Identification, prevention and management of diabetes
A waterfall starts with one drop of rain, help us to make a waterfall by sharing the differences that you have made, which could be spread across the region, to improve the lives of people with diabetes - either through identification, prevention or the management of the condition.

Ideas (Publish, Detailed Submission)

Innovation 'Elevator Pitch':
Changing Health address signficant barriers to access by providing X-PERT diabetes education on line together with personalised evidence based telephone coaching to enable sustained behaviour change leading to improved clinical outcomes.
Overview of Innovation:

Changing Health offers the first evidence based digital education and personalised support programme for people living with Type 2 diabetes. Our digital diabetes prevention programme is currently under evaluation by Public Health England to be launched in September.

Our high quality service is based on the evidence gathered from research led by Prof. Michael Trenell’s team at Newcastle University and the Newcastle Hospitals NHS Foundation Trust, conducted over 8 years and funded largely by the NIHR and MRC. This background has been licenced to Changing Health and combined with other state of the art structured education.

The service has been reviewed by NHS England Right Care, Public Health England, as well as other national stakeholders. Furthermore, it has undergone cluster based control trial, reviewed by NHS England and NICE, and submitted to be included in the first wave of approvals for mobile digital services.  Exclusive instant online access to X-PERT, the only Type 2 diabetes education programme proven to have clinically meaningful impact on weight and glycaemic control, together with ongoing learning via a referenced knowledge base. Re-designed for delivery through mobile and web apps, content is delivered in a variety of formats - including cartoon animations, interactive exercises and article text - and supported by a personal coach.

Key features incorporated:
- Evidence based behaviour change tools, including: the ability to create goals, make
specific plans and self-monitor by tracking physical activity directly from the phone,
record food intake, weight and other important data.
- Communication with a personally assigned coach trained in evidence based
behaviour change techniques, with the ability to book coaching sessions over the
phone.
- Online education modules in behaviour change for healthcare professionals,
accredited by the Royal College of Physicians, equipping them with evidence based
tools to help their patients better self manage. These modules are designed to be used
alongside the aforementioned patient-facing tools, enabling HCPs to hold informed
dialogue.
Recognising the important cultural and linguistic diversity Changing Health has collaborated with the South Asian Health Foundation and Diabetes UK to make services available in English, Punjabi, Gujarati (Bengali / Urdu dialects) and Polish languages.

The service is being offered by the Modality Vanguard and is ready for wider adoption.

http://www.changinghealth.com
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 / Education, training and future workforce / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Type 2 diabetes is characterised by progressive weight gain, driving the worsening of glycemic control. Changing Health directly targets this by providing evidence based weight management services through a digital platform. Excess weight is the greatest factor influencing the development of Type 2 diabetes, with over 80% of people overweight or obese. In the first five years post-diagnosis, a person with type 2 diabetes has a twofold increase in their risk of a stroke. They also have an ongoing risk of CVD twice that of a person without diabetes - and CVD is responsible for 52% of deaths in people with Type 2.
Changing Health’s service creates value for money by:
- Delivering better health outcomes: Audit results demonstrate that X-PERT provides a sustained reduction in HbA1c (-6mmol.mol) and weight (-4.4kg).
- Reducing spend: Over the first 6 months, X-PERT has been shown to generate an 8.3% reduction in prescribing costs equating to average savings in prescribing costs at £131,052 per 1,000 people attending, per year.
- Improving care quality: Reducing variation in care through a standardised and proven approach, coupled with personalised coaching.
- Opening access: Reducing barriers to access by making our services available anytime, anywhere, in English as well as the five most prevalent foreign languages.
- Engaging patients in self-care: Providing patients with the education and tools to self manage their diabetes.
- Supporting commissioning: Tracking outcomes easily and efficiently.
- Providing the opportunity for effective investment of resources.
- Supporting care teams: Providing evidence based online education modules, and freeing up healthcare professional time - such as enabling DSNs currently providing education to provide care and support to colleagues as well as patients.
- Helping people early with their diabetes: The younger someone is diagnosed with diabetes, the greater their lifetime cost of their condition. This younger group are also more likely to access digital tools, creating an optimal method of engagement.
 
