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 (Patient and medicines safety)

Innovation 'Elevator Pitch':
Florence is a sophisticated digital platform used to deliver personalised, targeted behavioural psychology-based messaging, interacting with patients as the friendly non-judgemental persona, “Florence” or "Flo" through familiar & accessible SMS texts
Overview of Innovation:
The NHS owned “Simple Telehealth” methodology on which Flo is based, has challenged clinical thinking about the role & effectiveness of messaging in healthcare, delivering better & faster clinical outcomes by improving patients’ motivation, engagement & adherence to their best practice healthcare regime. 

100,000+ patients on from inception, Flo continues to stand out by consistently producing independently evaluated positive results across wide-ranging clinical applications irrespective of patients’ age, ethnicity, socio-economic background or clinical setting.

With a not-for-profit Community of Practice & extensive independent evidence base, Flo is consistently integrated within treatment pathways across a breadth of diabetic patient cohorts targeting local needs & priorities, some independent outcomes here 

Many of Flo's patients experienced difficulties in managing their diabetes or were at high risk of further complications or exacerbation if their diabetes remained uncontrolled. Patients & clinicians reported experiencing a number of self management challenges that Flo now addresses:
  • Avoidable diabetic diagnosis
  • Adherence to blood glucose monitoring & self management advice
  • Titration of insulin
  • Confidence to administer own insulin as prescribed
  • Understanding diabetes for newly diagnosed patients & how dietary/lifestyle changes can significantly impact on clinical outcomes
  • Motivation to commit to lifestyle changes
  • Compliance with the administration of prescribed medications, including insulin
  • Increased acute admissions due to complications caused by uncontrolled diabetes
  • Management of associated comorbidities eg. diabetic foot care
The Simple Telehealth methodology is based on simple, interactive, practical & academic behaviour change principles designed to deliver a low cost approach for the NHS via an intelligent mixture of the almost invisible technical platform, subtle methods & psychology that invoke responses from patients akin to engagement with their own clinician.

The methodology balances the needs of the clinical community with everyday needs of patients & their aspiration to carry on life as normally as possible despite having a condition that
a) needs regular & consistent management or
b) displays indicators towards a disease diagnosis that may be avoidable with patient sustained behaviour change and/or improved health literacy. 

Flo creates a genuine partnership between professionals & patients, moving towards shared responsibility for health.
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: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Advanced diagnostics, genomics and precision medicine / Wellness and prevention of illness / Education, training and future workforce / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Patients increase their motivation, involvement and therefore engagement in the shared management of their health and consequently improve their clincial outcomes, faster.

Whether this be in becoming more engaged and adherent with pre-diabetic medication, commiting to and sustaining lifestyle changes recommended through face to face clinical contact or post diagnosis management of their diabetes and/or comorbidities. By following clinical guidance more thoroughly and developing what typically become sustained behaviour changes, both the patient and NHS benefit.

Since meeting Flo, patients demonstrate that her relevant, real time advice, aligned to their health is motivating them to become more engaged and regain a feeling of control over their likelihood of becoming diabetic/ their diabetes and consequently lives again. Flo will target the key risk factors for the patient as identified by their clinician, personalising care and prioritising the focus towards that which will deliver the greatest impact.
- Reduction in the likelihood of avoidable diabetes diagnosis as a result of non compliance to healthcare advice
- Reinforcement of management strategies to help patients take control of their lifestyle
- Improved sense of control of patient's own health and avoidance of interia due to feeling overwhelmed
- Improved feeling of support to implement lifestyle changes and accountability to their clinician when going about day to day life
- Can provide clinicians with additional insight into patients’ subjective measurement of their lifestyle changes to inform clinical sessions
- When targetted, improved risk reduction for modifiable diabetic risk factors
- Reduction in costs to the NHS associated with additional clinical sessions required as a result of a prolonged pathway to behaviour change and/or subsequent treatment post diabetic diagnosis.
- Reduction in DNA rate for clinical appointments where poor health engagement increases likelihood of non attendance
Initial Review Rating
4.60 (2 ratings)
Benefit to WM population:
Flo provides a low cost and scalable opportunity for population health coverage targetted at solving local challenges where improved engagament and adherence would impact on both the patient and service. Flo requires the patient to have only a basic mobile phone so is accessible and familiar and has high levels of patient and clinician acceptance. Flo is free for patients to use in the UK.

Flo provides an opportunity for a consistent digital tool to become familiar to patients regardless of their condition as can be applied across many patient cohorts. This also broadens the scope of Flo's use as additional protocols targetted at  subsequent patient and/or service need can be introduced as required.

Pre-diabetic and diabetic patient cohorts where supported by Flo feedback signifcant quality of life improvements as a result not only of becoming more compliant with preventative or treatment regimes but also of not feeling alone, feeling supported and connected to their clinician when the go about their day to day lives.
The reduction in the likelihood of a diabetic diagnosis has wide ranging savings for the NHS. The trajectory toward further complications when diabetes is diagnoses or remains poorly controlled is inevitable . Poorly controlled diabetes increases the risk of amongst others cataracts, glaucoma, various foot complications, cardiac and kidney complications are also more likely. All of these complications can be avoided or have the date of onset delayed by maintaining stable blood glucose levels. The reduction in cost implications and clinical impacts are significant.

Current and planned activity: 
Flo is currently commissioned by NHS organisations to support their patients and services according to local challenges. Once commissioned, support is included to develop pathways integrating Flo targetted at local priorities or to access the learning from existing applications withi the Simple Telehealth Community of Practice. Critically, being part of the Community of Practice means uses need to be evidence based so the design of uses, evidence and sharing studies and evaluation is key to the whole community. The culture is that it is as important to share what doesn't work as what does work and how that has been achieved. Our primary objective is to invest in organisations for the long term to continually increase their capabilities to ensure patients and the organisation benefit from evidence based implementations for the lowest possible cost. Our commitment to do the right thing for the right reasons for the benefit of patients.
What is the intellectual property status of your innovation?:
The NHS Stoke-on-Trent owned Simple Telehealth methodology including patent GB2483829, encompasses the design and methods to implement and exploit a sophisticated digital platform to deliver personalised, targeted behavioural psychology-based messaging, interacting with patients as a friendly, non-judgemental persona
Return on Investment (£ Value): 
Return on Investment (Timescale): 
2 years
Ease of scalability: 
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Lisa Taylor 11/10/2019 - 15:54 Publish 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): 
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
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Peter Swales 14/09/2017 - 17:48 Archived Login or Register to post comments

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Florence: Activating Patients to take Control over their Health, to Reduce the Incidence of Avoidable Diabetes Diagnosis has been moved from Initial Submission to Publish 4 months 1 week ago
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