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 (Education, training and future workforce)

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 1st 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 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 - supported by a personal coach.

Key features:
  • 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 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 offered by the Modality Vanguard and is ready for wider adoption.



Evidence & Research
https://www.changinghealth.com/evidence.html
 
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.
Online Discussion Rating
5.00 (1 ratings)
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
Public Health England estimate that there are 433,000 people with Type 2 diabetes in the West Midlands.

At current levels of attendance for education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today there is little, if any, coaching support to empower people to achieve the changes in behavious which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands region.

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, including 5 South Asian Languages (2 Bengali dialects, Punjabi, Gujarati and Urdu) and Polish. These will be phased in during the 4th quarter of 2017.

Changing Health is currently being used in Birmingham in conjunction with the Modality Vangaurd, working with the Connected Care Partnership https://modalitypartnership.nhs.uk
 
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
Regional Scalability:
Our ability to scale has been recently & satisfactorily tested by Public Health England. The digital elements of our service are designed for scale. We have capacity to provide personalised coaching services for up to 500,000 people.
 
Public Health England estimates 433,000 people with Type 2 diabetes in the West Midlands. At current levels of attendance of education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today, there is little if any coaching support to empower people to achieve the changes in behaviour which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands. 
 
Together with Diabetes UK & the South Asian Health Foundation we are currently translating our modules into 5 South Asian Languages: 2 Bengali dialects, Punjabi, Gujarati & Urdu as well as Polish. These will be phased in during 4th quarter 2017
Measures:
Changing Health would report process and output measures:
  • Referrals received
  • Patients enrolling
  • Patients completing
  • Complaints received/resolved
  • Patients empowerment scores
  • Patient experience questionnaires
For people with Type 2 Diabetes would like clinicians to gather and report:
Weight and Hba1c at referral, after 6 months and 12 months.
 
The X-PERT reporting processes include other metrics including cholesterol and blood pressure. We’d welcome this being reported too.
 
The metrics for the Diabetes Prevention Programme are being developed by Public Health England. A substantial data set is already in place for the face to face programme. The digital dataset is yet to be determined. 
Adoption target:
433,000 people with Type 2 in WM. NICE/NHSE/DUK all advocate education and support with parliament stating that CCGs should plan for radical expansion and improved access.  The unmet need is substantial. As a digital and telephone service we can operate at scale. Capacity is likely to be set by the funding available.
 
Min level is 250 people per CCG
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John Grumitt 03/05/2017 - 11:39 Sign Posted 8 comments
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 - 16:14 Publish Login or Register to post comments
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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 New Medicines Service (NMS) and Medicines Use Review (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 - 14:44 Detailed Submission Login or Register to post comments
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