Innovation Warehouse - Stories
Meridian is a resource for you to be able to share the changes that you have made to the way that you do things that have resulted in improved health outcomes for patients, a more effective way of delivering more for less, an increase in the productivity or just a different way of doing things.  Please use this space to upload the innovations that you wish to share and that others can benefit from.
Thank you.
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Innovation (Approved)

Overview summary:
North Staffordshire and Stoke-on-Trent CCGs, with the support of the WMAHSN LTC Network and social enterprise company Redmoor Health, have been supporting their GP practices to use social media to engage with their patients.  As a result of the programme, over 2/3rds of the practices are now regularly using social media, the most popular being Facebook.  The topics discussed range from simple health messages to the publications of DNA data and consultations on appointment and telephone systems.
 
Challenge identified and actions taken :
The challenge is convincing general practice teams that it is in their best interests to have their own official Facebook landing page providing accurate and useful patient information individualised to the practice. Otherwise an unofficial page may be generated by the public (not necessarily registered patients) who access Facebook on their own devices and create a profile for the practice.  These publicly created pages are then unmoderated by practices, usually containing negative unpleasant comments about the practice services, which the practice is unable to control.  Unofficial pages can also be used to relay content not related to the practice, i.e. advertising businesses, which gives the mistaken impression that the advertisement has been endorsed by the practice.
Impacts / outcomes: 
Once practices realised that an unofficial Facebook page had been set up they were keen to develop an official Facebook page. By owning an official page (or claiming an unofficial one) practices can increase the likelihood that their patients reach their official site which are listed higher than unofficial pages in searches. Establishment of Facebook has enabled general practices to increase engagement with their patient population by sharing useful patient information including opening times, services etc. 
 
The practices engaged have also developed an effective communication channel.  This was highlighted in the 2017 cyber attack which affected practices throughout the country – telephone lines were down, websites couldn’t operate and online bookings were also affected.  Those practices with Facebook could send out information quickly to their patients with instructions to share across  personal networks.  As services came back online practice staff were accessing their practice’s Facebook page from home and posting updates to their patients.
 
When a video produced by the stroke team at University Hospitals North Midlands (UHNM) was posted across practice Facebook pages it received over 20,000 views in one weekend. A poster advertising a drop-in heart screening programme for young adults reached over 45,000 people in one weekend and sessions were fully booked within two days. A typical practice page engages around 200-1500 patients in a week, but this increases dramatically with posts that trigger significant patient interest.
 
Facebook is also now being used to recruit new members to practice Patient Participation Groups to enable those with difficulty in attending face to face meetings to become involved in more effective ways.
 
Some practices have also set up closed private Facebook groups for specific cohorts of patients who are able to discuss concerns with peers.
 
The review undertaken by the medical student has been accepted for publication by BJGP Online.
Which local or national clinical or policy priorities does this innovation address:
This should list the NHSE priority areas that the project addresses. These will be used to ensure the case study is easily searchable on Atlas: - Care and Quality - Health and Well Being
Supporting quote for the innovation from key stakeholders:
Seema Gater, Practice Manager Apsley Surgery, Stoke-on-Trent
“As a forward thinking practice we are keen to use social media to give patients a different way to interact with us. We wanted to provoke reaction and engagement and we have started to successfully tap into this by highlighting our monthly breakdown of DNA statistics to our patients though Facebook.”
 
Jane Cope, Practice Manager Goldenhill Surgery, Stoke-on-Trent
"We use Facebook as an opportunity to advertise and educate patients on seasonal topics, i.e. influenza vaccines in the winter, holiday vaccinations in the summer etc. and also other information that would be of benefit to patients."
 
As technology develops and more patients use the web to communicate, as a forward thinking practice, we see Facebook as a new innovative tool to communicate and educate patients."
 
A video has also been produced in which two PPG chairs discuss how they benefit from using social media: https://vimeo.com/digitalhealthsot/socialmediappgs
 
The following articles have been published regarding social media:
 
https://www.pcc-cic.org.uk/article/stoke-practices-engage-social-media
 
http://practicebusiness.co.uk/the-seven-cs-to-creating-a-digital-practice/?platform=hootsuite%E2%80%AC
 
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
Plans for the future:
As well as continuing to expand the network of Facebook practices, the pages that exist are being used to promote CCGs’ priority health messages and programmes. This includes signing patients up to Patient Online and engaging new parents on the future of maternity services in Staffordshire. By inviting parents to join a closed Facebook group, the CCGs have recruited 144 people to the engagement programme.
 
The North Midlands Breast Cancer Screening team is now using practice Facebook pages to promote their service and interact with patients to explore how the service can be improved and how non-attendance can be tackled.
Tips for adoption:
Embedding the use of Facebook into health and care engagement can have a huge impact on spreading positive messages and helping shape behaviour. It is not without risk though so there are some important considerations that need to be made:
  1. Training and support for frontline NHS staff
  2. Adoption of trustworthy, safe protocols
  3. Dedicated clinical time set aside to manage the regular engagement with patients
Once these are in place, the toolkits and support packages that have been developed in the West Midlands will support any frontline staff use social media to engage with patients.  Click on the link below to access the Social Media Toolkit:
https://redmoorhealth.co.uk/wp-content/uploads/gp-social-media-toolkit-redmoor.pdf    
Contact for further information:
Marc Schmid
Project Lead
marc@redmoorhealth.co.uk
07736 008380
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Sue Wood 01/09/2017 - 10:30 Approved
Overview summary:
This initiative aimed to improve understanding of the challenges pharmacies face in the adoption of technology enabled care services (TECS) focussing on efficient medicines utilisation and adherence.  
 
20 pharmacies from North Staffordshire were approached with 17 agreeing and 5 remaining through to completion.  The patient cohort was defined as those with prescriptions for COPD, asthma, diabetes type 2, diuretics, NSAIDs or back pain with protocols developed by the WMAHSN LTC Network.

Further details on the study can be accessed here
Challenge identified and actions taken :
The challenge was how pharmacists might utilise TECS to add value to the delivery of the New Medicine Service (NMS) and Medicines Use Review (MUR) and Prescription Intervention Service at the point of dispensing, in the integrated care of patients. 

The aim was to improve patient convenience, experience and increase understanding of their conditions and thus improve patient participation in self care with subsequent clinical benefits and associated cost benefit in medication usage. 

