The Frailty Passport is intended to be used by health and social care professionals. The passport incorporates advanced care plans, supporting the patient or a new or revised care plan(s), in relation to the social situation, activities of daily living, crisis management plans, ceiling of care, and end of life plans including DNACPR documentation. Therefore, documenting and respecting patient wishes. This has achieved many positive outcomes which are mentioned below:

• By streamlining care and improving communication across the traditional boundaries of primary care, secondary care, ambulance services, social care, housing and care homes it improves the whole experience for both health and social care in later years.
   
• The written information is given to relevant staff in health, social care, carers and care home as guidance about matters that have been discussed in detail with patients (and/or representatives) and their medical records. This improves the quality of life, dignity, choice and autonomy.
   
• As the passport streamlines care it avoids unwarranted hospitalisation, facilitate discharges, readmission and lists patient’s wishes and preferences. It also aims to improve the patients experience across the whole NHS for the rest of their life.
   
• As this written plan is agreed by the MDT it will give enough confidence to health and social care staff to follow patient’s wishes.
   
• The Frailty Passport has been listed as a good practice example by NHS England.

Overall, the Frailty Passport has been effective by clearly communicating the patient’s wishes and putting them at the centre of the care plan. It also gives written information to health and social care staff and provides medico-legal assurance.

Within the deconditioning campaign there are resources such as banners, posters, screen savers, information leaflets, exercise programs, videos and practical demonstrations to raise awareness.

As older people are the core users of the NHS, they benefit most from this campaign.

Dr Arora says “An appropriate level of exercise, activity and mobility in older people is easily do-able with in the usual surroundings. We are not talking about going to gymnasiums here. It is about doing simple activities of daily living, exercises in bed or chair, walking to toilet, sitting out in chair, standing, walking etc...” Some of the information available includes advice on how people could be supported and encouraged to stay active and independent by performing activities of daily living and movement when in hospitals and care homes. For example staff could ensure that:

• Glasses, hearing aids, calendars and clocks are readily available and visible to promote awareness.
• Patients are sat up in chairs, rather than remaining stationary in beds.
• They should be dressed properly in their own clothes rather than in hospital gowns as it can make people feel better and more able.
• Meals are eaten whilst sitting in chairs and not spoon fed in bed unless circumstances dictate so.
• Patients should be encouraged to wash and dress independently, walk to the toilet where possible.
  • Appropriate mobility aids should be provided earlier on if needed.
  • We should ask if the mobility aids are of the right height.
  • We should check if the height of the chair for example is not so low that the patient can’t get up.
  • Patients should be encouraged to keep their arms and legs moving in their beds or chairs especially if they are unable to mobilize themselves.
• Restrictions on visiting hours should be adjusted to encourage normal social interactions, which will also help to maintain functionality, regain independence and reduce loneliness.
• Patients should be supported and encouraged to move as quickly as possible, where possible.

All of this support and encouragement movements could help to:

• Reduce the risk of harm from falls, infection, thrombosis and delirium.
• Reduce length of stay in hospital.
• Reduce the likelihood of having an increase in their future care needs.

In addition there are many benefits of staying active in hospital:

• Better able to fight infections
• Better appetite
• Better sleep
• Better mood
• Better able to cope at home
• Lower risk of pressure sores
• Less weakness and fatigue
• Less dizziness
• Lower risk of falls
• Less pain
• Less confusion

Moreover, this project noted that the biggest change was the individual’s behaviour and organisational culture generated through awareness.
 
The initial intended outcome was to achieve a 25% increase in the number of patients sat out, dressed and engaging in meaningful activity during their acute illness. However, there was an increase in the number of patients sat out, dressed in their own attire and mobilized by 60%. There was also an increase in therapy review and therapy led plan setting within 24 hours of admission. However, these can be fluctuant and dips were commonly noted so it is important to keep the momentum going.

There was also an enhancement in patient experience and in both staff and relative satisfaction...

Overall, the outcome from the ‘National Deconditioning Awareness and Prevention Campaign’ to get patients to “Sit up, Get Dressed, Keep Moving” has had a positive impact on patients and staff.  

Tracey Cole - the Head of CHC in Cheshire has presented at events with the NHS England SIP team with the following messages from utilising our solution.  These will be presented again at the Kings Fund Digital Health and Care conference in July 2018.

