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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
NiceDay provides a complete digital treatment concept:
  • NiceDay app and portal
  • new “flexible” way of working
  • Continuous training, support and knowledgebase
Our validated approach improves cost effectiveness with > 30%, and similar health outcomes.
Overview of Innovation:
Our approach is truly unique: we provide everything needed for services to successfully set up ánd run an Online treatment team that provides fully digital treatments in addition to their regular activities.

With NiceDay you can provide CBT, and EMDR, with treatment protocols available for Mood disorders, anxiety disorders and trauma

IT platform:
Patients use a mobile application, therapists use an online environment:
  • Communication between patient and therapist through secure chat, videocalls, audio calls
  • Threeway calls to include specialist therapists into calls
  • Patients can easily connect to a therapist
  • Daily planner for patients to actively work on recovery
  • Tracking and monitoring, e.g. automatic step count tracking, diary, emotion logging
  • CBT tools, such as thought scheme.
  • ROM measurements before ánd after every session
  • Shared meeting notes from therapists or patients
  • Psycho education librairies for depression, anxieties, trauma
  • Community experiences and –content from both therapists ánd patients
Working and communicating in a new way:
Therapists have a “decision support” dashboard to help them work more flexibly, delivering care and support at the moment (and in the context) in which it matters. Therapists will still have sessions (screen-to-screen) with patients, but in between they will be much more pro active and involved in the progress and activities of the patient. Typically, therapists will spend up to 2 hours per day on interactions with patients based on their progress, and communications.

Setting up and supporting Online teams:
We help services setup their online team. We require the service to create a dedicated new online. We then provide full support in setting up the service. We also provide the training of the Online team members to develop new skills such as:
  • Using the NiceDay platform
  • How to create a therapeutic relationship through digital communications
  • How to work more flexible, more interaction with patients
  • Get familiar with digital CBT protocols and way of working.
  • regular (monthly) contact moments to provide feedback based on the data, and reinforce the digital way of working.
Key innovation:
NiceDay offers a complete end-to-end approach based on best practices that allows services to easily (within 3 months), safely (without high up front investments), and securely (NiceDay is ISO 27001 certified) setup a new online service for their clients.
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)
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Innovation 'Elevator Pitch':
Big White Wall provides accessible, evidence based online therapy via a secure platform. Sessions are available 7 days a week between 7am and 11pm, providing enhanced accessibility. KPI's are fully reportable and the service is CQC regulated. 
Overview of Innovation:
Big White Wall (BWW) is a digital mental health support service which has been operating since 2007 and has supported 150,000 members in distress.

BWW provides Live Therapy, which is face to face therapy via the secure platform. Our clients, can complete sessions via video, audio only or text only. We provide NICE guided, evidence based interventions for common mental health disorders, such as OCD, Social Phobias, PTSD, Panic, Depression, GAD, Health Anxiety and Specific Phobias.

Many of our existing commissioners are IAPT services and we are fully IAPT compliant in our delivery including the sessional collection and reporting of the minimum dataset (MDS). Performance data can be submitted by the referrer themselves, either by collecting and inputting data from our platform or through the IAPTus PRISM integration, which feeds session data (clinical notes, attendance data and MDS) directly into the referring IAPT service's own IAPTus system. Or BWW can also submit data through the BWW IAPTus system which allows us to report data directly via an N3 connection, into NHS Digital under the appropriate service code.

We provide both NICE guided evidence based CBT and Counselling interventions and all of our Counsellors are additionally trained in Counselling for Depression. We also have a team of Long Term Conditions specialists (IAPT LTC Top Up trained) who can provide specialised interventions for those experiencing physical health issues. All of our therapists are professionally accredited and are experienced with at least 2 years post-accreditation.

We are CQC registered for our Live Therapy provision and remain the only digital service to have received this registered status. Our governance systems are therefore acknowledged to be safe and robust. We are included in the NHS Apps Library, requiring stringent assurance that we meet national standards, regulations and industry best practice.
 
Live Therapy at BWW is available between the hours of 7am and 11pm, seven days a week. We are able to meet an accessibility standard that many IAPT services are unable to achieve.

We are able to scale up or scale down provision according to demand and our waiting times to assessment / first therapy session are often measured in days rather than weeks or months. We are able to implement new contracts at pace. 

We also provide clinically moderated peer support on the platform 24/7, which can augment patient self-management and provide intersession and pre . post treatment support.