The project focussed on:
  • Recruitment of community pharmacies then agreeing a Memorandum of Understanding (MoU) detailing expectations under the project.  The MoU included a bursary of £500 for participation in training, identification and recruitment of patients, data capture and evaluation (Appendix 1);
  • Training to pharmacists followed by the licensing of pharmacies for Florence simple telehealth with ongoing on site support from local clinical telehealth facilitators and the Local Pharmaceutical Committee (LPC);
  • Protocols in the specified LTC's providing TECS introduction pathways (Appendix 2)
  • Florence and Manage Your Health aide memoirs
  • Baseline survey of participating pharmacies at project inception and a post participation survey (Appendix 3)
  • Patient feedback on Florence 
  • Patient feedback on the Manage your health app 
Impacts / outcomes: 
This was designed and delivered as a discovery project. As a consequence, the impacts and outcomes are limited to learning.  Based on critical reflection and consideration of the evaluation and surveys completed as project actions the project team identified where the project could have been more impactful in terms of retaining the participation of those pharmacies that expressed an interest. Then better retention and participation rates could have secured higher incidence of TECS adoption from the cohort of patients covered by the project.  These conclusions and the resulting recommendations recognise the small numbers involved and that further exemplar projects would be required before at scale roll out could be considered.
 
17 community pharmacies expressed an interest and progressed to training and receipt of the MoU and were deemed to be fit to participate – five of these accredited pharmacies went on to complete the project.  The number of interactions (contacts with patients) reached 88 realising 93 incidences of patients becoming engaged with or interested in TECS (patients could elect for either / both Florence and the Manage Your Health app).  The demographics of the patients reached during the project shows 5.7% (5) to be children (<20years old) and 19.3% (17) to be older adults (> 59 years old).  With an even distribution of participation by gender (42M / 46F) and by condition the willingness of patients to consider TECS when introduced by the pharmacist could be considered high as the 88 patients – based on participation data collected at the pharmacy – converted or stated an intention to convert to simple telehealth or an app.
 
The conversion rate supported the hypothesis that community pharmacies are in a position to introduce and generate adoption of TECS during their participation in a single patient focussed care plan.  However, if the project was to be replicated more attention would be required in the recruitment and preparation of the participating community pharmacy teams.
 
  • The MoU in itself was helpful for recording and agreeing the basis of participation but it could have contained more on the objectives and outcomes expected from participating pharmacies;
  • Experience showed that while the strategic involvement of the pharmacist(s) was fundamental to placing the project in context for the pharmacy the pharmacy staff (including counter staff) were better placed to manage the interactions with patients on the practicalities of enrolling with Florence or the downloading and then utilisation of the Manage Your Health app;
  • Training for the pharmacy team would be better delivered out of hours or by remote delivery (e.g. skype) as the day to day operations of the pharmacy made the delivery of training during opening hours problematic with frequent breaks in the training being required and on some occasions the training could not be completed within the time slot allotted for it;
  • The community pharmacies without exception had sufficient private space in which to interact with patients but they would benefit from more mobile IT to improve the content and value of the interactions e.g. by demonstrating TECS on an iPad to an interested customer;
  • In project planning, more could be done in helping community pharmacies understand patient flows and when this type of activity might best be done – during the project more than 40% of activity took place on a Friday with 20% on a Wednesday;
  • Survey at inception showed a healthy degree of scepticism on behalf of pharmacists as to the demand TECS would make on their colleagues but that TECS was an important and legitimate part of the pharmacy role. They agreed that the introduction of TECS into patient care was desirable and likely to improve their outcomes – the post participation survey illustrated that pharmacist time with patients was the key factor in patients adopting TECS (within the constraints of the project offer) and that TECS should be part of the pharmacy menu of services; and
  • Future initiatives would benefit from a much closer link with the outcome responsibilities placed on community pharmacies for NMS, MUR and the prescription intervention service as the project did not provide any causal link from the pharmacy activity to medication utilisation, adherence of cost effectiveness in prescribing.
 
It is worth noting that the demographics of the patient cohort recruited suggested significant levels of participation by older age groups generally considered to be ‘digitally excluded’. However, in the post participation telephone survey – albeit for small numbers – pharmacists reported patients not having a mobile phone (telehealth) or a smart phone or tablet (Manage Your Health app) as only occasional incidental occurrences.
Which local or national clinical or policy priorities does this innovation address:
Care and Quality Health and Well Being Health Education England’s Building a Digital Ready Workforce. https://hee.nhs.uk/our-work/developing-our-workforce/building-digital-re...
Supporting quote for the innovation from key stakeholders:
During the post participation survey the following comments were noted based on conversations with the participating pharmacists and pharmacy teams:
 
“Patients felt that the info on the Apps was reliable rather than just looking on the internet”
 
“I can see the benefits of using technology ………… new launches always take time, cannot expect new service to be instantly successful.  Once established and embedded expect it to be more successful”
 
“It would be good to have a self-service portal (in the pharmacy) i.e. tablet/lap top for patients to use to become familiar/comfortable”
 
“Pharmacist would have liked more telephone support”
 
“Delivering healthcare technology is easier than pharmacists believe …..”
 
“(The) Service is easy to sign up to but (I) just haven’t got the time. …….. apologies for lack of participation but owners not prepared to commit to staffing required”
 
“Try to link patients’ info and needs with the pharmacy from GPs.  Create better awareness – leaflets, posters, media and promotional material – poster/leaflet to encourage patient/customers and make aware
 
Please note:  These references are from notes taken during the post participation telephone survey and have been presented out of the context of that survey and the individual discussions that took place and, in some instances, represent multiple responses on the same or similar themes.
Plans for the future:
The learning from the initiative was substantial and consequently there would need to be significant redesign before it was run again.  There was much to commend the project recognising that it ran for a short time and yet the take up or conversion rate to the TECs offer was in itself significant and therefore of value in the context of what the project hoped to achieve.
 
The case for another initiative involving pharmacies and pharmacy teams is strong providing there is a greater emphasis placed on how their investment of time in introducing TECs impacts positively on pharmacy relative and important outcomes.  There is a valid argument for developing and introducing a currency for this work that is of value to pharmacies.
 
Since this initiative, Healthy Living Champions have been introduced into all pharmacies in Northern Staffordshire and it would make good sense to have them involved in this type of initiative in the future. Healthy Living Champions have a role to promote Public Health messages.
Tips for adoption:
The initiative brought home the importance of securing senior pharmacy managers support for the community pharmacists’ wider role, recognising that they need protected time to be effective.

