BBC news broadcasts special feature on ESCAPE-pain programme

As part of National Arthritis Week, BBC London have featured the innovative rehabilitation programme, created by Prof Mike Hurley, Clinical Director at Health Innovation Network.

The special report included the fact that over 1,000 people have been trained to deliver this programme at 230 sites, including at least one in every region in England. In a boost to out-of-hospital care, an ambition of the NHS’ Long Term Plan, these trained professionals include fitness instructors delivering the programme in community halls and leisure centres, as well as hospital-based physiotherapists. ESCAPE-pain’s rapid growth over the past two years has been supported by the NHS’ innovation bodies, Academic Health Science Networks, NHS England, charity Versus Arthritis, and Sport England.

It is estimated that over 14,000 people will have taken part in ESCAPE-pain programmes across 230 sites in the UK.ESCAPE-pain is for people with chronic knee and hip pain (known as osteoarthritis, a musculoskeletal condition) and has been shown to make marked improvements to quality of life for people living with the condition. The success of ESCAPE-pain has also led to a newpilot programme for back pain being launched.

Around 8.75 million people aged 45 years and over (33 percent) in the UK have sought treatment for osteoarthritis. Despite the risk of side effects and high costs, treatment for osteoarthritis has traditionally been the prescription of painkillers, typically non-steroidal anti-inflammatory drugs (NSAID), with little practical support.

ESCAPE-pain’sfocus on education and exercise offers people and GPs options to better manage pain associated to osteoarthritis.The programme runs for a total of 12 sessions over six weeks with participants attending two, hour-long classes a week.The classes teach people the skills they need to self-manage and reduce their pain.Each class starts with a brief discussion about pain and how it can be reduced and is then followed by an individualised exercise programme.

ESCAPE-pain creator Professor Mike Hurley said:

“Chronic joint pain is miserable. It creates a vicious cycle of severe pain, leading to prolonged rest, which leads to further muscle weakness, which leads to physical instability and fatigue. This inactivity increases the risk of co-morbidities such as diabetes and cardiovascular disease. These physical health issues and disability then contribute to social isolation, feelings of helplessness, anxiety and depression, and long-term use of pain killers that people don’t like taking and haven’t been proven to work in the longer term.

“I wanted to find a better way to help people living with chronic pain and with ESCAPE-pain, we’ve shown that a combination of education, self-management, coping strategies and individualised exercise regimes can achieve better outcomes.”

David Rawlings, exercise referral specialist at gym and leisure centre, Leisure at Cheltenham, has been running the ESCAPE-pain programme at the centre with physiotherapists from Cheltenham General Hospital for over three years.

David said:

“People love it and for some it literally is life-changing. Some of the participants we have had on the course had stopped going out and participating in family life or in their community.  After attending ESCAPE-pain they become more active, are able to manage their pain and their arthritis better and build the confidence to move and become more active again.”

Jenn Holeman, senior musculoskeletal physiotherapist at Cheltenham General Hospital leads the ESCAPE-pain programme at the leisure centre said:

“I would recommend the ESCAPE-pain programme 100 percent both professionally and personally.  It is great and I think all areas should be taking it up.  It saves the NHS money because rather than 30 minute one-to-one physiotherapy sessions up to 16 people are having group sessions with one physiotherapist and gym instructor twice a week and it relieves the pressure on GPs because it cuts down on the amount of patients seeking treatment for their symptoms.”

Recent independent evaluations have also reinforced how much money the NHS saves by taking this approach, showing that every £1 invested returns over £5 in wider health and social value through people needing to use services and medication less. Overall it equates to an estimated £1.3 million total savings in health and social care for every 1,000 participants who undertake ESCAPE-pain.

Now, Londoners with chronic back problems have been given the opportunity to access a similar self-management programme. This pilot programme available at four London Trusts and over 150 people have benefitted to date.

Matt Whitty, deputy director of Innovation and Life Sciences, NHS England and NHS Improvement says that the ESCAPE-pain programme is a: “great example of a proven, low-cost innovation that transforms lives.”