 
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 / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
The benefits to the NHS of using BWW to deliver services include;

a) Eliminating unwarranted variations in health indicators and the outcomes of care - through the utilisation of national standardised measures and KPIs.

b) Improving and increasing equitable access as outlined in the Five Year Forward View for Mental Health, by providing digital interventions, not reliant on geographical location, not limited by affordability or complexity of transport. Available nationally online to all, removing socio economic barriers, with hours of service availability outside the scope of normal IAPT service provision. Clients can access high quality support from the comfort and safety of their homes.  

c) Giving the best possible experience for patients and carers by providing a high level of customer support and service satisfaction. Measured by standardised Patient Experience Questionnaires (PEQs) and survey data.  

d) More cost-effectively integrating care and resources around the needs of patients and populations though specialist LTC interventions.

e) Reducing healthcare utilisation costs (survey data reveals usage of BWW (peer support network) reduces GP / acute service usage across populations).

f) Reducing social isolation, stigma and associated costs in decreased in wellbeing, and increases in physical health decline and frailty

g) Population based access to BWW, provides early and easy access to mental health support, which aids the prevention and early identification of MH issues.

h) Use of BWW to provide services improves patient choice. Members can choose to remain within the sphere of clinically moderated peer support and self-manage using resources and self-directed courses or can engage with Live Therapy and can select a modality and mode of treatment.


i) Provides an embedded, scalable, evidence based solution which is cost effective, high quality and safe.

 
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Benefits to the WM population as outlined for the NHS
Current and planned activity: 
BWW provides services for several CCG's, Local Authorities and NHS Trusts, augmenting IAPT service provision. BWW has recntly completed a successful single point of access pilot for a London CCG, which allowed for population based self-referral into BWW Live Therapy. BWW submitted monthly data to NHS Digital and reported monthly recovery rates as high as 68% against a nationally set target of 50%. 

BWW is contracted by the MOD and the Home Office to provide Support Network peer support services and is currently commissioned by over 70 UK Universities. BWW is also comissioned by governement in Canada (Ontario Telemedicine Network) and New Zealand to provide Support Network access. OTN video linked here; https://youtu.be/OLG_OMHU4-s

BWW continues to grow and use technology for good and is currently undergoing a refresh of the platform - which  will enable an enhanced user expereince as well as improve the capability to innovate, scale and incorporate new technologies which augment care. 
 
What is the intellectual property status of your innovation?:
Intellectual Property is owned by BWW.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Ieso Digital Health delivers NICE recommended cognitive behavioural therapy (CBT) one-to-one between patients and IAPT trained therapists via online (live) typed conversation. Appointments are available when suit patients on any web enabled device.
Overview of Innovation:
Ieso Digital Health (“Ieso”) provides NICE recommended cognitive behavioural therapy (CBT) through our proprietary 'ThinkWell' web-based platform. Both Step 2 and Step 3 therapy is delivered one-to-one between a patient and an IAPT-trained PWP or a BABCP-accredited high intensity therapist online through typed conversation, supported by offline messaging in-between sessions; treating all IAPT-applicable conditions:
  • depression
  • generalised anxiety disorder
  • social anxiety disorder
  • panic disorder
  • agoraphobia obsessive-compulsive disorder (OCD)
  • specific phobias (such as heights or small animals)
  • PTSD
  • health anxiety (hypochondriasis)
  • body dysmorphic disorder
Ieso’s fully-managed service has been developed in association with, and operating within, the NHS IAPT services since 2011. We have steadily built up our customer base and are now commissioned in over 65 CCG areas across England, either working directly with the CCGs or as sub-contractors to NHS Trusts and independent healthcare providers. To date Ieso have treated in excess of 43,000 patients and conducted over 210,000 hours of therapy within the IAPT programme.

Ieso summary information sheet is attached for review.
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 / Digital health / Innovation and adoption
Benefit to NHS:
With growing demand for psychological therapies, traditional services can struggle to maintain NHS service standards relating to access, waiting times and recovery. As a result, services from around the NHS need to consider how to extend their care to patients without increasing their costs; including delivering digital interventions for appropriate cohort of patients. Although our service utilises the same human resources for the therapy itself, we have no additional overheads with regards to room hire, travel costs or other traditional overheads seen within the NHS.

Ieso's financial model is focused around patient treatment with no limit on session numbers. Pricing is based upon per episode of care, meaning a certain number of patients will be treated as part of allocated budget rather than assumed therapist capacity. 
 
Analysis of that data (Jan-Dec 2017) shows that Ieso delivers:
  • 22% better outcomes than the national average
  • 48% more patients’ complete treatment than the national average
  • 96.5% accessing treatment within 6 weeks, compared to 93.7% nationally, but with no waits for subsequent appointments.
In addition, Ieso’s “patient experience questionnaire” data shows that 82% of patients rate Ieso as good or excellent, and 66% of patients’ treatment is conducted outside of normal office hours.
 
