Diabetes Prevention
How can people have a better understanding of diabetes and its risks, knowledge of the things they can do to avoid developing diabetes, and support to stay healthy? 

Ideas (Publish, Detailed Submission)

Innovation 'Elevator Pitch':
OurPath is a 3-month online programme to help you build healthier habits and reduce your risk of Type 2 diabetes. We provide: health-tracking technology, personalised health coaching from a dietician and evidence-based structured education.
Overview of Innovation:


The health needs of the UK population are changing and the way we interact with healthcare is evolving. Nationally, the internet is being used to manage our lives, changing the way we shop, bank, watch TV and communicate. The west midlands has one of the highest rates of diabetes and pre-diabetes in the country. Many of these people may benefit from digital services that may help them manage their lifestyles, preventing them from moving into higher risk stratification levels which would ultimately require increased GP time to manage.
OurPath provide a 12 week behavioural change programme for people at risk of, or already living with type 2 diabetes. The programme helps people to change their behaviours for the long term, and improve their health outcomes. The programme delivers:

• Evidence-based structured education on nutrition, exercise, sleep, stress management, and positive psychology
• Peer group support (an online group of 10 others similar to the user)
• Personalised health coaching from a registered dietitian
• Tracking technology (smart weighing scales and a wearable activity tracker).

The programme is already being trialled as part of NHS England's digital diabetes prevention programme and across the extremely diverse area of 6 CCG's in North West London. Following positive outcomes data and feedback from the NWL team, we are looking to open up OurPath to the rest of the country.
We are proposing a pilot project to deliver the OurPath programme to 500 people at risk of developing type 2 diabetes in the west midlands. The project will demonstrate the outcomes of the OurPath programme in the local population in order to enable future widespread commissioning.

1-minute introduction to OurPath video: https://vimeo.com/199648301

www.ourpath.co.uk

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
The Diabetes UK 2016 state of the nation report states that 'type 2 diabetes is the fastest-growing health threat facing our nation.' With over three million people already living with the condition and many millions more at high risk. This high prevalence means treating type 2 diabetes absorbs NHS budget at a rate of knots, around £1million per hour.
Clinicians have welcomed the recent focus on in-person prevention with open arms but the needs of their local populations are changing. They lead busy lives, work 9 to 5's and have children to pick up from school, making it difficult to attend face to face programmes. We intend to provide a solution for the NHS by offering easily accessible, online, 24/7 support from a registered dietician and other people taking the programme in their group. By combining support beyond the consultation with wireless healthcare tracking technology and a sustainable approach to diet and lifestyle change, we have created and demonstrated an effective, digital method of reducing risk of type 2 diabetes. 
According to Diabetes UK research: for every 1kg of weight lost a person's risk of diabetes is reduced by 15%. This emphasises the need for prevention and adapting the current strategies to align with the evolving needs of local populations. Only by making prevention as accessible as possible can we hope to help patients make sustained lifestyle change a reality. This accessibility is something we have already demonstrated we address in our trial in North West London (NWL), a  diverse area with similar type 2 diabetes prevalence and population challenges to the West Midlands. We achieved an uptake rate of over 70% from GP referral and a 3-month programme completion rate of over 80%. Compare this to the reported in-person programme attendance of 20-40% and for us, this is proof that digital works. Citing our research published in the Journal of Future Healthcare shows we have also demonstrated mean weight loss of around 8.1% of total body weight, and the preliminary weight loss and HbA1c outcomes from our real-world NWL trial are even more positive. 
Through reducing body weight and HbA1c levels we are drastically reducing the risk of type 2 diabetes. This means the NHS is able to deliver better outcomes whilst also saving money on expensive medications, treating complications and in-patient bed days. We estimate a return on investment within 2 years and savings for the NHS of £1000+ per patient over the following 5 years. 
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
The West Midlands has one of the highest rates of type 2 diabetes in the UK and based on current trends the number of people diagnosed is predicted to reach 538,000 by 2035. The only silver lining to this explosion in type 2 diabetes is that it's entirely preventable through diet and lifestyle change. 
By working with GP surgeries and community teams in the area we can also help to take some of the intense diabetes treatment workloads off these overstretched local services, freeing up more time to deliver better, more consistent care. 
Reading through the West Midlands 2016 Pledges to Improve Local Diabetes Care Diabetes UK document shows the quality and commitment of the local health service. To quote one pledge: “Prevention, prevention, prevention! Better targeting of patients with impaired glucose tolerance (IGT) to help themselves where possible and improving access to lifestyle services when required”. OurPath aligns completely with this and is a proven lifestyle service, demonstrating improved outcomes and patient-self care in a real-world patient population similar to the West Midlands. We propose working alongside these passionate people at the clinical coalface, providing their patients with continued support even after they have left the surgery. The task of changing a patients lifestyle for clinicians in any area is a difficult one. Unhealthy lifestyle habits have often been ingrained into peoples lives for decades and changing those behaviours in a series of infrequent 10-20 minute appointments can sometimes be an insurmountable task.  Patients have 24/7 access to their peer support group and our health coach team, who guide patients through our healthy recipes, structured education and exercise programme, teaching them new behaviours and embedding them into their daily lives.
Based on our positive outcomes data and uptake figures that we have already mentioned, we feel confident that we could make a tangible dent in the current projections for type 2 diabetes diagnoses in the West Midlands area, drastically improving the future quality of life for the people enrolled in the programme.
 