Community pharmacists are motivated to use their knowledge to help patients, and projects like this one should capitalise on this.

If locations, such as pharmacies, are to be the focal point of introducing TECs to patients and the public promotion and support material for use on site is important.
 
Much is assumed about the digital awareness of professionals and employees in health and health care services – the initiative identified that greater digital awareness created by other programmes may help the future recruitment of willing participants from within clinical and healthcare teams and from the public and patients.
Contact for further information:
Tania Cork
Chief Operating Officer
North Staffs & Stoke LPC
taniacork@northstaffslpc.co.uk 
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Sue Wood 01/09/2017 - 10:21 Approved
Overview summary:
This tool has been developed by a team at UHCW, headed up by Professor Meghana Pandit, Chief Medical Officer & Deputy CEO.

This is a digital tool that will enable tracking of all post-surgical complications / morbidity by surgeon for each patient. It will enable learning and help reduce complication rates and identify trends in complications and morbidity.
Challenge identified and actions taken :
This innovation is a surgical morbidity scorecard developed at UHCW. It allows capture of theatre details and complications from two different systems onto a scorecard. The idea being that each month, surgical teams can review their performance as a team or as individual suegons and analyse the data. The indicators include generic surgical morbidity measures such as length of stay, readmissions, heamorrhage, DVT, PE, wound infection, return to theatre and unexpected admission to ITU. With this data available for each surgeon and each patient, surgeons will be able to iddentify need for change in practice and equally will be able to counsel / consent patients before surgery with their own morbidity / complication rates. 
 

This information is sufficiently robust to enable identification of trends in morbidity, allow in depth review when concerns are highlighted.  Such morbidity data, when appropriately actioned can be utilised to improve quality of patient care. 

The morbidity scorecard demonstrates that it is possible to establish an automated system capable of identifying trends in outcome. Accurate recording and reporting of surgical outcomes, in particular morbidity figures, is important in maintaining and improving surgical practice and perioperative care.
Impacts / outcomes: 
This innovation has a clear benefit to patient care and to the NHS. It will improve an understanding of surgical morbidity prospectively enabling surgeons to change practice when rquired. It also enables reduction of complications through learning therby reducing cost to the NHS. Furthermore, patients will benefit from improved counselling and consenting process.
Which local or national clinical or policy priorities does this innovation address:
NHS England guidance on the review and monitoring or morbidity rates.
Supporting quote for the innovation from key stakeholders:
In Healthy Measures: A UK gynaecologist’s plan to improve hysterectomy outcomes led her to develop a Surgical Scorecard that can be used in all surgical specialties. 
Plans for the future:
In terms of the development of the system itself, we plan to increase the number of indicators on the scorecard. These will be speciality specific bespoke indicators.

We are also hoping that this may be taken up throughout the region and the wider NHS and would welcome enquiries about assisting other organisations in doing so, either licensing the materials that we have develoed here at UHCW, or passing on knowledge to enable similar systems to be developed in-house elsewhere.
Tips for adoption:
As above, we would be happy to have a discussion with you regarding implementing this in your organisation. Please see the contact details below.
Contact for further information:
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Meghana Pandit 15/07/2017 - 15:13 Approved
Overview summary:
The Sutton Coldfield Unplanned Admission Avoidance in the Elderly Project involved six General Practices working together to design and implement a method of improving unplanned care for their patients over the age of 70.

Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.

Approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes.
Challenge identified and actions taken :
Experienced community nurses were employed to undertake urgent assessment and intervention in patients at risk of imminent admission and of all patients soon after discharge to reduce readmissions. A later additional work stream facilitated earlier safe discharge for inpatients, the ‘pull system’, with active monitoring via a live software feed with real-time details of admitted patients. Relationships between hospital and community medical and social teams were formed and strengthened and new pathway models planned and implemented.

Data collection was both subjective and objective.

The subjective data of ‘crisis’ admission avoidance indicated that 75% of interventions had a significant impact on reducing the likelihood of admission for a relatively low number of interventions each month. For post-discharge reviews this level of impact was much lower at 15%, but for a much larger number of contacts. Early safe discharge intervention demonstrated a moderate or more level of impact for at least 60% of up to 230 interventions each month.
Impacts / outcomes: 
​Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.
There were significant reductions in both average length of stay and cost of admission. A system-wide change in average length of stay and cost was observed but the project practices saw greater reductions compared to the other local practices, and we estimate that we achieved an additional cost saving of £324,000 over 2 years.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Unscheduled Care, Primary Care.
Supporting quote for the innovation from key stakeholders:
In conclusion, approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes. The observed reduction in hospital mortality, in particular, points towards a significant improvement in patient safety. Reductions in cost and average length of stay also occurred but, as clinicians, nothing compensates for the significant time and effort involved in changing how our National Health Service functions better than the knowledge that patients are now less likely to be harmed.
Plans for the future:
Share the message and continue delivering and improving the service.  
Tips for adoption:
Invest up front in the Improvement Science Foundation training and support before attempting to replicate this elsewhere. 
Contact for further information:
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Simon Dodds 28/06/2017 - 11:41 Approved
Overview summary:
For three years now, dedicated staff in Birmingham Children’s Hospital have been using Appreciative Inquiry as the method for a programme called Learning from Excellence, and the WMAHSN has had such good reports of their work and such interest from its members that they have decided to support its rollout across the region.
Challenge identified and actions taken :
We all have a strong tendency to reflect on things that haven’t worked well, but Appreciative Inquiry helps us understand that we can learn much more from things that go well. It’s an idea that’s catching on in the mainstream, too. Increasingly, it’s an idea being used in sports psychology, where teams who review their good performance are shown to improve more than teams who review the things that didn’t go well.

Traditionally, safety in healthcare has focused on avoiding harm by learning from error, but this approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it.
Impacts / outcomes: 
When we learn from our good practice, morale and resilience is improved and our psyche is in a better position to learn. It’s called Learning from Excellence.

A series of introductory talks have ran called Where did it all go right? and then asked interested people to sign up for a two-day AI training course run by Appreciating People. We’ve been asked to provide five of these two-day courses, and they’ve all been fully booked. The participants on them have been amazing – dedicated, talented and really interested in using Appreciative Inquiry to take another approach to learning and enhancing safety.