• Single point of entry of referrals into the process offers control and transparency over the work load
• Improved quality of assessments received – particularly checklists being digital
• Reduced volume of cases by better and quicker assessment and education of referrers at the checklist stage
• Reduced paper and postage costs
• Reduced admin time for the operations team
• Reduced admin time spent by clinical team – quicker completion of DST’s
• Better allocation of positive checklists to the clinical leads
• Automation of communications across stakeholders reduces delay
• Improved morale in the team – people doing a better job
• Improved delivery of 28-day standard
• Digital checklist supporting discharge to assess to achieve the 15% standard
• Full transparency of patient progress through the CHC system

Cheshire and Wirral CCG’s performance against an 80% target has improved from 66% to 82% during the period of implementing chc2dst.
 

In partnership with Health Navigator and York Teaching Hospital NHS Foundation Trust, the CCG delivered an effective preventative strategy for identified patients that simultaneously provides better care for patients and reduces stress on A&E departments.
 
Using an algorithm, Proactive Health Coaching identifies patients before they become high users of urgent care services it works by supporting patients with weekly coaching calls in a randomised control trial and facilitates:
 

• putting patients at the centre of care
• patients being able to define their own goals so they can take control of their health and care journey, using services other than A&E
• a better experience and outcomes for patients
• commissioners, acute providers and primary care being able to work together
• a reduction of the burden on A&E and inpatient services by reducing unnecessary attendances from some patient cohorts
• a more efficient use of healthcare resources.

 
By supporting patients with weekly coaching calls, the randomised control trial is already showing high levels of improved patient experience, a reduction in attendances at A&E and fewer unplanned admissions to hospital. Patients being supported by the health coaching intervention are also reporting more confidence in the management of their conditions.



Results from an earlier NHS case study collated by York Teaching Hospital NHS Foundation Trust are currently being evaluated and published by the Nuffield Trust, an independent health charity. The patients formally contract with Health Navigator, which at present covers a relatively small patient group of 183 study participants, of which 121 patients have had the support of a health coach. At the time of evaluation, this has yielded savings per patient in the first year of the intervention of £1,034 less than the control group. This means that the service is already close to break-even in its first year, as it costs £1,200 per person for a two-year intervention.
 
Based on results in Sweden, it is anticipated that those receiving the service will have a further benefit in year two, equating to around 40 per cent further savings. This should mean a total saving of £1,448 per person and a net benefit to the commissioner of £248 per person over the two-year intervention.
 
Moreover, there are the associated operational benefits from taking activity out of the system. In particular, the intervention group has had 63 per cent fewer non-elective admissions and 60 per cent fewer A&E attendances. The number of bed days was 17 per cent less than the control group.
 
All of these represent the first year of the intervention only and across a small population group. The CCG recognises that results may change as study numbers increase. It is fully expected that over time, and as a greater number of patients are included within the study, the potential impact is normalised out across the population and the end result may be a slightly lower number, but the trend is clearly a positive one.
 
These early results mirror the significant impact that has been seen in the much larger trial in Sweden where over 12,000 patients have received similar support. Results from the Swedish trial have been published in the European Journal of Emergency Medicine in 2012 and 2015. The most recent results are showing statistical reductions of 30% in non-electives and 36% in A&E attendances.
 
The results also provide evidence of relevance, spread and replicability, with the initiative being easy to replicate nationally, even in financially challenged care economies. It also has the ability to be scaled up to cover a wider range of conditions.

The SCIT app is designed to be simple, straightforward and above all safe, and there are many positive outcomes from its development outlined below:

• The app ensures that when the Medical Illustration team are not available, clinical images can still be taken of patients in a secure manner. It allows clinicians to send images to patient records which can be reviewed by other clinicians via the Clinical Portal

• The SCIT console gives a real-time view of all user activity, provides a control mechanism to authorise new users, monitors activity, and assesses the quantity of images and data flow
  
   
• SCIT has allowed for faster patient diagnoses and consequently quicker treatment plans

• The SCIT app is unique as it only allows images to be taken and sent to the patient record system without them being accessible on any device 
  • This also makes it ideal to be developed into a patient app to avoid patients sending on their own clinically sensitive images through insecure and unsuitable electronic routes which is occurring regularly, especially in dermatology
     
• There is no cloud involved, which means that the image is transmitted directly from the device to a Trust server, therefore making it secure enough for the NHS.