Current and planned activity: 
In early 2017 OurPath was commissioned across 6 CCG's in North West London to trial the programme in patients already living with type 2 diabetes. In October 2017, Partha Kar, associate director of diabetes for NHS England, announced a local commission for OurPath to provide a pilot service to patients living in the Portsmouth area. On world diabetes day in November 2017 Simon Stevens also announced that OurPath was to be one of 5 digital providers offering a digital alternative to the in-person national diabetes prevention program (NDPP). Following great feedback from clinicians and patients, we have the ambition to roll out the programme nationwide for people at risk or already living with type 2 diabetes. We hope to work closely with the academic health science networks across the country to help achieve widespread lifestyle change across the UK.
What is the intellectual property status of your innovation?:
All IPR has been developed internally and is owned by OurPath, including all technical and software IPR. 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Simple
Regional Scalability:
​The problem with introducing something across regions is making sure it doesn't negatively impact on the already overworked, understaffed organisations delivering primary care services. Driving adoption is a key KPI for regional scability and we have learnt from experience and feedback on how to implement the programme as painlessly as possible alongside existing care pathways. The programme requires no extra work for primary care and nurses have loved having something new and exciting to offer patients. We have been blown away by the adoption and feedback from across our other sites in the NHS such as 6 CCG's in North West London, 3 CCG's in the Portsmouth area and 2 STP areas. 
Measures:
OurPath will also collect the following data to measure health outcomes and predict long term cost effectiveness assessment:
  1. Weight (measured automatically via wireless scales)
  2. Activity (measured automatically via activity tracker)
  3. Wellbeing (measured with before and after wellbeing questionnaires)
  4. Engagement (measured by 'Core Actions' per day, such as messages sent to mentors, weigh-ins, and the reading of OurPath article content)
  5. Retention (measured by 'Core Actions' over time as mentioned above)
  6. We would prefer to work with GP practices to take before and after HbA1c assessments as well - which is particularly important for people at risk of type 2 diabetes.
Adoption target:
  1. Signing up and implementing a referral pathway across a minimum of 5 GP practices
  2. Onboard of 500 patients at risk type 2 diabetes to the OurPath programme
  3. Completion rate of at least 70% of the OurPath programme
  4. Of those who complete the programme, average weight loss of at least 4% 
  5. Minimum viability would be 350 participants (70%)
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Michael Whitman 23/11/2017 - 14:32 Detailed Submission Login or Register to post comments
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Innovation 'Elevator Pitch':
Milestones DM2 combines nutritional and digital innovation to help people with T2DM lose at least 15kg of bodyweight, which will improve diabetes treatment targets, reduce complication rates and generate NHS cost-savings.
Overview of Innovation:
The challenge:
Diabetes costs the NHS £10 billion a year, approximately 10% of the entire NHS budget, much of which is spent treating complications that can be prevented through good diabetes control defined as achieving ‘treatment targets’ in blood glucose (HbA1c), blood pressure & cholesterol. Most T2DM patients do not achieve these targets, but weight loss can help.