The benefits of our innovation are not limited to quick and flexible access to treatment and better outcomes for patients. Our unique position of having access to extensive patient data can be used in clinical research to develop improvements in mental health care:
• Catarino, A. et al. (2018) Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety. BJPsych Open (attached.
• Ewbank, M. et al (2019) Quantifying the Association Between Psychotherapy Content and Clinical Outcomes Using Deep Learning (attached)
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Patients are able to access clinically validated, NICE-approved, one-to-one typed CBT with an IAPT-trained PWP or BABCP-accredited high intensity therapist from the comfort of their own home using nothing more than their smartphone, tablet or computer to access our ThinkWell platform via a reliable internet connection.

With appointments available 24/7, traditional CBT can be conducted at a time and place that suits the patient. This means that those who are time poor, struggle to access traditional services due to geography, physical difficulties or personal boundaties are able to access the treatment that's right for them.

Approximately 66% of Ieso’s therapy sessions happen outside the traditional Monday-Friday 9-5 window,
with the majority taking place on week day evenings; in addition, Ieso’s “patient experience questionnaire” data shows that 82% of patients rate Ieso as 'good' or 'excellent'.

You can view an Ieso explainer video here:
https://www.youtube.com/watch?v=H5cID-JGSXU

As well as a 'people' video showing some of the people behind Ieso Digital Health here:
https://www.youtube.com/watch?v=ryIFZNBVkhk

We have also attached a patient case study.
Current and planned activity: 
Ieso manages IAPT contracts with large footprints, such as in Surrey, where we treat approximately 20% of the total number of patients accessing IAPT across the five CCGs within the AQP contract. In addition to Surrey, Ieso holds 26 IAPT contracts delivering a Primary Care Psychological Therapies Services. These contract areas are listed below;
•        Bolton
•        Bromley
•        Camden
•        Cambridgeshire and Peterborough
•        Derbyshire
•        Devon
•        Dorset
•        Dudley
•        East Riding of Yorkshire
•        Gloucestershire
•        Buckinghamshire
•        Herefordshire
•        Islington
•        Lancashire
•        Leeds
•        Medway
•        Merton
•        Norfolk
•        Nottinghamshire
•        Salford
•        Southampton
•        Southwark
•        Suffolk
•        Sussex
•        Wandsworth
•        West Kent

We continue to expand enabling more and more people to access clinically-validated CBT at a time and place that suits them.
What is the intellectual property status of your innovation?:
All IP is owned by Ieso Digital Health.

Ieso is ISO9001 and ISO27001 compliant and our IG Toolkit for 2017-18 (v14.1) had an overall score of
95%.

Ieso is fully operable with all major patient management systems (IAPTus, PCMIS).
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
TPT is a new delivery platform for CBT offering easily accessible pre-recorded therapy sessions using a customised interactive phone system. Patients call TPT free - anytime, anywhere. Healthcare providers reduce treatment costs & cut waiting lists
Overview of Innovation:
TPT is a personalised, guided self-help psychological therapy delivered over the telephone in a range of pre-recorded modules for the treatment of mild to moderate anxiety-based mental health problems. It uses modern telephone technology to achieve vastly reduced costs with no waiting lists and is designed for use in NHS primary or secondary care settings.

Easy to prescribe, easy to use
TPT is available 'on prescription' to patients from their GP or other healthcare provider. The therapy can then be regularly accessed by the service-user making a simple free telephone call. An interactive, intelligent computer controlled telephone system using voice recordings of therapeutic scripts and questionnaires will then guide the service-user through a psycho-education, treatment and recovery programme that is responsive to the patient's individual presentation and circumstances. Patients will typically complete the programme in 8 to 12 weeks.
Instant access
Psycho-education, guidance and structured self-help for managing their condition are available to service-users wherever they are and at all times of the day and night. This immediacy of access is of particular benefit to patients with conditions that require help managing situational responses to emotional and environmental triggers or developing and maintaining impulse control strategies.
 