There are many other benefits of adopting the SCIT app:

• The app can be used on clinicians’ own mobile devices or tablets to securely take and sent clinical images
• The app works with iOS, Android and Blackberry
• The app is fast and hassle free
• The app eliminates the risk of sending un-secured images and protection from large fines for non-compliance on clinical information governance issues
• Military level encryption means patients’ images are always secure
• The app streamlines diagnosis, improves efficiency and reduces paperwork
• The app can be used offline in areas where wifi connectivity is poor
• The console monitors all activity and provides robust audit trails every time the app is used.

UHNM has had positive outcomes from facilitating the SWITCH Waste innovation. Firstly, managing their waste has reduced costs and improved the patient environment. The correct segregation of waste has provided UHNM the opportunity to reduce waste costs. For example:

• Using Tiger bags (offensive waste) as standard and only using Orange bags if the patient is infectious;
• Using clear bags (recycled waste) alongside black bags (domestic waste)

SWITCH Waste achievements made by UHNM:

• The safe and compliant declassification and diversion of a significant proportion of waste went into non-hazardous waste streams.
• Introducing a culture of staff empowerment and a ‘blended learning’ technique for education which comprises:
  • SWITCH Waste e-Learning modules
  • Waste Management e-Learning modules  for specific staff groups
• By improving the quality of waste segregation and declassifying a large proportion of waste to ‘non-hazardous’, UHMN has enabled an opportunity/freedom to transport and dispose waste in a different way by no longer requiring the use of a specialist clinical waste contractor and facility.
• With specific waste procedures and staff education in place, the local Waste to Energy facility have deemed the risk of contamination by hazardous waste at a low level and accept UHNM non-hazardous waste as ‘mixed’ waste stream, duel consigned by the European Waste Catalogue (EWC) code.
  • This is a first for the NHS and a municipal disposal facility- achieved with engagement by the Environment Agency.
• UHNM is a zero waste to landfill Trust.
• SWITCH Waste adopted by UHNM has resulted in a Waste Management service that is regarded as a national leader and is currently positioned in the lower quartile for waste costs according to Lord Carter.

There are many impacts and outcomes that the software’s system has been shown to achieve, for example it has significantly reduced shift handover and ward round times. During its trial introduction period data showed it to save 24 hours per week.
The system has also enabled staff to have more time to carry out other duties, such as increased time with patients and families and opened up time for teaching students and junior clinicians.

Below are some more of the outcomes that the Handover system has achieved:

• The electronic solution automatically placed the time, date and patient identifiers on each page and the entries were all typed, which meant that all ward round entries completed using the electronic system that met 100% of NHS Litigation Authority audit standards.
   
• Based on the data available from the Handover software, it is estimated that the time of intervention has saved on average 57 minutes per day of time for the members of medical staff involved in the ward round. Based on this alone it can be estimated to save the Trust over 24 hours of staff time each week.
   
  • As the system has saved time and allowed an earlier completion of ward rounds, it has enabled staff to spend more time with patients and completing routine work during daytime hours.
     
  • Earlier completion of ward rounds also meant that routine tasks such as placing long lines could now be completed in working hours rather than be handed across to the on-call team.
     

• Medical staff were freed from the process of duplicating documentation from one day to the next reducing the risk of errors when transcribing information.
   
• The nursing team were pleased with the improved standard of documentation and legibility of the ward entries and have started using the printed sheets as a handover tool for their nursing shift handovers.
   

Overall, the use of the low cost, unified electronic ward round and handover solution has demonstrated a significant reduction in average ward rounds and handovers whilst simultaneously improving documentation standards.

There are many positives outcomes from the eAIMS project. It has made a positive impact within the healthcare industry and helped to improve patient safety, reduced the time from AI identification to MDT decision and much more. The impact that eAIMS has made is discussed in more detail below:

1. By using the newly published European guidelines, we developed a novel, web-based eAIMS that links the clinical, biochemical and radiological data necessary for assessing and managing AI patients.
    
2. Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in:
   • A 78% reduction in the time from AI identification to MDT decision (vs. our original primary objective of 20%). This significantly reduced delay, which will result in less patient anxiety.
      
   • A 49% reduction in staff hands-on time.
      
   • Improved patient safety:
     • A reduction in the risk of transcription errors, given the in-built error validation of entered data and the automatic generation of the MDT outcome letter as opposed to repeated human-instigated steps.
        
     • Our analysis identified that 70% of AIs were not being followed-up, and hence we are now developing the next stage of the programme to proactively identify all new AI cases, thereby avoiding missing cases (work in progress).
        
   • A 28% reduction in costs (from an independent health economics analysis).
      
3. Links outside UHNM: Built-in the project is the partnership with UHSM to explore the generalisability and utility of the system. The system was conceived as web-based from the outset to facilitate wider adoption. We have also established dialogue with the Association of British Clinical Diabetologists to showcase our work.

One of the outcomes was that with several years of success within the Trust behind the project (which became a Health Service Journal Award finalist in 2008); it was clear that the idea was ripe for further development and commercialisation.

In less than a year, the contracts were signed. Matthew Smith, Business Strategy Manager for Wellbeing Software Group, believed this process was crucial to successfully taking eConsent to market.

eHealth Innovations had the know-how to take a Microsoft Access database and turn it into something slicker and more intuitive to use. The package now runs off a hospital server and displays in an attractive user interface optimised for mobile devices, such as tablets. The process is fully digital too – the paper form is being finally consigned to history.

MidTECH are continuing to consult with e-Health Innovations and the Worcestershire team, supporting eConsent in its broader adoption. Via its links with the West Midlands Academic Health Science Network, MidTECH has encouraged regional adoption through workshops and launch events.

eConsent is a software application that originated within Worcestershire Acute Hospitals NHS Trust, resulting in a licensed commercial product which is now available on the market.

Such has been the success of the partnership that was facilitated by MidTECH that the adoption of eConsent doesn't stop there. "Only months after the official launch, we were invited to tender for introduction in thirty-eight hospitals in the USA," says Chris. "As of now, we've made it through to the shortlist”.

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."

Therefore, MidTECH has helped this project take international adoption.
 

The immediate training priority for the West Midlands was to train sufficient numbers of health care professionals, with some existing genetics knowledge, to recruit and consent patients across a number of local delivery partners (LDPs) in line with the phased roll out of the 100,000 Genomes project. A further learning need was identified whilst working with the University of Birmingham (UoB), the local provider of the MSc in Genomic Medicine;  non-medical health care professionals were dissuaded from applying for both CPD modules and the MSc due to insufficient knowledge in basic genetics science. 
 
The West Midlands working with UoB developed an Access Course designed to educate non –medical healthcare professionals who had little knowledge of genetics or genomics and to support them in successfully meeting the entry requirements for the MSc in Genomics. Other courses provided by the WMGMC included an interactive one-day recruitment and consent programme as well as a blended E-Learning Consent course which built on work from Health Education England (HEE).
A national consent training day was also organised to allow for additional training alongside the blended learning package.
 
The Recruitment and Consent course delivered both centrally and through blended learning has been hugely effective. Locally it enabled individual clinics across 18 LDPs to meet recruitment targets across cancer and rare diseases. Furthermore, these genomics training events are thought to have contributed to interest in and attendance on CPD modules as well as the full MSc in Genomic Medicine at the UoB.
 
The phased roll out of the 100,000 Genomes Project has also been assisted by the three Genomic Ambassadors. As part of a focus on precision medicine the AHSN sought to fund these 3 innovative posts known as Genomic Ambassadors. In the early days the role largely comprised of engagement of various healthcare professionals, coordinating teams ahead of going live to recruitment as well as training staff to consent patients. The genomics ambassadors regularly take part in regional and national events to raise awareness for not only the 100,000 Genomes Project but also personalised medicine, an important aspect which has also developed their ability to educate groups of people including nurses, scientists and students.
 
As well as events focussed on workforce training the Education Team have helped with activities to ensure the future workforce is aware of genomics. This includes enabling work experience opportunities for  school, college and university students ensuring the next generation of scientists, nurses and doctors receive vital experience within the genomics and genetics field.
 