NICE recommends T2DM patients with a BMI over 30kg/m2 be considered for bariatric surgery & that all patients referred to bariatric surgery enter a tier 3 weight management service to attempt medical management. However, provision of such services is variable & existing services are limited in accessibility & cost-effectiveness.



Our solution:
Milestones DM2 provides an effective alternative to traditional services utilising digital technology for a remote, high-frequency, multi-disciplinary service via initial face to face then phone calls, online learning and a smartphone app. This ensures lower delivery costs by not requiring continuous face-to-face clinics, increased accessibility and improved effectiveness as patients are provided with the high frequency support shown in clinical trials to be superior to low frequency care.
 
Milestones DM2 builds on evidence which has shown a medical weight loss programme using 8-12 weeks of 800kcal total diet replacement (TDR) followed by supported food reintroduction can achieve 15kg bodyweight loss, with 60% of those with T2DM for <4 years reducing and maintaining their HbA1c to <48mmol/mol at 9 months. **
 
As such, Milestones DM2 is delivered over 12 months by a remote multidisciplinary team (MDT) of diabetes specialist dietitians and nurses, along with psychologists, exercise therapists and endocrinologists.
 
The patient journey in 3 phases:

1. Eight weeks of an 800 kcal TDR (OPTIFAST® from Nestlé Health Science). Note that the option of intermittent TDR (2 days/week for 27 weeks) is available for those who cannot tolerate continious TDR (7 days/week for 8 weeks)
2. Four weeks supported food reintroduction
3. Nine months of maintenance
 
             

Patients receive weekly healthcare professional support throughout Phases 1 & 2 and then monthly during Phase 3. This is provided via phone calls and/or text and video support via the Milestones DM2 smartphone app (which can also be used for self-monitoring). The technology enabling remote care for Milestones DM2 is provided by Oviva UK Ltd, an SME focused on provision of digitally enabled dietetic services across 17 NHS CCGs.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Alignment with strategic priorities:
 
Milestones DM2 is closely aligned to NHS strategic priorities, including the NHS England Five Year Forward View by reducing variability in quality and improving access to treatment in complex obesity. Furthermore, it helps drive significant efficiencies by ‘getting serious’ about preventing complications in obesity and diabetes such as heart disease and cancer, and innovates with a new model of care. Implementation will also support NHS commissioners and primary care to meet targets in the Improvement and Assessment Framework regarding diabetes treatment targets.
 
Improvement in clinical outcomes:
 
In its existing clinical services, Oviva UK Ltd, the provider of the technology and clinical services associated with Milestones DM2 achieves superior engagement from its high-frequency remote approach, with >90% programme completion rates. In turn, this achieves 7% bodyweight loss at 1-year in morbid obesity, vs. c. 0% in typical T3WM programmes. This drives improved management of diabetes, thus reducing patient risk of devastating complications such as amputation, sight loss and renal failure.
 
Cost efficiencies:
 
Frontier Economics completed a health economic assessment of potential cost savings for the Milestones DM2 programme, based on clinical outcome data to date. From this, estimated cost savings are at least £10,000 per patient in year 1 (through direct costs such as avoidance of bariatric surgery and reduced prescribing of medications), and £14,000 by year 5 (through indirect costs, such as service utilisation in primary, secondary and urgent care and treatment of complications).
 
Improved access and experience:
 
The remote nature of the service expands accessibility to patients that are less likely to access traditional services due to the time and cost required to attend face-to-face clinics, such as those of working age, people with caring responsibilities, mobility issues, or other characteristics associated with inequity in healthcare access – particularly as many existing Tier 3 services are only available on specific times of the day during the week. Mobilisation of the service includes engagement with ‘hard to reach’ groups, and Oviva’s existing services have uptake rates of c.90% and very low DNA rates.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
There are an estimated 360,450 people in the West Midlands with diabetes, when adjustments are made for age, sex, ethnic group and deprivation. This is 8.1% of the adult population, higher than the average prevalence for diabetes for England of 7.4%.
 