“It will mean more people with chronic joint pain getting better care in their local communities and being able to live more independently with a higher quality of life. Responding to needs through this sort of cross sector working is crucial to how we will deliver the NHS Long Term Plan,” he continued.

Sarah Worbey, health and inactivity national partnerships lead at Sport England adds:

“The Sport England Active Ageing fund supports innovative approaches that aim to tackle inactivity among older people, the ESCAPE-pain programme fits perfectly into this.

“We are pleased to have partnered with the Health Innovation Network and Versus Arthritis to enable this programme to be tested through community and leisure settings, for those who are the least active and need it the most.

“It is encouraging for us to hear how participants are making important lifestyle changes and becoming more physically active through their participation in the programme.”

Data gathered from over the last three years from more than 5,000 ESCAPE-pain participants shows consistent improvements in pain levels, quality of life, and movement.

Almost three quarters of the participants who took part in the programme (70 percent) reported to have improved their ability to take part in daily activities, 66 percent reporting pain reduction and 59 percent having a better quality of life and mental wellbeing.

Further information

Learn more about ESCAPE-pain and find a class near you here.

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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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ESCAPE-pain programme reaches 200 sites

ESCAPE-pain programme reaches 200 UK sites

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

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

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

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

ESCAPE-pain has been shown to:

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

You can find your nearest ESCAPE-pain programme here.

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

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

 

Meet the Innovator

Meet the Innovator

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

Tell us about your innovation in a sentence

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

What was the ‘lightbulb’ moment?

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

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

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

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

What three bits of advice would you give budding innovators?

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

What’s been your toughest obstacle?

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

What’s been your innovator journey highlight?

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

Best part of your job now?

There are two:

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

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

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

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

A typical day for you would include..

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

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

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Award-winning ESCAPE-pain programme now online

Award-winning ESCAPE-pain programme now online

The award-winning ESCAPE-pain programme for the management of chronic joint pain is now available online to help ease the suffering of thousands of people across the country.

Chronic joint pain, or osteoarthritis, affects over 8.75 million people in the UK, including half the population over the age of 75, and one in five of the population over 45. A small proportion proceeds to surgical intervention while the vast majority are managed in the community with painkillers.

GPs typically spend around a day a week on appointments related to joint pain; by helping those people with joint pain undertake regular exercises evidenced to improve mobility and reduce pain, a large number of GP appointments can be freed for other people to be seen more quickly.

The new online version of ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain through Exercise), is a digital version of the well-established, face-to-face group programme that is now delivered in over 80 sites across the UK and is already being used to improve the lives of over 7,000 people with chronic joint pain.

Under the new digital programme, people can choose from 16 high-quality exercise videos to help improve joint pain including engaging animations and education videos to learn to manage their condition better. They can feel more in control of their pain through this free NHS resource developed by the South London-based Health Innovation Network which works to innovate health and care in the NHS.

Professor Mike Hurley, originator of the ESCAPE-pain programme, said:
“Thanks to ESCAPE-pain Online anybody with chronic knee or hip pain can now access the ESCAPE-pain programme regardless of where they live. ESCAPE-pain Online isn’t a replacement for attending the face-to-face programme, as that’s the most effective way to experience its benefits but it will support people to exercise safely and regularly in their own homes. People who are unable to attend a face-to-face programme or those who don’t have access to a smartphone can use ESCAPE-pain Online.”

Health Innovation Network Chief Executive Tara Donnelly said:
“ESCAPE-pain is a proven rehabilitation programme with a strong evidence base approved by NICE that is helping thousands of people who have been suffering in pain. By making use of digital technology and extending the programme through offering videos online, we are rolling out the potential benefit of this programme to many more people experiencing chronic joint pain; currently affecting one in five of the population over 45.”

ESCAPE-pain has been recognised with awards from both the Royal Society for Public Health (RSPH) and the British Society for Rheumatology, and is cited in the NICE clinical guidelines for osteoarthritis. More recently, ESCAPE-pain has been recommended as a preferred intervention for musculoskeletal conditions by Public Health England, which showed a positive Return on Investment of £5.20 for every £1 spent.