The WMGMC has also worked closely with the national Genomics Education Programme team to ensure national requests are fulfilled. This has included producing a training needs analysis questionnaire to highlight the needs of different staff groups. Each GMC was asked to produce a questionnaire suited to their workforce with the focus of the WMGMC being Healthcare scientists. From this a national report is to be produced which will hopefully influence training and education opportunities in genomics that will be available in the future.

These initiatives have resulted in two large village practices having an increase in the overall uptake rate in 2017, compared to 2014. With a large increase in prevalent ladies attending from both practices. It was also noted that the number of ‘A’ symptomatic cancers diagnosed with the screening service in 2017 was double compared to 2014. The Facebook engagement initiatives have resulted in uptake amongst the prevalent and incident cohorts and therefore improved cancer outcomes.
 
Nationally we have the largest number of followers out of all the Breast Screening services, this currently stands at 1,172. On average, the monthly reach of published post is 37,464, with a high proportion of this being organic.
 
The animation of the breast screening pathway, which is understandable to all health literacy levels and is also culturally sensitive has been viewed over 26k times.
Improved digital communication and engagement methods have resulted in a number of perpetual non-attender ladies making direct contact over the page. With the practitioner-patient conversation, individuals then felt empowered to make a positive behavioural change and attend for their screening invitations. 

The security MidTECH provided to the Solihull Approach and their efforts to spread their successful model ever further can't be underestimated: on the day we touched base with Hazel to write this article, the Trademark Office had called her to highlight a new trademark which had the potential to infringe upon Solihull Approach's.  Needless to say, she turned immediately to MidTECH for advice on liaising with her lawyers, the Trademark Office – and assessing the potential clash.
MidTECH have helped to create a strong theoretical model which now educates people in how to understand their relationships and in a way that increases the wellbeing of individuals with of training health visitors supporting parents of children experiencing sleep, feeding, and toileting or behaviour difficulties.

Trajan Series 3 adhesive microscope slides assist investigation of BMT biopsy samples with an aim to support diagnosis and management of hematological conditions. The slides provide excellent specimen adhesion and the mounted sections can be used for an array of routine and IHC stains.
 
Since the adoption of the Series 3 adhesive microscope slides, they have been used in more than 235 bone marrow trephine biopsy cases at New Cross Hospital and have demonstrated outstanding results with regards to stain quality as well as minimum repeat rates due to tissue loss.
 
Previously each repeat stain for a repeat test would take a day and a half to complete (cut and dry on overnight and stain the next day). With Trajan Series 3 Adhesive slides, due to their strong adhesion quality, no repeat tests are required.
 
Trajan Series 3 Adhesive slides are now used for ALL Bone Marrow Trephine biopsies at New Cross Hospital.

National Clinical / Policy Priorities:

NHS England’s 2016-17 Business Plan – https://www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf
 
“Cancer is increasing – there will be 300,000 new diagnoses a year by 2020. Following publication of the Cancer Taskforce report in July 2015 we will drive down waiting times, increase diagnostic capacity and develop a modern national radiotherapy network.
 
Trajan Series 3 adhesive microscope slides assist investigation of BMT biopsy samples with an aim to support diagnosis and management of hematological conditions, helping to improve patient experience and outcomes.

Image below: Robust tissue adhesion with H&E stain of bone marrow trephine (BMT) biopsy section on Trajan Series 3 adhesive microscope slide.



Image below: Minimal background staining with the reticulin silver stain of bone marrow trephine (BMT) biopsy section on Trajan Series 3 adhesive microscope slide.


 

Lantum’s technology now allows OHP practices find GPs in seconds.
 
When a job is posted on Lantum it triggers smart app, text message and email notifications to be sent to GPs who are available to work in the area. OHP Practices can also choose for any sessions not filled by staff from the collaborative bank to be made available for the wider community of local GPs on Lantum.
 
3 months after the launch, OHP practices filled 90% of all hours posted on Lantum. 46% of those hours were filled with an OHP bank GP, saving practices £2,653 in agency fees.
 
Cumulative savings 12 months after launch were in excess of £24k and there are now nearly 90 OHP bank GPs, working as many as 100 hours per month across member practices.