By 2030, levels of diabetes in the West Midlands are expected to rise to 488,711 people or 10% of the adult population, compared with 8% for. However, 80% of all cases of Type 2 diabetes are preventable.
 
Diabetes has a huge impact on life expectancy, with Type 2 diabetes reducing a patient’s life by up to 10 years. Both patients and the NHS bear the brunt of this disease, with an estimated cost of £10 billion for treating diabetes.
 
The indirect costs of diabetes (such as increased mortality and morbidity, work loss and the need for informal care) are currently estimated to be £13.9 billion per year, rising to £22.9 billion in 2035/6.
 
Deaths from diabetes in 2010/11 are estimated to have resulted in over 325,000 lost working years.*
Current and planned activity: 
Our approach to engaging with the NHS & other stakeholders has been to focus on working with the AHSN network to help us diffuse our innovation & better understand the needs of local NHS commissioners/providers. Through Oviva’s role in the Diabetes Digital Coach NHS England test bed we are hoping to offer Milestones DM2 to a number of patients to further demonstrate impact & a clinical trial is underway at University Hospital South Manchester
 
Support sought

- Identify opportunities to offer Milestones DM2 to patients in the region in order to improve health outcomes & demonstrate cost-savings
- Learn from WMAHSN's LTC Network regarding their work on the use of telehealth & telecare & how we might engage with this work stream

The programme is flexible & can meet local/regional NHS requirements as well as complement established NHS diabetes & weight management services. Milestones DM2 is delivered by Oviva UK Ltd meaning minimal impact on existing NHS resources in terms of cost or staff time
What is the intellectual property status of your innovation?:
Nestle Health Science and Ovivia UK Ltd’s IP will be preserved.
Milestones DM2 is the intellectual property of Nestle Health Science.

OPTIFAST® is a total diet replacement (TDR) for weight control. It provides all essential nutrients for the day and is for use under medical supervision only.
 
It is available as three easy-to-prepare shakes (chocolate, strawberry or vanilla), and a vegetable soup. Each OPTIFAST® sachet provides approximately 200 kcal per serving.
 
OPTIFAST® is bound by the EU FSMP (Food for Special Medical Purposes) Directive 1992/21 EC and is subject to FSMP regulators. It comes under EFSA control and is nutritionally complete
 
Nestle Health Science adheres to the National Dietetic Guidance set out in the 1991 Dietary Reference Values (DRV) DoH publication.
 
Technology provided by Oviva UK Ltd complies with all NHS data protection standards, and has IG Toolkit level 2 accreditation. All clinical staff involved in delivery are registered with the relevant professional body (e.g. HCPC, RCN, RCP), and undergo NHS pre-employment checks.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Peter Swales 14/09/2017 - 15:48 Publish Login or Register to post comments
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Innovation 'Elevator Pitch':
The Sound Doctor is the leading source of film and audio patient information in the UK, offering a coherent and authoritative learning programme encouraging effective self-management of diabetes.
Overview of Innovation:
The Sound Doctor's unique self-management library includes 60 short films covering all aspects of living with diabetes. The material is of exceptionally high quality and offers a structured programme of education, which can be a lifelong companion for people living with the condition. 

The aims of The Sound Doctor self-management programme are:
 
1. To reduce the number of avoidable admissions (and readmissions) to hospital
2. To reduce the need for face-to-face contact with clinicians (and to improve the quality of meetings which do take place)
3. To improve medicines management and compliance with medications
4. To improve the quality of care for patients (and patient experience of their care)
5. To help people get the most out of life through effective self-management

The diabetes library
Developed after consultation with Diabetes UK, leading clinicians and patient groups, the films offer detailed and practical advice about diet, activity, medicines, blood glucose monitoring and many other aspects of living with diabetes. The material is motivational, positive and reassuring. We include interviews from healthcare professionals that people will come across in the course of their journey, including consultants, GPs, podiatrists, dietitians, psychologists, specialist nurses, pharmacists and Diabetes UK. There is also reassuring advice from people living with diabetes about taking day-to-day control.