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
Changing Health addresses signficant barriers to access of supported self management for patients with Type 2 diabetes, making information and evidenced based support available anytime and anywhere and in 6 languages.
Current and planned activity: 
Changing Health's innovative service is currently deployed in 7 georgraphies including West and East London, Birmingham and Manchester.

Our prevention service is currently being evaluated by Public Health England and is expected to be deployed in September 2017.
What is the intellectual property status of your innovation?:
The intellectual property of our behaviour change techniqes has been licenced exclusively to Changing Health by the NIHR and MRC.

X-PERT Health has exclusively licenced its programme to Changing Health to be made available in a digital format accessbile via a mobile, tablet or computer.  
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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John Grumitt 03/05/2017 - 09:39 Publish 3 comments
5
1
Votes
-99999
Innovation 'Elevator Pitch':
Solesee is a foot inspection mirror designed for people with diabetes to help them see the whole of the bottom of their feet to check for cuts, grazes, dry skin & blisters. Solesee makes this much easier to achieve and encourages daily use.
Overview of Innovation:
The Solesee Foot Inspection Mirror has been specifically designed for people with diabetes to help them to see the whole of the bottom of their feet. With diabetes, people should be checking their feet every day for cuts, grazes, dry skin, blisters, changes to the colour and general condition, etc. Due to nerve and blood capillary damage caused by diabetes, people with the disease can develop peripheral neuropathy that reduces or removes any sensation or feeling in the feet.

If any break in the skin is not quickly noticed and treated, then it could become ulcerated. Ulcers are slow to heal and can quickly become infected. If this happens then the possibility of amputation is increased as the only means to treat the condition. In England alone there are over 140 diabetes relates lower limb amputations a week. Each ulcer can cost the NHS about £5,000 to treat. An amputation can cost £15,000 with the resulting rehabilitation of the patients costing a further £18,000.[Source: Diabetes UK].

Having a product like Solesee makes checking feet much easier to achieve and encourages daily use thereby helping to prevent problems occuring in the first place.  Solesee was developed, using input from both podiatrists and diabetes patients, as a result of hearing about the lack of anything simple and easy to use to check the soles of your feet every day. The key elements to Solesee are:
  • A large shatterproof mirror;
  • The mirror is set at the perfect angle to allow users to see the whole of the sole of their foot when in a seated position;
  • It folds into an iPad sized folder for easy carrying and storage
  • ​It has been designed and manufactured in the UK
  • It is design protected
A big part of what Solesee aims to do is educate people about making foot checks as regular a part of the morning and evening routine as cleaning your teeth. Part of this is consumer education through general awareness building, but it is also through getting the professional clinicians involved as they are the people who probably have most influence over the patients that they are seeing.

The National Diabetes Foot Co-ordinator for Scotland sees a clear role for clinicians to use Solesee in their clinics to not only show the patients what the soles of their feet look like (before, during & after treatment) but also to show them how to use Solesee - to encourage them to go and buy one and use it themselves.Taking ownership of their condition if you will. Wider clinical take-up and patient awareness is our key aim.
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 / Person centred care
Benefit to NHS:
Due to nerve and blood capillary damage caused by diabetes, people with the disease can develop peripheral neuropathy that reduces or removes any sensation or feeling in their feet. As a result they are not able to feel if they have cut or damage to their feet in any way e.g.a stone in a shoe, a blister, a cut, a scold from hot bath water or burn from a radiator or open fire.

If any break in the skin is not quickly noticed and treated, then it could become ulcerated. Ulcers are slow to heal and can quickly become infected. If this happens then the possibility of amputation is increased as the only means to treat the condition.In England alone there are over 140 diabetes relates lower limb amputations a week. Each ulcer can cost the NHS about £5,000 to treat. An amputation can cost £15,000 with the resulting rehabilitation of the patients costing a further £18,000.[Source: Diabetes UK].

