 universities and over 1,100 users.

HealthSHIP are keen to support Care Home Pioneer staff with any shopping, errands or help for their own families. In addition, care homes wanting volunteers to volunteer in their care homes can also request help – local medical students will volunteer to support if they can. The Health Innovation Network is helping to coordinate this pilot.

To register for the scheme, care home managers should:

1) Make an account for your care home on www.healthSHIP.org with your email and post tasks/roles you need help with. This would then prompt medical student volunteers to respond to the requests and then become volunteers of the care homes / care home staff.

2. Distribute the HealthSHIP website to your care home staff members who can sign up in a personal capacity and request help for their personal lives. You will need to email HealthSHIP with the personal email addresses of care home staff who want to register, so they can be verified.

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Topol Review highlights potential of digital technologies to address the big healthcare challenges

Topol Review highlights potential of digital technologies to address the big healthcare challenges

Written by Anna King, Commercial Director at Health Innovation Network.

It is not often that an independent review for a UK Secretary of State gets held up for a book launch, but such is the case when you ask a world-eminent, California-based cardiologist to review the changes required in the NHS healthcare workforce to ensure preparation for the technological future.

Dr Eric Topol, probably best known for his book, The Patient will see you now, published his long awaited The Topol Review: Preparing the healthcare workforce to deliver the digital future last month. The report highlights how digital healthcare technologies have the potential to address the big healthcare challenges as well as tackle increasing costs. The report observes that innovation will “increasingly shift the balance of care in the NHS towards more centralised highly specialised care and decentralised less specialist care”. This shift in the pattern of need and services is aligned with much of the HIN’s work and our focus on out-of-hospital care. Flatteringly, Topol also supports the ambition that the UK has the potential to become a world leader in such healthcare innovations. This is particularly exciting to hear given the work the HIN has been doing locally with DigitalHealth.London building upon local strengths in clinical care, research, education and business to boost London as a world leader in digital health.

However, Topol also offers words of caution for those impatient for new digital healthcare technologies to reach their full potential. As he observed, “it can take up to 10 years to realise cost savings, investment in IT systems, hardware, software and connectivity, as well as the training of healthcare staff and the public”.  The potential benefits of genomics moving beyond rare diseases and cancers is a good example of this. Allowing better prevention and management of conditions that could reduce costs and disease burden in the 10 to 20 year timeframe will require the NHS to have completed the “digitisation and integration of health and care records if the full benefits of digital medicine (earlier diagnosis, personalised care and treatment) are going to be realised”.

Whilst much of the report focused on the longer-term revolutionary technologies, there was also an acknowledgement that some data-driven technologies can and are being deployed today. Particularly, those with the aim of improving ease of access or remote monitoring, designed to reduce unplanned hospital admissions and decrease non-attendance rates. This is an area that we see many solutions being developed by the innovators of the NHS Innovation and DigitalHealth.London Accelerator programmes. Companies like Transforming Systems and Dr Doctor use data to improve access and system efficiency, and companies like Lumeon and Health Navigator helping improve individual patient pathways. Topol is also refreshingly realistic about the issues we see many innovators face because of “uneven NHS data quality, gaps in information governance and lack of expertise”. Potential enablers to overcome the barriers to adoption, he suggests, include: an information governance framework, and guidance to support the evaluation, and purchasing of AI products.

In the report, genomics, digital medicine and artificial intelligence were all seen to have a major potential impact on patient care, but it also showed how digital will help improve the lives of the NHS workforce. There was a helpful introduction to a number of emerging technologies, including low-cost sequencing technology, telemedicine, smartphone apps, biosensors for remote diagnosis and monitoring, speech recognition and automated image interpretation, that are seen to be particularly important for the healthcare workers.

Topol also finally puts to rest dated concerns that technology exists to replace people working in healthcare. The report clearly responds to this fear confirming that technology is intended to ‘augment’ healthcare professionals, rather than replace; releasing more time to care for direct patient care. Whilst, some professions will be more affected than others,Topol finds that the ‘impact on patient outcomes should in all cases be positive’.

At the HIN we have been supporting the development of the NHS workforce as a necessary part of the journey to digital transformation. I was pleased that Health Education England’s involvement in the Topol Report means that training and education will be modernised, as it is still very dated both in its methods of delivery and syllabus. However, this education should not focus solely on just educating new NHS staff members – but we should also be digitally upskilling the workforce we have now, and at every level. And herein lies the real complexity of the digital revolution. What Topol finds undeniable is that the roles of healthcare staff will change and new skills will be required, and it is good to see Health Education England responding to this challenge – although, it was shocking to learn that radiologist are still be taught how to develop traditional x-ray films, despite them rarely being used in the NHS!

Learning from previous changes, implementation will require investment in people as well as technology. It bodes well for the exciting wide-ranging programmes of the AHSNs, that support a learning environment, understand the enablers of change and create a culture of innovation. Programmes of ours like the Graduates Into Health Fast Track IM&T programme and the DigitalHealth.London NHS Digital Pioneers programme will play an important role in developing an agile and empowered workforce to facilitate the introduction of the new these new technologies. The report is clear that it is an exciting time for the NHS to benefit and capitalise on technological advances, and the AHSNs are well place to support this. The observation that ‘within 20 years, 90% of all jobs in the NHS will require some element of digital skills, illustrates the need for digital education revolution perfectly, even if it did raise the question what would the 10% be doing!

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About the author
Anna has been Commercial Director at the Health Innovation Network since July 2013. Prior to her current role Anna was the Commercial Programme Director at the London Commercial Support Unit (Commissioning Support for London, NHS London and NHS Trust Development Authority).

A manifesto for spread

A manifesto for spread

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

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

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

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

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

Spend on spread

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

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

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

 

Valuing innovation as much as invention

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

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

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

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

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

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

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

Research and data

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

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

Clinical innovators and spread

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

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

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

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

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

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

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

 

Patient-led innovation

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

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

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

A system for spread

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

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

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

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

Acknowledgments

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

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

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

Follow Tara on Twitter at @tara_donnelly1­­­­

References:

AHSN Network: ahsnnetwork.com

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

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

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

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

Digital Health.London: digitalhealth.london

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

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

Donnelly, T. Dec 2017. Why SBRI matters

Health Innovation Network: healthinnovationnetwork.com

Creating waves across the Pond

Creating waves across the Pond

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

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

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

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

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

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

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

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

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

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

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