ESCAPE-pain Online is a free resource produced in the NHS by the Health Innovation Network and Salaso Solution Ltd. It is best viewed on a computer and is accessed via the ESCAPE-pain website homepage. For more information please visit escape-pain.org or email hello@escape-pain.org. Watch a film about ESCAPE-pain here.

Keeping active is a vital part of keeping steady

Keeping active is a vital part of keeping steady

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

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

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

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

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

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

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

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

HIN out and about in London

HIN out and about in London

Find out what our HIN team has been up to recently, and some events we’ve taken part in or led.

Technology & Informatics

On 13 September, our T&I team visited Tameside and Glossop Integrated Care NHS Foundation Trust, just outside of Manchester. They learned about an innovation set up by the hospital called Digital Health Centre aimed at reducing the number of unnecessary attendances at Tameside Hospital’s A&E department through the use of Skype. The learning pilot, which has extended the number of local care and residential homes involved, focuses on when patients within the homes become unwell, staff will have the option to Skype a dedicated registered nurse at the Trust who will be on hand to give expert advice and guidance throughout a video conversation. This has already reduced the number of attendances to A&E. The team learned about innovative techniques being used in other parts of the country, and took on board the advice provided by the team to aid some of their projects.

Musculoskeletal (MSK)

Supported by Arthritis Research UK, the MSK theme successfully organised the annual ESCAPE-pain conference which was held on 11 September as Guy’s Hospital. Sarah Ruane, Strategic Lead at Sport England to our very Innovation Fellow, Andrew Walker took to the stage to present to a full room of delegates who were keen to share best practice and ideas. Read more on the event here.

Alcohol

Paul Wallace, Clinical Director for the alcohol theme presented a paper at the International Network on Brief Interventions for Alcohol and Other Drugs Conference in New York on “Use of SMS texts for facilitating access to online alcohol interventions – a feasibility study”. This is a presentation of the pilot project undertaken with three GP practices in Kingston.

ESCAPE-pain conference: Learning from each other

ESCAPE-pain conference: Learning from each other

(Image: Sarah Ruane from Sport England presenting to a full venue)

The annual ESCAPE-pain conference was held at Guy’s Hospital on 11 September. Supported by Arthritis Research UK, the conference aimed to provide a learning and sharing opportunity for current and prospective providers. It brought together providers from NHS and leisure sector settings, commissioners and private practitioners.

After a warm welcome from Zoe Lelliott (Director of Strategy and Performance, HIN), Andrea Carter (Programme Director, HIN) and Professor Michael Hurley (Clinical Director, HIN) provided an update on ESCAPE-pain and future plans.

Speaker round-up

  • Sarah Ruane (Strategic Lead – Health, Sport England) presented on Sport England’s initiatives that support their new strategy ‘Towards an Active Nation’, and in particular, their insight into motivating inactive older adults to achieve recommended physical activity levels
  • Adrienne Skelton (Director of Strategic Development, Arthritis Research UK) presented on the charity’s new strategic focus on quality of life and commitment to increasing adoption of effective interventions, such as ESCAPE-pain
  • The team at East Surrey and Caterham Dene Hospitals presented their case study on how they engage patients and encourage them to continue exercising after ESCAPE-pain. They also brought along a recent ESCAPE-pain participant, Chris, who shared her heartwarming story about how ESCAPE-pain has changed her life
  • Zoe Zambelli (Project Support Officer, HIN) presented on learnings on a review of ESCAPE-pain clinical outcomes and data collection processes
  • Andrew Walker (Innovation Fellow, HIN) presented his research on the spread and adoption of ESCAPE-pain, including the challenges of programme scale-up and sustainability
  • The team at Cheltenham General Hospital and The Cheltenham Trust presented on the benefits of their partnership, how they achieve a high retention rate and their future plans
  • Amy Semple (Senior Project Manager, HIN) presented on Joint Pain Advisor, highlighting how its different from ESCAPE-pain, the delivery models and its impact.

ESCAPE-pain is currently running in over 30 sites across the UK. As our partnership with Arthritis Research UK develops, we expect an accelerated roll-out of sites before the year ends.

Follow tweets from the conference: @escape_pain and #ESCAPEpainConf

For more information, visit www.escape-pain.org or email hello@escape-pain.org