There are also other, hidden costs, that could manifest themselves in a wider health issue to the patient. Being incapacitated with a foot ulcer can lead to a lack of exercise, low morale, lack of social interaction (due to being housebound) and potentially a poor diet as a result. There is also the mental strain of not being able to get out and about. This can be multiplied when you consider the impact of having an amputation.

From general research and discussions with people who have diabetes, there appears to be a lack of understand about how diabetes really affects your feet. A number of people we spoke to indicated a degree of knowledge, but said they were 'happy to wait until a problem occurred' before really taking it seriously.  Other people had little idea why they should check their feet or even what to look for on their feet if they did check them.

Using Solesee to increase awareness and education, about how serious this condition is, leads to a greater chance that ulcers will not develop in the first place.  Even if a cut or ulcer did occur, the chances of getting it treated at an early enough stage are greatly increased if people are making ther own regular foot checks, especially if encouraged by professionals. A product like Solesee makes checking feet much easier and encourages daily use thereby helping to prevent problems occuring in the first place. Compare using Solesee to using a toothbrush. 30 years ago cleaning your teeth once a day was probably the norm.  Now people clean their teeth twice a day without thinking - and few people die from getting a cavity!
Initial Review Rating
2.60 (1 ratings)
Benefit to WM population:
The aim is to get every clinician, that deals with foot care related issues and education, using Solesee as part of their normal clinical practice.  Whenever a patient presents for an annual foot check or prior to/during treatment for any foot disorder, the clinician should use Solesee to show them what the sole of their foot looks like.  This can be a 'before' and 'after' treatment scenario, so the patients can see what the clinician has done.  It would also be useful for patients to know what signs of irregularity or infection they should be looking out for, if they need to change their dressings between appointments.

It can also be an means to educate patients what their feet should look and what they should be looking for prior to any issues occurring in the first place.  If there are indications that problems could occur, such as the start of dry skin or calluses, then the clinician can clearly highlight this to the patient with some advice about what they should do. 

In all the above cases the clinician should be able to recommend that the patient starts to make regular checks using a mirror, like Solesee, so they get used to seeing the bottom of their feet and what issues to be aware of and look out for.

In this way the level of education about foot related issues for people with diabetes will be raised.  The potential problems, and what that really means to the patient can be discussed in detail, and the frequency of diabetic foot related problems reduced in and around the clinics where it is practiced.

Birmingham has one of the highest incidences of diabetes in the country (according to a recent BBC Panorama programme) and as such has a lot to gain from better educating the patients about the potential foot related problems.  The cost of giving one Solesee 10,000 clinicians or patients is the equivalent to the cost of 56 individual ulcers being treated.  We would like to think that, out of 10,000 people using Solesee, that we could reduce the incidence of diabetes related ulcers by at least 56 patients!

All the above doesn't take into account the longer term benefits to the region. Reducing the incidence in ulcers will reduce days lost to sickness in industry, as well as the the other 'hidden' costs assocuated with someone who is incapacitated through not being able to walk or work.  This includes mental health related issues.
Current and planned activity: 
I have been speaking to Duncan Stang (the National Diabetes Foot Co-ordinator for Scotland) who sees a clear role for clinicians to use Solesee in their clinics to not only show the patients what the soles of their feet look like (before, during and after treatment) but also to show them how to use Solesee - to encourage them to go and buy one and use it themselves.  Taking ownership of their condition if you will.  I am in contact with Dr Jane McAdam (Head of prosthetics and podiatry at Salford University) and I am also trying to speak to Dr Paul Chadwick from Salford Royal Hospital NHS Fundation.

However I need to try and get a better access to the wider NHS and the clinicians who deal with diabetes patients on a regular basis e.g. GP's diabetes nurses, etc as well as the NHS podiatrists.  Getting professionals to use and recommend Solesee will help increase the awareness of the foot issues related to diabetes and hopefully increase the daily foot checks of patients. 
What is the intellectual property status of your innovation?:
Solesee is design protected and the brand name is a registered trade mark.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Regional Scalability:
Scalability is simple as it is a self contained product.  Our only challenge would be to fund product production should there be a very large upswing in demand.  However this could be managed if we have POs from recognised organisations or bodies such as the NHS.
Measures:
The aim is to see a reduction in the number (percentage) of people that present themselves with a reoccurrance of a diabetic foot ulcer.  By taking a more proactive approach to daily footcare the chances of an ulcer reoccurring are significantly reduced.