The participants we worked with at WMAHSN really responded to using AI to create positive education, and work on their Quality Improvement. It helped them build resilience, as they were focusing on the things they were good at, and celebrated their successes.
Which local or national clinical or policy priorities does this innovation address:
Learning from Excellence - Patient Safety
Supporting quote for the innovation from key stakeholders:
In Learning from Excellence [learningfromexcellence.com/], Adrian Plunkett says: We tend to regard excellence as something to gratefully accept, rather than something to study and understand. Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It’s time to redress the balance. We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale.'

Quote from a participant of AI training: ‘The Appreciative Inquiry training will help me to run round table meetings exploring episodes of excellence better. But it will also be useful for my everyday practice, where I will use its strength-based methodology to help me get the best out of the theatre teams I work in.’
Plans for the future:
Studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale. The plan is to continue to study excellence and create more opportunities for learning.

Also aim to get other health organisations in the region to begin to adopt Learning from Excellence and Appreciating Inquiry in their work of practice. 

 
Contact for further information:
Helen Hunt: helen.hunt@wmahsn.org 
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Manish Patel 02/06/2017 - 11:22 Approved
Overview summary:
The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (WMPSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.  The programme is being evaluated by the NIHR Collaboration for leadership in applied health research and care (NIHR CLAHRC).  
Challenge identified and actions taken :
Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse
safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on:care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data
on hospital activity by residents at participating care homes will be compared to matched controls. 
Impacts / outcomes: 
This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety.
events such as falls and pressure ulcers, and potentially reduce care home resident’s use of acute services.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Improved Quality of care, Prevention of adverse events, Improved staff morale, Improved Dementia Care
Supporting quote for the innovation from key stakeholders:
"Giving the Care Sector a voice"
"supporting each other to provide a positive safety culture"
Plans for the future:
Evaluation to be published in 15 months time 
Regional Care Home Conference in October 17 in the north of the Midlands 
Contact for further information:
Helen Hunt 
Assistant Programme Manager - PSC 
0121 371 8057
Helen.Hunt@wmahsn.org
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Helen Hunt 02/06/2017 - 11:15 Approved
Overview summary:
The Long Term Conditions (LTC) Network has delivered a stream of programmes to encourage uptake of remote delivery of care for LTCs and adverse lifestyle habits. These include options for delivery of care such as Flo simple telehealth, video consultation, Closed Facebook Groups, apps and aid to diagnosis.
Challenge identified and actions taken :
Lack of clinicians’ awareness of viable options for TEC; competence and confidence in their usage:
  • good practical examples described and signposted in LTC Network bulletin to clinicians
  • publications in national journals
  • support for development & launch of national training module 
Lack of patients’ awareness of viable options for TEC;competence and confidence in their usage
  • good practical examples described for patients 
  • pilot upskilling course for patients 
  • support set up and usage of health professional supervised Closed Facebook Groups by three specialties in acute healthcare settings (and a few local Patient Participation Groups (PPGs) in practices
  • support medical students Year 5 to encourage patients to sign up to Patient Online to access their own records 
  • write article for citizen readership in the North Staffordshire Sentinel newspaper 
Confusion about universal approach to shared management of care of LTCs between providers of care and different modes of remote delivery of care:
  • Create LTC shared management website, with clinician and patient sections; 
Lack of leadership across health economies in relation to synchrony/sharing of remoted modes of delivery of care
  • create example interaction across Staffordshire in relation to videoconsultation for clinical consultations
  • shared learning of usage of TECs 
Impacts / outcomes: 
Facebook:
UHNM closed Facebook groups – a total of 354 members, MS (168), AF (91) and cardiac rehab (95)
Public pages – AF – 895 reach per month/498 post engagements per month; Cardiac rehab – 2099 reach per month/791 post engagements per month
 
Twitter: Over 97,000 accounts reached from tweets
 
Manage your Health App: 330 users
 
Flo Simple Telehealth: 652 protocols registered across the West Midlands region
 
Telehealth E-learning course: Since December 2016 when the RCGP CPD course went live there has been 236 registrations with 42 people having completed the course.  Users have rated the course 4.3 out of 5 stars.
 
Publications:
‘Digital Healthcare: The essential guide’, (Authors: Chambers R, Schmid M, Birch-Jones J), 2016
http://www.otmoorpublishing.com/publications/digitalhealthcare
‘Clinicians rise to the social media challenge’ – Primary Care Commissioning CIC
https://www.pcc-cic.org.uk/sites/default/files/comm_excellence_june_2016_aw_web.pdf
‘How video consultations can benefit patients’ – GP Online
http://www.gponline.com/video-consultations-benefit-patients-nhs/article/1401346
‘How to set up a Skype consultation service’ – Medeconomics
http://www.medeconomics.co.uk/article/1401405/set-skype-consultation-service
‘GPs launch Skype to care homes project in Staffordshire’ – Fabsnhsstuff
http://fabnhsstuff.net/2016/06/26/gps-launch-skype-care-home-project-staffordshire/
‘How should we respond to negative comments on social media’ (Authors: Ruth Chambers, Marc Schmid):
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
‘How a Skype trolley saves GP time’ (Authors: Ruth Chambers, Marc Schmid)
http://www.pulsetoday.co.uk/your-practice/focus-on/how-a-skype-trolley-saves-gp-time/20032834.article
Evaluation report, Autographer plus Flo (Authors: Sue Molesworth, Lisa Sharrock)
http://www.simple.uk.net/home/casestudies/casestudiescontent/mental-health-memory-support-for-mild-cognitive-impairment-or-mild-to-moderate-dementia
Stoke and North Staffordshire leading the way in hi-tech help for patients:
http://www.leek-news.co.uk/8203-stoke-and-north-staffordshire-leading-the-way-in-hi-tech-help- for-patients/story-29733613-detail/story.html
‘Revamp your website to reduce demand’ (Authors: Ruth Chambers, Marc Schmid)
http://pulse-learning.co.uk/practice-business-finance-modules/practice-business-finance/revamp-website-reduce-demand
‘Helping the elderly take tablets’ (Authors: John Marszal, Aoife Donnelly, Ruth Chambers)
http://www.health21.org.uk/2016/11/01/old-people-will-use-tech-if-clinicians-let-them/ 
‘Promoting best practice in COPD management’ (Authors: Rosie Piggott, Elaine Cook, Faye Foster, Alwyn Ralphs, Lucy Teece, Roger Beech)
https://www.bjpcn.com/browse/editorial/item/1943-promoting-best-practice-in-copd-management.html
Video: ‘COPD patient avoids A&E and acute admissions through self-management with Flo’ (Author: Ann Hughes)
https://sites.google.com/a/simple.uk.net/community/home/casestudies/casestudiescontent/copd-patient-avoids-a-e-and-acute-admissions-through-self-management-with-flo
The Health Foundation - The Power of People
Video: Introducing Flo: Telehealth with a human touch
http://healthfdn.org.uk/4Y2-4MPPC-35ITUGKE86/cr.aspx
E-Learning: Telehealth, telemedicine and telecare: an introduction to “TECS” (Technology Enabled Care Services)
http://elearning.rcgp.org.uk/mod/page/view.php?id=4117#register
BMJ – Link to back pain article (STarT Back Tool)
http://www.bmj.com/content/356/bmj.i6748
Year 5 Medical Students x 4 Patient Online Initiative – North Staffordshire & Stoke-on-Trent CCG newsletter publication –
www.stokeccg.nhs.uk/news/staffordshire-students-help-patients-to-log-on-to-gp-services-online-4028/<http://nhs.us6.list-manage.com/track/click?u=ef12432f7b285a04d0bfe1494&id=21f44def52&e=33cdefcc95>
Video: https://vimeo.com/206196885/4a38152bac
WMAHSN LTC Network Newsletter – Publication commenced in January 2017 to 500+, the database has now increased to c.750.
Staffordshire Sentinel – weekly ‘Ask the Doctor’ health articles:
http://www.stokesentinel.co.uk/search/search.html?searchType=&searchPhrase=Ruth+Chambers&where=
‘GP praises Endoscope-i’: https://vimeo.com/191810628?ref=em-share
 
