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 (Long term conditions: a whole system, person-centred approach)

Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care. 

Oviva services offer accessible, evidence-based, personalised care 
All Oviva services combine:
  • High-frequency, 1-to-1 coaching from a diabetes specialist dietitian to drive behaviour change and tackle psychological barriers, delivered over the telephone or using the Oviva app.
  • Supporting materials for participants to access in their own time, including videos, podcasts, and written guides, which explain more about type 2 diabetes. Participants retain access to resources for life, and they are available online or as hard copy booklet and/or DVD. All Oviva resources reflect NICE and NHS guidelines and are reviewed by a clinical advisory board regularly.
  • Optional use of the Oviva smartphone app, which participants can use to maintain a food diary and access learning resources. This app links to the dietitian’s electronic patient record to enable the dietitian to provide feedback. 
  • Activation call from Oviva patient pathway coordinators, who are trained in motivational interviewing and focused on driving uptake.
This approach is tailored to meet the needs of different patient cohorts, as described below. 

Oviva Diabetes Prevention: an 8 week intensive education and behaviour change programme with follow up care at 3, 6 and 12 months, focused on weight loss and reducing HbA1c levels (for patients with non-diabetic hyperglycaemia). This service has recently been adopted as part of the NHS Diabetes Prevention Programme in England, and real world data will be available for analysis soon.

Oviva Diabetes Support: an 8 - 10 week QISMET-accredited structured education and behaviour change programme, focused on supporting patients to meet diabetes treatment targets, lose weight, and develop sustainable self-management skills. Real world data demonstrates an average HbA1c reduction of 13mmol/mol at 6 months, weight loss of -4.5%, whilst patients report that their average confidence in managing their diabetes increased from 4/10 to 8/10 (clinical outcomes from 85 patients). Uptake in 1453 referrals is c.70%, compared with c.30% in traditional models. 

Oviva Diabetes Support has now been selected by NHS England to join the NHS Innovation Accelerator and the Digital Diabetes Coach Test Bed. 

To view our Information Pack - click here.
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:
Oviva Diabetes Support and Prevention benefit the NHS by widening access to effective care, and generating improved patient outcomes for people with or at risk of type 2 diabetes. In turn, this drives efficiency savings in terms of avoiding preventable utilisation of services in primary and secondary care, along with medications and treatment costs associated with disease progression and diabetes complications. 

As described in the overview, service uptake is c.71%. By contrast, the National Diabetes Audit indicates that uptake of structured education for people newly diagnosed with type 2 diabetes is c.7.4% (2.9% in the West Midlands), and uptake of the National Diabetes Prevention Programme is 49%. Increased accessibility and flexibility enables people unable or unwilling to access traditional face-to-face courses, along with supporting commissioners and clinicians to meet targets associated with attendance at diabetes structured education included in the NHS Improvement and Assessment Framework and Quality and Outcomes Framework.

Moreover, real world data (85 Oviva Diabetes Support patients) demonstates an average HbA1c reduction at c.6 months of 13mmol/mol, and bodyweight loss of 4.5%, supporting the achievement of diabetes treatment targets (also included in the Improvement and Assessment Framework and Quality and Outcomes Framework). 

These clinical outcomes can drive a return on investment for CCGs; Frontier Economics modelling indicates that based on existing clinical outcome data, provision of Oviva Diabetes Support for 500 participants achieves £219k of year 1 savings, rising to £550k by year 5. This is comprised of avoidance of 72 admissions, 100 outpatient and 280 GP visits, along with avoidance of more than £17k of prescribing costs. Targeting the service at patients receiving or likely to need high cost medications (including insulin, SGLT-2, and GLP-1) could drive additional savings of more than £800 per participant per year. 

Oviva Diabetes Support and Prevention also offer commissioners a 'payment by engagement' cost model, ensuring that commissioners only fund the service for active participants. This contrasts with the block contract model of traditional face-to-face group courses, which offers commissioners limited recourse to challenge poor uptake locally.  
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
By providing an accessible, flexible and effective approach to improving outcomes for people with type 2 diabetes Oviva Diabetes Support and Prevention can impact on the WM population (7.7% of whom have type 2 diabetes, and 11% of whom are likely to be at risk) beyond the local health economy by:
  • Reducing the need for people with or at risk of type 2 diabetes requiring time away from work to attend education courses or future appointments associated with the treatment of complications, thus contributing to maintaining productivity and the local economy.
  • Providing participants with personalised and remote care widens access to cohorts identified as less likely to attend traditional programmes, such as working age men, BME groups, or rural communities, particularly essential in diverse populations such as the West Midlands. Evidence of accessibility can be seen in the success of Oviva Diabetes Support in areas such as London and Devon.   
  • Reducing the impact on the environment associated with delivery of traditional models of care, which drives a number of journeys for patients and staff and the environmental costs associated with physical premises.
  • Improving outcomes enables people with type 2 diabetes to remain in work; Diabetes UK has estimated that the costs of reduced productivity at work due to people with diabetes not working because of death or poor health, or working at a lower level of productivity are estimated at nearly £9 billion.  
Current and planned activity: 
Oviva Diabetes Support is currently in pilot or commissioned in the following areas: North West London collaborative of CCGs, South West London collaborative, NEW Devon CCG, Chiltern and Aylesbury Vale CCGs, Swindon CCG, Somerset CCG, Leicester, Leicestershire and Rutland CCGs, and Salford CCG. Oviva Diabetes Support will soon be available to self-referral nationally as part of the Diabetes Digital Coach Test Bed. Oviva Diabetes Support is supported through NHS England through the NHS Innovation Accelerator, and has been rewarded a research grant via Innovate UK and the digital health catalyst to evaluate our clinical outcomes with King's College London. 

Oviva Diabetes Prevention is part of the NHS England Healthier You - Diabetes Prevention Programme digital stream, recently launching in North West London, Somerset, and Chiltern and Aylesbury Vale CCGs. 

Oviva is keen to explore opportunities for adoption of our service in the West Midlands. 
What is the intellectual property status of your innovation?:
All intellectual property is owned by Oviva. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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Olivia Hind 23/02/2018 - 20:22 Sign Posted Login or Register to post comments
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 - 17:48 Archived Login or Register to post comments
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 - 12:15 Publish Login or Register to post comments
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