To measure this, we would need a clinic to a group of patients who have previously had a diabetic foot ulcer that has been successfully treated.  They would then be split into two groups - those who are given a Solesee and shown how to use it and those that are told to check their feet but not given a Solesee to use.  The condition of their feet would be checked at the usual regular intervals over the course of a 6 month period to assess the condition of their feet.  The expected result is that group using the Solesee would see a lower reoccurance rate compared to those that were not given a Solesee to use.

We would also assess usability and product quality issues looking at both groups using more qualitative techniques.  We would want to assess how people found using Solesee on a daily basis and also what the people, who were not given a Solesee to use, did instead.

Using the approximate costs to treat an ulcer that have already been stated (to treat a foot ulcer on the NHS is about £5,000) we would look at developing a commercial case for that clinic based on the number of patients that have a diabetic foot condition, using the data produced from the trial.  This should give a firm commercial argument for investing in Solesee mirrors and prescribing them to pateints with diabetes and at a high risk of developing a foot ulcer.
Adoption target:
This is difficult to gauge as the number of people with diabetic foot conditions will vary from clinic to clinic.  To be able to price Solesee at a level that the NHS would feel is suitable, then there would need to be economies of scale as far as production is concerned.  This would mean a minimum order of about 1,000 units.
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David Smyth 26/10/2016 - 16:40 Detailed Submission 1 comment
5
1
Votes
-99999
Innovation 'Elevator Pitch':
The Sound Doctor has over 250 high quality short educational films. Evaluations show they work by changing behaviours and improving outcomes to help people get the best out of life with long term conditions. 
Overview of Innovation:
The Sound Doctor is the leading provider of film and audio content for patients in the UK. Our content is thought to be unmatched in quality, range and production values and evaluations show it works by changing behaviours.and improving outcomes to help people get the best out of life with long term conditions.
 
Our films are endorsed by leading charities and adhere to NICE guidelines.
Conditions covered are COPD, Diabetes, back pain, dementia and weight management surgery.  A large series on heart conditions including cholesterol and hypertension, will be made shortly. 
There are over 250 films in our library so far and it is constantly growing.
We also create animations. We have a range of health and wellness short animations which are now being used in pharmacies and GP surgeries around the country. 
In addition, the team also devised and produce Health Today, a national radio programme for NHS England – nhs.uk/healthtodayradio
 
We have evidence that patients with diabetes, for example, have changed their attitudes towards diet and exercise as a result of watching our films. People with COPD are more confident about dealing with exacerbations at home. We also know that across all conditions they are considered a valuable part of people’s health care and improve patient experience.
 
The aims of The Sound Doctor, and there is evidence of this as well, are:
 
1. To reduce the number of avoidable admissions (and readmissions) to hospital
2. To reduce the need for face to face contact with consultants, physicians, nurses, physiotherapists and others (and to improve the quality of meetings which do take place)
3. To address the issue of co-morbidities by creating a multi-condition library
4. To improve medicines management and compliance with medications
5. To improve the quality of care for patients (and patient experience of their care)
6. To help people get the most out of life through effective self-management
   
About us:
The Sound Doctor was founded by Dominic Arkwright and Rosie Runciman and is a registered social enterprise.
Dominic worked as a reporter at the BBC for more than 20 years, mostly on Radio 4 's Today Programme as well as Newsnight and PM. He also presented discussion programme 'Off the Page' and 'The Call' on Radio 4.
Rosie Runciman also worked at the BBC for more than 20 years on Radio 4's Today programme, Newsnight, Radio 5 Live and at The World Service. She was Editor of Newshour and Assistant Editor at Five Live.
 