Your healthcare team in your pocket, available 24/7. The advice you need when you want it.

The films specifically address the causes of diabetes, the long and short-term complications and risks and more than half of the films detail steps that people can take to take ownership of the condition, improve their lifestyle and reduce the risks of complications. A list of content is available.

The Sound Doctor has a proven and demonstrable role in improving self-management, and has been exceptionally well received by patients.

The films are extremely well reviewed by healthcare professionals and other experts and, in evaluations, users overwhelmingly report increased knowledge and confidence as well as fewer visits to the GP and fewer hospital admissions. We have evidence that people change their attitudes and behaviour towards diet and exercise. We also know that the films improve people’s satisfaction with, and experience of, their care.
The Sound Doctor is currently being used in a number of CCGs and Hospital Trusts around the country as well as community pharmacies.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
Diabetes costs the NHS £10bn every year – mainly due to complications which can be avoided or delayed through effective education. People with diabetes are more likely to be admitted to hospital and have longer stays.
 
Those with diabetes may see their healthcare team only once or twice a year so effective self-management driven by effective information is essential.
 
The Sound Doctor library is not an ad hoc series of films touching on a few subjects that might be of interest to someone with diabetes. It is a comprehensive, structured education programme that can be a companion for life.
 
An evaluation carried out in West Leicestershire in December 2016 among long-term users of The Sound Doctor found:
 
96% of users understood their condition better
98% learned new information about their condition
96% felt more confident about managing their condition effectively
88% had a better understanding of their medicines (10%not applicable)
93% have changed their self-management technique
98% found The Sound Doctor easy to use
99% found it a useful addition to their healthcare
 
Crucially:
 
92% of users reported fewer visits to their GP
62% said they had been to hospital less often
 
 
Why The Sound Doctor?
 
80% of the cost of diabetes is spent on complications. The Sound Doctor films aim to reduce the likelihood of developing complications by delivering effective advice on diet, activity, medicines management, blood glucose monitoring, HbA1c and other aspects of  self-management including specific films on looking after your feet and eyes that can directly reduce the likelihood of amputation and blindness. There are sixty films in all. 
 
Self-management is the key to reducing the costs of treating many long-term conditions in a testing financial climate. The Sound Doctor is a class-leading information product that can achieve this.
 
“The quality of the product is, in my experience, unmatched anywhere in the world.”
Dr Charles Alessi, Senior Adviser Public Health England
 
 ROI
 
Costs are reduced in various ways including GP appointments at an average cost of £25 and hospital admissions for foot ulcers and amputation, dialysis, cardiovascular disease, sight impairment and neuropathy. Other benefits are derived from decreasing the number of bed days in hospital and increasing attendance and productivity at work.

For more information please contact Rosie Runciman: rosie@thesounddoctor.org (Tel) 01285 850887
Website: www.thesounddoctor.org
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
All the benefits outline above apply equally to the West Midlands population. This is a versatile and scalable product which has been adopted in several CCGs and hospital trusts around the UK. 

We are particularly keen to develop our product and produce new material for and in the West Midlands as a local company benefiting from the Serendip programme at iCentrum.
Current and planned activity: 
When funds permit, The sound Doctor intends to continue producing new libraries of films addressing other conditions. In particular we plan a comprehensive package of films covering stress, anxiety and depression; alcohol; further musculo-skeletal conditions and weight management.

We are open to discussion on co-producing further, localised material on diabetes to reflect the West Midlands population more accurately.
What is the intellectual property status of your innovation?:
The Sound Doctor owns all IP in all products. Material is generally licensed to clients on an annual or monthly basis (min 12 months) and allows access for up to 100,000 users
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Dominic Arkwright 26/05/2017 - 10:15 Publish 1 comment
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