Choice of treatment modules for different presentations
A range of TPT modules is available for the treatment of different mild to moderate anxiety-based mental health problems such as generalised anxiety disorder, OCD and agoraphobia. Although each module is written with the specific presentation in mind there is a broad commonality of structure. A typical TPT module will have some of the following elements delivered by spoken scripts and using targeted questionnaires:
  • Introduction to anxiety and its effects
  • Description of the symptoms and causes
  • Psycho educational quizzes and self assessment measures
  • A range of anxiety management strategies
  • Instant-access session for managing acute symptoms
  • Cognitive techniques for overcoming negative thinking
  • Text messages which are sent to service-users to give feedback, reinforcement and reminders
  • Tailored sessions to inform and support friends and family
For a quick introduction to TPT, its operation and its benefits visit our 3 minute video at: https://vimeo.com/145905041
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 / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Lower costs
  • TPT costs are 80% less than the cost of a course of therapy by a psychological wellbeing practitioner
  • No need for staff training or regular patient supervision by a therapist
  • No extra capital investment
  • Secondary prevention reduces need for further treatment
  • Reduction in demand for consultations by 'revolving door' patients
Instant access
  • Presenting service-users can leave the consulting room with a prescription giving immediate access to a suitable treatment offered in the 'language of their thoughts'.
  • Ease of use – familiar telephone dial in system for patients to access the session they require.
  • Help is available 24/7 whenever the patient needs support
Cuts waiting lists
  • High-level IAPT and secondary care services are freed up for more seriously ill service-users
Reduced dependency
  • Opportunity to reduce risk and cost of service-user dependency on prescription drugs
Reduced benefits bill
  • Patients can get back to work without deteriorating on a waiting list for other treatments
Fully translatable for the BAME community:
  • TPT modules can be translated once and used by many, reducing the cost for conventional translators
Meeting the Government agenda
In the face of growing numbers of people with common mental health problems and in an environment of increasing costs and reduced budgets the Government is directing commissioners to look for new ways of improving accessibility to treatment. TPT falls in line with many of these objectives, such as:
  • Cost reductions in the NHS
  • Increased patient choice
  • Flexible delivery of services
  • Access by minority groups
  • Use of new technology
  • Innovation programmes
Quality Assurance
The Cognitive Behavioural Therapy delivered by TPT is well researched, evidence-based, and commonly practiced in the NHS. The therapy scripts have been peer reviewed. The technology of the delivery platform has been exhaustively tested to ensure reliable operation in the face of intensive and unpredictable use.

Performance metrics
Standard reports showing patient outcome and experience measures are available from the database which manages TPT. Healthcare providers can monitor their consumption of TPT licences. Cornard Healthcare is happy to work with clients on their reporting requirements in the light of user experience.
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
Prevention of Mental Health Problems
We believe that TPT can address the needs identified under the ‘Prevention of Mental Health Problems’ campaign. It is a simple, easy-to-use delivery platform which gives patients with mild to moderate mental health problems instant access to CBT and gives healthcare providers a cost-effective and flexible treatment option.
TPT is designed to teach people coping strategies for mild to moderate mental health problems. This, in turn, will improve the lives of the friends and family who are supporting them.
Using TPT in a primary care setting such as the Sandwell Model will reduce the burden on GPs and, by improving access to cost-effective treatment, will improve the mental health of the population. With only a few mouse-clicks during a consultation, GPs and other healthcare professionals log in online, prescribe a unit of TPT and print a simple two-page user-guide for the patient to take away.
The modular nature of TPT means it can be tailored to the needs of the population across the West Midlands, thus reducing the number of people directly and indirectly affected by mental health problems. Cornard Healthcare can work with healthcare providers and with commissioners to develop modules to best address the specific needs of the region.
The confidentiality of the TPT delivery platform for CBT and its ready translatability make it specially well suited to the diverse multi-ethnic and multi-cultural population groups in the West Midlands where language barriers and the stigma associated with mental health problems can prevent  patients from accessing the services they need.
Patient data protection
There is no personal data stored within the system as all patients are only referenced via their unique ID number.
Delivery Costs
The cost to the prescribing healthcare organisation is in two parts:
  • The prescribing licence for the organisation
  • A service-user licence for each 12 week course of treatment. These are pre-purchased in blocks by healthcare organisations.
Cornard Healthcare is happy to discuss favourable terms for early-adoption sites.
Patient Cost - None
TPT is free at the point of use. There is no cost to the patient as this covered by the service-user licence, so those on low income or benefits do not need to use valuable mobile credit or incur large telephone bills.
Current and planned activity: 
Cornard Healthcare is currently working with MIND in Suffolk who are using the TPT system to help their clients. The pilot study has already shown the system to be easily accepted and used by patients, popular with clinicians and reliable in use.

Required activity:
  • Procurement / Adoption of TPT across the West Midlands Trusts within both primary and secondary care settings
  • Feedback from clinicians and patients on how to develop the service to best suit the needs of patients and providers


 
What is the intellectual property status of your innovation?:
IP held and owned by Cornard Healthcare Limited.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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