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 / Education, training and future workforce / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
  • For clinicians  
    • Complements and supports sessions
    • Sessions more focused and efficient to achieve better health outcomes
    • Reduces appointments, admissions and DNAs
  • For providers  
    • More efficient caseloads, better outcomes for patients, reduced waiting lists
    • Money saved through reduced numbers of GP appointments, hospital admissions and DNAs
Return On Investment (GPs)
Cost of TSD per patient per annum = £5.00
 
Average number of GP visits pre TSD = 3.7 appointments Average number of GP visits post TSD = 0.42 appointments
 
3 fewer appointments per TSD user x payment for each appointment of
£23.50 (NHS tariffs) = £70.50 per patient; an ROI of 1:14
 
Average number of GP DNAs pre TSD = 2.5 appointments Average number of GP DNAs post TSD = 0.5 appointments
 
2 fewer DNAs per TSD user x cost of each DNA of £36 (Kings Fund) = £72 per patient; an ROI of 1:14
Initial Review Rating
3.80 (1 ratings)
Benefit to WM population:
  • Empowers and encourages people’s engagement with their condition
  
  • Improves medicines adherence
  
  • Improves overall quality of care
  
  • Improves people’s experience of and satisafaction with their care
Current and planned activity: 
Who’s using The Sound Doctor
•  CCGs 
  • Barnsley, Gloucestershire, West Leicester, Wirral, Newcastle, Central London Community Health Trust
  
  • Hospital Trusts  
    • Guy’s and Tommy’s NHS Trust
    • Liverpool Heart and Chest Hospital
  
  • Other  
    • Philips Healthcare
    • All South London pharmacies
    • Jhoots Pharmacies
    • NAPC Practice Innovation Network
What is the intellectual property status of your innovation?:
We own the IP on all our content
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Dominic Arkwright 26/09/2016 - 14:14 Publish Login or Register to post comments
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1
Votes
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Innovation 'Elevator Pitch':
This project aims to improve patient knowledge and confidence in the correct use of injectable therapies via pharmacy intervention with NMS and MUR. 
Overview of Innovation:
It is intended that this work will develop:
  • A framework for both the NMS and MUR consultation for community pharmacists on injectable therapies in diabetes. To include safe administration, safety, including appropriate quantities of insulin adn adherence. 
  • Pharma outcomes will be used to support framework and implementation of project. This will also enable commissioners to understand the quality of the interactions from pharmacy. 
  • Develop an education framework for pharmacists to deliver injectable therapy NMS and MUR.
  • Upskill community pharmacists around the pilot site to deliver patient support for injectable therapies via NMS and MUR.
  • Process map current and future state for MUR service.
  • Measure outcomes to show the value of interventions.
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Patient and medicines safety / Person centred care
Benefit to NHS:
  • Reduce medicines wastage.
  • Reduce hospital admissions due to adverse events from medicines.
  • Lead to increased Yellow Card reporting of adverse reactions to medicines by pharmacists and patients, thereby supporting improved pharmacovigilance.
  • Pharmacist's intervention receives positive assessment from patients.
  • Improve the evidence base on the effectiveness of the service.
  • Support the development of outcome and/or quality measures for community pharmacy.
This project will develop resources which in turn can be used to replicate this work - to include the following:
  • Consultation framework to be adopted for NMS and MUR in Pharma Outcomes.
  • Integration of pharmacist care in line with the 5 Year Forward View.
  • Improvement of pharmacist skills around injectable therapies through NMS and MUR. 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Patient benefits will be those expected from the NMS and MUR service, which are:
  1. Improve patient adherence which will generally lead to better health outcomes
  2. Increase patient engagement with their condition and medicines, supporting patients in making decisions about their treatment and self-management.
  3. Improve patients' understanding of their medicines
  4. Highlight problematic side effects and propose solutions where appropriate
  5. Improve adherence
  6. Reduce medicines stock piling adn safety but encouraging patients only to order the medicines they require
Current and planned activity: 
A Joint Working Agreement is being established between the West Midlands AHSN, Sat Kotecha, Chair of Local Professional Network, NHS England, Mark Galloway, Head of Medicines Management, Coventry and Rugby CCG, Novo Nordisk, Eli Lilly and Sanofi. 