Conferences:
Person Centred Care Conference held in Birmingham on 6th May 2016 – 60 delegates
 
‘Making Change Happen with Simple Telehealth and Florence’ held in Stoke-on-Trent on 25th January 2017 – sharing success and best practice with breakout sessions for Acute, Community and Primary Care – 82 delegates
 
Which local or national clinical or policy priorities does this innovation address:
GP Forward View (New models of care/patient empowerment) Underpin delivery - clinical management of key LTCs: Asthma, COPD, diabetes, hypertension, AF
Supporting quote for the innovation from key stakeholders:
Marc Schmid – Digital Expert, Redmoor Communications:
“The programme has brought patient networks together around MS, cardiac rehab and AF and stroke, providing peer to peer support and regular information from clinicians. The introduction of video consultations has enhanced the care available as well as improving the efficiency of service delivery”.

Luke Bracegirdle – Head of Digital & Business Analytics, Keele University School of Pharmacy:
“West Midlands Academic Science Network part funded a development project to extend work on the Manage Your Health app, to include additional content on long term conditions. Prof Ruth Chambers (Clinical lead Long Term Conditions Network, WMAHSN) has been very supportive and used the network to connect our development team with partners with complementary skills as well as link to further initiatives in the region to promote patient information resources in the area of Atrial Fibrillation”.

Phil O’Connell – Chairman & Chief Innovation Officer, simple.uk.net:
"The WMASHN Long Term Conditions (LTC) Network has provided invaluable support for clinical teams, helping to raise awareness of practical and pragmatic remote delivery of care options.  The LTC Network has worked with us, encouraging evidence based uptake through clinical peer to peer sharing of case studies and evaluation across traditional organisational boundaries of the techniques and methods used by our members to address LTCs and adverse lifestyle habits.
International dissemination of the learning, evaluation and case studies developed through the 'Simple Telehealth' programme of work including Florence in the UK, has been greatly assisted by the practical clinical applications and evaluation made possible by the WMAHSN.  The techniques and methods evaluated have achieved replicable positive clinical and productivity outcomes that are now being studied for implementation in Ireland, USA and Australia."

Jodie Williams – Stroke Prevention Clinical Nurse Specialist, University Hospitals of North Midlands NHS Trust:
“The AHSN has widely supported the AF Stroke Prevention Team over the last 2 years.
It has supported the provision for expert advisory for Atrial Fibrillation, its education and management throughout both Primary and Secondary Care.  It has supported the promotion of an online GP Masterclass for Atrial Fibrillation to GPs in Primary Care to continue education and evidence based management for AF patients reducing the risk of AF related stroke. The AHSN has supported the AF stroke prevention team in becoming champions within both Primary and Secondary Care enhancing self care management, reducing major disabling strokes with a positive impact to the Local Health Economy”.
Plans for the future:
  • Continue with pan-Staffordshire rollout of video-consultation option for clinician/patient follow up interaction in all healthcare settings; extend to social care settings as appropriate; share learning and urge adoption across the region
  • Promote the impact/how to overcome inertia to remote options for delivery of care at all levels of NHS across West Midlands and beyond via events, conferences (e.g. focus on CVD and diabetes 10.5.17; quality improvement 13.6.17), publications, LTC Network bulletin, Twitter, etc.
  • Evaluation of Trust-wide rollout of Flo Simple telehealth Sandwell & West Birmingham Trust; county-wide rollout of videoconsultation; use of Facebook in general practices
  • Develop online learning resources and simple course for citizens to use to enhance their confidence and competence in personal use of TEC for their own LTC(s)
  • Promote or develop online learning resources for clinicians to enhance their competence & confidence in adoption of TEC
Tips for adoption:
  1. Inertia is common in the NHS in relation to any new way of working – persist in engaging all those who are vital in making change happen.
  2. Don’t keep what you’ve learnt about the adoption of an innovation to yourself - evaluate, promote, disseminate it. 
Contact for further information:
Ruth Chambers - LTC Network Clinical Lead 
Ruth.Chambers@stoke.nhs.uk

Sue Wood - LTC Network Project Manager 
Sue.wood@wmahsn.org

Marc Schmid - Digital Expert, Redmoor Communications Social Media
Marcgs72@gmail.com

Luke Bracegirdle - Head of Digital & Business Analytics, Keele University School of Pharmacy - Manage Your Health app
l.bracegirdle@keele.ac.uk

Chris Chambers - Telehealthcare Facilitator, Stoke-on-Trent and North Staffordshire CCGs - Flo telehealth
chris.chambers@stoke.nhs.uk
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Sue Wood 23/05/2017 - 09:29 Approved
Overview summary:
Health innovations and ideas frequently require robust research evidence to demonstrate clinical and cost efficiency, or structured real-world trials to support scale and speed of adoption. WFC provide a range of specialist support services in regulatory affairs. 