This project will focus on the community pharmacists surrounding specific surgeries within Coventry and Rugby CCG and is to prove the solution before wider scale adoption.  It interfaces with a number of other pieces of work:-
  1. Coventry and Rugby Programme Board for service improvement in diabetes.
  2. Reducing variability and improving diabetes care project with UHCW and specialist input into improving the care in 8 practices in Coventry.
  3. Coventry diabetes community service is looking at compliance with diabetes medications.
  4. There is closer working between Coventry and Rugby CCG and North Warwickshire CCG. 
What is the intellectual property status of your innovation?:
Support from MidTECH in identifying the potential for IP to fall out of this piece of work would be appreciated. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
3
Co-Authors:
Regional Scalability:
This is the proof of solution and will provide the framework for how this could be scaled across the region. Having the LPN Chair leading on this piece of work alongside the CCG Head of Medicines Management means that wider adoption is a key predictor of success for this programme. 
Measures:
Measures are currently being developed with the core team in further detail. However the high level outcomes and measurements currently identified are: 
Outcomes
Patient confidence for use of injectable therapies
Community pharmacist confidence in delivery of NMS and MUR on injectable therapies.
Delivery of NMS and MUR on injectable therapy

Measurements
Community pharmacists engaged with the project to measure via PROM – to be developed as part of the project.
Measure pre and post education and at 3 months post.
Measure baseline of chosen pharmacist and end point of NMS+ and MUR+.
Adoption target:
Fully implemented across Coventry and Rugby CCG
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Lucy Chatwin 05/09/2016 - 12:44 Detailed Submission Login or Register to post comments
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0
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Innovation 'Elevator Pitch':
The FREMS Solution is an effective means of combating neuropathic pain in diabetics with clinical trials showing the benefit persists at the 4 month follow up.  For chronic ulcers FREMS restores perilesional perfusion and rapidly reduces pain.
Overview of Innovation:
FREMS is the result of research dedicated to realise a non pharmacologic system able to treat vascular and neurological diseases such as diabetic neuropathy.
 
FREMS is a new-generation biocompatible electrical neurostimulation.  The healing effects of FREMS occur through a direct and indirect action on the biological control systems and especially in the autonomic system.
 
FREMS works thanks to a series of two-phase, asymmetrical and electrically balanced electrical pulses: a “simultaneous modulation’ of pulse Frequency, Amplitude and Duration.  FREMS is an innovative, proven and easy-to-apply treatment method against pain.
 
FREMS is delivered via Aptiva and Satellite medical devices with dedicated transcutaneous electrodes for clean and simple application without side effects.  The treatment involves a series of 30 minute daily sessions over a few weeks that can be performed both at hospital or at home.
 
As demonstrated by studies performed in recent years, FREMS delivers pulse sequences that can significantly increase the release of plasmatic growth factors.  The analysis of systemic blood samples in diabetics and non-diabetics, taken before, during and after FREMS neurostimulation, has shown increases in the levels of VEGF and other angiogenetic growth factors.
 
For painful chronic leg ulcers FREMS significantly promotes epithelisation and decreases pain levels after as little as 36-48h with no side-effects.  It has long-lasting effects which can be seen 2 months after the end of treatment and significant accelerates healing times.
 
For various etiologies of chronic leg ulcers FREMS can be a valid method of healing chronic cutaneous ulcers with significant reductions in area and depth a few weeks after commencing FREMS.  The treatment increases the quality of assistance and the quality of life of the patient.
 
For painful Diabetic neuropathies FREMS provides safe and effective treatment for neuropathic pain in diabetics and can modify some functionality parameters of the peripheral nerves such as an increase in tactile sensorial perception and in the speed of conduction of the motor nerve.  The clinical effects persist at the 4 month follow-up.
 