An example of the services that we can provide is illustrated through the case study of how WFC supported Electromedical Products International, Inc (EPII), to gain real world-data for the adoption of an innovative medical device at scale.
Challenge identified and actions taken :
EPII and the UK distributor The Microcurrent Site (MCS) offer the Alpha-Stim AID medical device. Alpha-Stim AID is proven to be clinically safe and effective in the alleviation of anxiety, insomnia and depression.

To enable EPII and MCS to offer the Alpha-Stim AID to patients in the NHS, research data was required to be submitted to the National Institute for Clinical Excellence (NICE) to evidence the clinical and cost effectiveness of the device when used in an NHS setting. Neither EPII nor MCS had any experience of designing and submitting research studies in the UK.

WFC took a protocol outline and developed it into a full clinical trial protocol with essential documentation following engagement with all stakeholders.

Regulatory submissions were made to the Health Research Authority (HRA) for approval (inclusive of ethical favourable opinion), to the National Institute for Health Research (NIHR) for inclusion onto their portfolio, and to an NHS Improving Access to Psychological Therapies (IAPT) service in the East Midlands.

WFC designed a site initiation training package which was attended by over 60 members of the IAPT team over 2 days to ensure successful and compliant trial delivery.

All aspects of design and delivery were undertaken on behalf of EPII and MCS who were provided with regular progress reports.
Impacts / outcomes: 
The clinical trial, which had been planned for many years, was designed and initiated in just 15 days of WFC consultancy time, enabling EPII and MCS to gather the valuable clinical and cost effectiveness data sooner than expected.

EPII and MCS were able to delegate all aspects of set-up to WFC with confidence, thus reducing the burden upon their teams.

Extensive initiation training ensured a prompt start to recruitment and rapid generation of data.

Strong working relationships with all stakeholders ensured a well-designed study which quickly processed through regulatory approvals. WFC were also able to facilitate conversations with the relevant Clinical Commissioning Groups (CCGs) and patient advocacy groups, with the result that real-world data collection is near completion and ready for submission for adoption of the device in the NHS. 
Which local or national clinical or policy priorities does this innovation address:
NHS IAPT services are committed to initiating treatment for 75% of people within 6 weeks of referral, and 95% within 18 weeks of referral, a clinical target formalised in policy framework Achieving Better Access to Mental Health Services by 2020. Alpha-Stim AID provides a maintenance therapy for people whilst on the waiting list following referral, thus enabling the target to be achieved. Additionally, a significant proportion of people using Alpha-Stim AID achieve full recovery, and so do not require further individualised treatment from NHS IAPT. This represents a considerable saving, and is in line with the NHS Mandate 2017/18 priority to balance the NHS budget and improve efficiency and productivity. WFC support clients to meet the national requirement for a technology appraisal from NICE, which is based upon clinical and economic data. The NHS is legally obliged to fund and resource treatments recommended by NICE’s technology appraisals within three months, as reflected in the NHS Constitution. As such, WFC are experts in navigating local and national priorities and processes. 
Supporting quote for the innovation from key stakeholders:
“Everything was great and highly professional”: Steve Hutchinson, MCS Managing Director. 
Plans for the future:
EPII and MCS will shortly be submitting the clinical trial data to NICE for technology appraisal. Recommmendation for use in the NHS is anticipated due to the high-quality clinical and economic data gathered, working relationships built with clinicians, NHS IAPT service managers, and Clinical Commissioning Group leads, in addition to support from patient groups.

WFC are ready and available to support other users of the Meridian platform to navigate regulatory affairs issues.
Contact for further information:
Mark Terry, Senior Consultant: mark@wendyfisherconsulting.co.uk
Luke Brewer, Senior Consultant: luke@wendyfisherconsulting.co.uk
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Mark Terry 10/05/2017 - 11:32 Approved
Overview summary:
"Let's talk about anticoagulation" video gives information that can be shared with patients who need to consider having anticoagulation therapy.
 
Challenge identified and actions taken :
To support a consultation with a clinician.  The video shows the reasons for anticoagulation therapy, the choices available, including the risks and benefits of the different types.
Impacts / outcomes: 
Gives a simple clear understanding of anticoagulation options for patients and their carers.
Which local or national clinical or policy priorities does this innovation address:
WMAHSN reducing unwarranted clinical variation in AF
Plans for the future:
This video will be included as part of the toolkit of resources the WMAHSN is producing to support AF detection and treatment,
Tips for adoption:
To be used as part of a consultation.
Contact for further information:
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Karen Morrey 03/05/2017 - 14:50 Approved
Overview summary:
Birmingham Community Healthcare (BCHC) NHS Foundation Trust have created an interactive PDF version of the Trust Clinical Handbook for use on smart devices.

To save the recurring cost of reprinting to keep the handbook up-to-date, and to keep up with the demand of the digitally enabled workforce, this tool has now been converted to an interactive PDF that can be accessed on smart devices. Examples of procedures included in the handbook are Sepsis screening tool, Resuscitation flow chart, Urine Colour chart, and normal blood values.

Challenge identified and actions taken :
The Clinical Handbook with one-page clinical guidelines on various procedures has historically been printed in a physical hand book.  It was found that there was a large recurring cost associated with this and it was difficult to ensure that clinicians were up to date and has acess to the guidelines in a managable format. 
Impacts / outcomes: 
BCHC has seen a considerable reduction in the printing costs of producing a physical handbook.  The has been estimated in the region of £5-8000.
Which local or national clinical or policy priorities does this innovation address:
Long term sustainability of the NHS - Paperless NHS
Plans for the future:
After a 6-month period of evaluation, the need to create an App with the additional functionalities of user statistics and remote content updating will be considered.

This handbook can be tailored for use in other Trusts and we would like to share this with other organsiations.  Provided that the cost of changing the contents to fit the needs of your Trust are covered and that BCHC copy-rights are mentioned and respected we are willing to openly share this. This means that you will be permitted to use the branding of your own Trust on the handbook, alongside BCHC's logo and branding.
Contact for further information:
Hamid Zolfagharinia, BSc, MSc, MIPEM, CSci
Innovation Manager
Email: hamid.zolfagharinia@bhamcommunity.nhs.uk
web: http://www.bhamcommunity.nhs.uk
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Hamid Zolfagharinia 30/03/2017 - 13:31 Approved
Overview summary:
The film was developed by Wessex AHSN and will support practitioners with discussions with patients on anticoagulation but also be a tool that patients can return to after discussions in clinics. 

Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects. To view the film in full please click here
Challenge identified and actions taken :
Many people taking anticoagulants don't fully understand what side effects to look out for, or when to seek help.  Starting Anticoagulation with Jack has been created to prevent people becoming unwell while on anticoagulant medicines, and avoid unnecessary admissions to hospital.
Impacts / outcomes: 
Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects and to help them to improve adherence to prescribed medication.
Which local or national clinical or policy priorities does this innovation address:
Reduction of unwarranted clinical variation in Atrial Fibrillation
Supporting quote for the innovation from key stakeholders:
We’d like to share our new anticoagulation film with you and ask you to share it with your networks.
 
It would be really helpful if you could consider how it can be made easily accessible to patients to support them with anticoagulation treatment.
Plans for the future:
The West Midlands AHSN is working on an Atrial Fibrillation, (AF), programme to support clinicians, patients and their carers in the detection and treatment of AF.  We have an Advisory Group and plan to launch the first part of our project in May.  We will be developing a toolkit to support clinicians, patients and their carers.
Tips for adoption:
This film has been developed after significant research into what patients and their carers want to see.  It can be used to support clinicians explaining about the treatmen they are prescribing.
Contact for further information:
For information about our West Midlands programme contact:
Karen.Morrey@wmahsn.org
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Karen Morrey 29/03/2017 - 13:39 Approved
Overview summary:
Diabetes is a major health challenge in the UK with a rapidly increasing number of people affected. Active disease of the foot is a crisis situation for a patient with diabetes & requires timely referral & management. A new solution for reliable & remote monitoring of diabetes foot ulcers, Silhouette, was implemented as part of an integrated primary & secondary care pathway. This initiative is supported by EMAHSN.

Who’s involved? 
  • Entec Health Ltd
  • Aranz Medical Ltd
  • Derby Teaching Hospitals NHS FT
  • Derbyshire Community Healthcare Services NHS FT
  • EMAHSN
Challenge identified and actions taken :
The challenge:
  • > 61,000 people with a Diabetic Foot Ulcer (DFU) at any given time
  • 6,000 people with diabetes have leg, foot or toe amputations each year in England - many avoidable
  • Improving DFU outcomes can avoid amputations, improve quality of life & mortality
  • Total NHS spending on ulceration & amputation estimated at £651m
  • 50% of foot care expenditure in diabetes is for primary, community & outpatient care
Innovation deployed:
  • Technology-enabled new model of care: 3D wound imaging & information system - Silhouette®. Enabling routine DFU treatment to be delivered in the community
  • SilhouetteStar camera uses laser-assisted 3D measurement technology to accurately map wound size, enabling clinicians to assess wound progress & response to treatment with objective data
  • Supports reliable, reproducible & remote monitoring & management of patients with active DFU & chronic complex wounds
How?
  • The partners have collaborated to implement the Silhouette® 3D wound imaging system as part of an integrated pathway across both primary & secondary care
  • EMAHSN assisted with the procurement of the system & worked with all partners to get the new pathway implemented in four settings
  • EMAHSN is providing support with the implementation, communications, patient & public involvement, planning & procurement for wide adoption & spread
Impacts / outcomes: 
Impacts to date:
  • Moving 35% treatment sessions to community clinics forecast to reduce DFU service costs by 15- 20%
  • Patient feedback very positive
  • Quality of treatment maintained with opportunities for improvements
  • Secondary applications of digital wound imaging system being explored
  • Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum


Nigel Baggaley - Podiatrist at Ripley Community Clinic


SilhouetteStar Camera


Dr Bruce Davey - CEO ARANZ Medical with SilhouetteStar Camera

        
Which local or national clinical or policy priorities does this innovation address:
Long term conditions: a whole system, person-centred approach
Supporting quote for the innovation from key stakeholders:
Clinical Champion:
Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust said; “This innovative service means patients can be seen and monitored much closer to home, outside of the often busy hospital environment. This is better for the patients and is also easing the pressure on our foot clinic at the hospital."

Service User, Patient Experience: 
Albert Sutton from Kilburn said; “We only live just down the road from the clinic and it saves so much time for us, it is much closer to home than the hospital is, which means we are not spending so much time getting to and from appointments.”
Plans for the future:
Next steps:
The project is being evaluated to confirm the health economic model and business case for spread of the innovation to other locations within and outside the East Midlands.
Tips for adoption:
  • Develop good relationships with all the key stakeholders.
  • Fully define the challenges experienced first, then consider if this is the right solution.
  • Ensure there is a clinical champion.
Contact for further information:
Achala Patel, Managing Director – achala.patel@entechealth.com
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Achala Patel 02/03/2017 - 12:43 Approved
Overview summary:
Four years ago Wandsworth CCG embarked on their Referral Management Programme and chose Kinesis as one of the core elements supporting it.
In 2015 Kinesis was used to seek advice on 3639 patients by GPs from across the CCG. The advice they received from specialists at their providers resulted in 1700 of these patients avoiding an outpatient referral & receiving faster access to appropriate treatment. They also saved over £300,000 in referral costs. Since then 6 further CCGs to adopt Kinesis and are beginning to see the same benefits.
Challenge identified and actions taken :
The average cost of an outpatient clinic referral is around £204.
In 2009 the problem associated with increasing referrals was reported by NHS Institute for Innovation & Improvement (Delivering Quality and Value - Focus on: Productivity and Efficiency. April 2009); evidence presented showed that “up to 65% of patients attending outpatient specialty clinics are discharged with no significant pathology being detected”.
NHS Midlands & East reported (Confer: End of Pilot Report 2012) “marked and ongoing increases in outpatient referrals” (13% during 2008/09 HES online) and discussed the demand management challenge for primary care commissioners and acute trusts. The trend has continued with 13.6m GP referrals in 2015, a 5% rise on the previous year.
Continued pressure on outpatient clinics due to increased demand, and the necessity of decreasing the time to appropriate treatment in order to minimise health costs and maximise clinical outcomes lead some organisations to wonder if there were better ways of supporting GPs when making referral decisions.
 