For arteriopathy FREMS has significant effects on diabetics with PAD; increase in oxymetric values at the 3-month follow-up; increase in walking distance free of pain at the 3 month follow up; improvement in the characteristic parameters of the endothelial system.
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
Benefit to NHS:
The most comprehensive analysis to date concludes that the cost of diabetes to the NHS is £9.8bn in direct costs in 2010/11. Around 80% is spent on complications. (Hex et al. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine (2012).  Available at: http://onlinelibrary.wiley.com/doi/10.1111/ j.1464-5491.2012.03698.x/abstract)
 
People with diabetes are more likely to be admitted to hospital than people without the condition. In 2009-10 there were 160,000 more admissions for people with diabetes than would be expected for people of the same age without the condition.
 
They have longer hospital stays and are more often admitted overnight for planned procedures that could be performed as day cases. There were:
  • 570,000 extra bed days for people with diabetes
  • 40,000 more overnight admissions that would be performed as day cases in people without diabetes.
 Annual inpatient care, to treat short and long term complications of diabetes, is estimated at between £1,800 and £2,500 per patient.  This compares with annual outpatient costs, which includes the cost of medications and monitoring supplies, estimated at between £300 and £370 per patient. (http://www.diabetes.co.uk/cost-of-diabetes.html)
 
The following annual costs result from diabetes (http://www.diabetes.co.uk/cost-of-diabetes.html):
  • Cost of absenteeism: £8.4 billion per year
  • Cost of early retirement: £6.9 billion per year
  • Cost of social benefits: £0.152 billion
 People with diabetes are at increased risk of peripheral arterial disease and neuropathy, as well as having a higher risk of developing infections and decreased ability to clear infections. Therefore, people with diabetes are prone to frequent and often severe foot problems and a relatively high risk of infection, gangrene and amputation.
 
In 2010 to 2011 the NHS spent an estimated £639 million to £662 million on diabetic foot care. (https://www.diabetes.org.uk/Documents/Diabetes%20UK%20Cost%20of%20Diabetes%20Report.pdf)
 
Early detection and effective management of diabetic foot ulcers can reduce complications including preventable amputations, improving patient outcomes and reducing cost to the NHS.
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
Diabetes has huge implications for quality of life and life expectancy, with costs to the NHS and to the economy.
 
The West Midlands has a considerable healthcare problem due to diabetes. 8.1% of the West Midlands’ adult population has diabetes, higher than the English average, with the figure predicted to rise. 
 
There are 346,339 registered patients with diabetes out of a reported population of 4.76 million. The prevalence is therefore 7.28%, whilst nationally the England prevalence is high but only 6.37%. Of concern is the fact that the rate of increase in the prevalence of diabetes over the last 3 years was 34.9% higher than in England as a whole. (NHS England (West Midlands)  http://www.wmscnsenate.nhs.uk/files/7914/6169/3440/Diabetes_Service_Specification_Final_April16.pdf)
 
The FREMS Solution is an effective innovation against pain and functional recovery that can increase quality of life for patients and reduce the burden on health services, thus reducing cost to the NHS, and increasing economic productivity.
Current and planned activity: 
BHR is looking for the following with respect to their involvement with WMAHSN:

1.       Creating awareness of the FREMS system both within the west midlands and the wider NHS arena
2.       To help identify interested diabetes centres who can utilise the FREMs for their patients
3.       To provide a platform for application for grant funding for further research into the use of the FREMS Aptiva system  
4.       To support an application of an HTA assessment by NICE
5.       To provide support to BHR in gaining access to the health networks that have an interest in new and novel technologies
 
BHR is hoping to start an evaluation of the FREMS Aptiva at the Endocrinology and Diabetes Centre at the Birmingham Heartlands Hospital subject to committee approval to show the utility of the FREMS Aptiva system.
What is the intellectual property status of your innovation?:
The FREMS IP is covered by worldwide patent.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
3 years +
Ease of scalability: 
3
Regional Scalability:

Please describe how the innovation could be scaled across the WM region. Have you implemented at scale in any other regions?

Measures:

What outcomes are you hoping to achieve and what are the measures that you will use to gauge the success of the innovation and how will these assessments be made? Please ensure that you have quality, safety, cost and people measures.

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Bharat Vadukul 21/07/2016 - 09:15 Detailed Submission Login or Register to post comments
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