A Kings Fund Report concluded that supporting GPs in their practice to make better referral decisions was the best way forward (Referral Management – Lessons for Success. Candace Imison and Chris Naylor, Kings Fund 2010).
Introduction of Kinesis has begun to adress this
Impacts / outcomes: 
Since adopting the programme was a CCG now have 5 providers supporting over 40 specialties. All GPs in the area are able to request advice about a patient using a secure but simple browser-based application and expect to receive a reply within a day.
Wandsworth are on target to make over 4000 requests for advice this year with 58% of these resulting in a permanently avoided outpatient appointment.
6 further CCGs have adopted the same approach and are beginning to see equally positive results.
Where patients do need to be referred, this is often to the correct clinic with the right information and tests having been completed and, in some cases, an expedited referral since a specialist has effectively triaged the referral and is expecting this particular patient.
The benefits are not restricted to time-saving and cost saving. Patients benefit from greater reduced waiting times for appointments and treatment, and mostly benefit from continuing to be treated in primary care without a burdensome trip to hospital. GPs have responded I favourably to the system and report significantly improve care and treatment options for patients as well as being able to build relationships with their secondary care colleagues. They also report increased knowledge and confidence in their referral practice and this is reflected in the referral data. Meanwhile the specialists avoid their clinics being burdened with unnecessary referrals, ensuring they can spend more time with patients with greater needs; they also report enhanced relationships with their primary care colleagues and the ability to pass on their knowledge and expertise.

The experience at Wandsworth CCG is a sustained 5 to 1 ROI can be achieved within two years, based on avoidance of referral tariffs alone. It is believed (as suggested by the CCGs) an equal amount of savings are experienced across the health economy in terms of improved clinical outcomes, but this is not be objectively measured.
Which local or national clinical or policy priorities does this innovation address:
Referral management and reducing time to treatment
Supporting quote for the innovation from key stakeholders:
  • and there’s now an opportunity for us ALL to benefit from the recent progress
"It's a very well designed and easy to use system that bears no relationship to typical NHS IT"
Sarah Thurlbeck, Consultant Paediatrician, St Georges Hospital
 
"I think you have an impressive system in Kinesis. It's simple and intuitive and  really makes a difference."
Mike Conlon, Service Redesign Manager, Sutton CCG
 
"the issue isn't really about these savings, it's about the improved patient care…"
Dr Nicola Jones, chair Wandsworth CCG
 
Plans for the future:
We are in ongoing discussions with eRS to integrate Kinesis once they have released the APIs that will allow this. We are also aiming to integrate directly with the main primary care systems to make it even easier for GPs to request advice when required.
In the longer term we are looking at using machine learning to provide even quicker suggestions based on the responses from specialists.
However our main goal is to drive up the number of CCGs and GPs using the system and to increase the number of times they seek a conferral rather than a referral.
Tips for adoption:
  • Ensure that you have a dedicated programme manager - change management is harder than technology.
  • Get the support of your local seconary providers - the CEO is good to have on board, but equally find some individual specialist who really want this to work
  • Chase down any requests for advice that take longer than a couple of days to receive a reply - GPs need to have faith in the process.
  • Feedback to users on how much good it is delivering
Contact for further information:
info@kinesisgp.co.uk
or call Simon Hudson on  0773505295
 
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Simon Hudson 25/10/2016 - 17:15 Approved
Overview summary:
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout. The results have shown incredible improvements in physical capacity including a reduced frailty, enhanced mental state following classes and high levels of enjoyment. Patients have reported reduced medication use showing potential for impact for wealth as well as health for the region. 
Challenge identified and actions taken :
There are currently 1 million diagnosed cases of COPD in the UK, and 2 million undiagnosed cases. It is the fifth biggest killer disease in the UK and costs the NHS an estimated £1.2 billion per annum. It is the second largest cause of emergency admissions accounting for one million bed day per year. 
Not only does COPD impact on the health of those with the condition, but it also places huge economical burdens on the NHS. 
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout.
Impacts / outcomes: 
Following the 12 weeks of FABS exercise classes: 
  • 30s sit to stand scores increased by 120%
  • Timed Up and Go times improved by 27% to within the normal age-related range
  • Patient use of medication reduced, including steroids, antibiotics and COPD exacerbation pack 
  • Physical frailty reduced from 'mildly frail' to 'managing well' 
  • Patients reported high levels of enjoyment and social interaction 
Which local or national clinical or policy priorities does this innovation address:
Long-term health conditions
Supporting quote for the innovation from key stakeholders:
Patient quotes:
"I have really enjoyed the classes. This has changed my life!"
"Breathing is easier to control."

Here are some videos that demonstrate the benefits:
https://www.youtube.com/watch?v=lWFBTQGrILY
 https://player.vimeo.com/external/214476540.hd.mp4?s=efd5a41e987f6998e458bfa9f7089f750f605af7&profile_id=119
Plans for the future:
Scale the programme nationally and adopt for other long term health conditions such as diabetes, frailty.
Tips for adoption:
This programme can be delivered in GP surgeries where room allows, or in local community centres which are easily accessible.
Contact for further information:
Joe Robinson 
0800 612 7785
joe@moveitorloseit.co.uk
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Joe Robinson 19/10/2016 - 18:39 Approved
Overview summary:
The review of mortality within health care settings is a long established tool for quality improvement. There is no agreed methodology or standardised measure and no national mortality measures for community hospitals.
Challenge identified and actions taken :
In 2015 I set the task for all deaths in community hospitals will be reviewed to learn about the quality of care provided to patients and in year added for all unexpected deaths for patients outside of community hospitals will be reported and reviewed by our Mortality Review Group (MRG).
Impacts / outcomes: 
Our team have developed a mortality trigger tool that allows a review of any death and then grades it according to NCEPOD style grading. The tool has been refined over the past 12 months by front line clinicians and allows us to analyse our mortality data as well as use the tool as part of MDT case reviews. We have gone from reviewing 48% of deaths by a labourious paper based system in 2013-14 to 98% for 2015-16 with the current version of the the tool. The CCGs and Trust Board are much more assured about the quality of care and analysis of our mortality data. 
Which local or national clinical or policy priorities does this innovation address:
Reducing avoidable harm
Supporting quote for the innovation from key stakeholders:
To be added - we have just had a review of our mortlaity processes from the CQC and await their assessment which will be added to this page in due course
Plans for the future:
We are looking to develop a mortality tool for use in community non-bed based settings. 

If anybody is interested in using the tool then please contact myself, the WMAHSN or James Turner at MidTECH innovations (www.midtech.org.uk).

 
Tips for adoption:
This requires a sense of purpose, a defined end point, a vision and people committed to learn from mortality and quality improvement.
Contact for further information:
Dr James Shipman, Medical Director SSOTP
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James Shipman 11/08/2016 - 17:25 Approved

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