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.
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Innovation (Approved)

Overview summary:
Brush DJ is an app designed to motivate children to have an effective oral hygiene routine by making tooth-brushing fun! The main feature of the app is a timer, which plays 2 minutes of music taken at random from the user’s device or cloud. The app also contains the evidence-based oral health information given in the Public Health England document ‘Delivering Better Oral Health’.  Reminders can be set to prompt at least twice a day brushing, when to change toothbrushes and visit the dentist.   
Challenge identified and actions taken :
Approx 26,000 children are admitted to hospital each year (England) to have decayed teeth extracted under general anaesthetic, the most common reason for children between 5 & 9 to be admitted to hospital. At least 50% of NHS dental budget is spent on treatment of preventable disease c.£1-1.5bn p.a. (England) with £30m spent on hospital tooth extraction for children aged under 18, these costs don’t include loss of income/productivity for parents/carers & lost school hours or the psychological cost of treatment to all involved.
 
The Brush DJ app is free (no in-app purchases or adverts). Videos showing how to effectively use a manual toothbrush, floss & interdental brush can be watched for free on YouTube. Using an app to raise awareness of evidence-based oral health information has financial advantages over methods such as leaflets as there is no printing, storage, distribution cost associated with an app. Apps are instantly scalable & updatable with the cost of producing one app being the same as any multiple, unlike a physical product. Because an app can use local reminders generated by the app itself they have an advantage over text message reminders, which have been used to motivate better oral health.  
Impacts / outcomes: 
The Brush DJ app has been already been downloaded in 193 countries on to 246,000 devices and received mainly 5 star reviews in the app stores https://itunes.apple.com/us/app/brush-dj/id475739913?mt=8 https://play.google.com/store/apps/details?id=uk.co.appware.brushdj&hl=en .  Diffusion of the app can be measured by the number of downloads it achieves.

The main measure of success of the Brush DJ app at a population level will be if there is a fall in the number of decayed, missing or filled teeth reported in the Nation Dental Epidemiology Programme for England, oral health survey of five-year-old children and a reduction in the number of children attending hospital for tooth extraction under general anaesthesia.

The information given in the app comes from the Public Health England document ‘Delivering Better Oral Health – an evidence-based toolkit for prevention’ https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention . PHE have reviewed the app and have no concerns.

The next step in the development of the app will be to include software to measure when users open the app, how long they stay on each screen and if they uninstall the app. The data obtained from this would be used to improve the user experience.

Research is soon to begin to measure the effectiveness and cost effectiveness of the app in comparison to traditional methods to motivate an evidence-based oral hygiene routine in children. This will involve a randomised control trial comparing the app to traditional methods by monitoring levels of plaque on children’s teeth in the short and long-term.
Which local or national clinical or policy priorities does this innovation address:
Wellness and prevention of illness.
Supporting quote for the innovation from key stakeholders:
The City of York council has started to promote the app in children’s centres and reception classes. http://www.yorkpress.co.uk/news/14306759.Free_dental_packs_for_York_children__as_city_tries_to_tackle_shocking_child_tooth_decay_figures/?ref=fbshr
Plans for the future:
The next step in the development of the app will be to include software to measure when users open the app, how long they stay on each screen and if they uninstall the app. The data obtained from this would be used to improve the user experience.
 
The main barrier to scaling the app is lack of awareness – this could be reduced by all those involved in health in the WMAHSN region actively promoting the app at every contact with patients and the public who would benefit from using it - making every contact count.
 
I have recently been appointed as one of the inaugural NHS Innovation Accelerator fellows http://www.england.nhs.uk/ourwork/innovation/nia/ to try to get the app adopted at a scale and pace in the NHS. With the programme comes a bursary which is being used to improve the app and raise awareness.  To make the app sustainable in the future funding will be needed to cover the cost promoting and maintaining the app.
 
Research is soon to begin to measure the effectiveness and cost effectiveness of the app in comparison to traditional methods to motivate an evidence-based oral hygiene routine in children. This will involve a randomised control trial comparing the app to traditional methods by monitoring levels of plaque on children’s teeth in the short and long-term. 
 
The main measure of success of the Brush DJ app at a population level will be if there is a fall in the number of decayed, missing or filled teeth reported in the Nation Dental Epidemiology Programme for England, oral health survey of five-year-old children and a reduction in the number of children attending hospital for tooth extraction under general anaesthesia.
Tips for adoption:
The City of York council has started to promote the app in children’s centres and reception classes. http://www.yorkpress.co.uk/news/14306759.Free_dental_packs_for_York_children__as_city_tries_to_tackle_shocking_child_tooth_decay_figures/?ref=fbshr
Contact for further information:
Ben Underwood - ben@brushdj.com
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Ben Underwood 19/05/2016 - 10:57 Approved
Overview summary:
WIN is a group of professionals and enthusiasts passionate about utilising digital technology to improve the healthcare. It collates information and provide guidance on health informatics solutions. It facilitates discussion forums through social media, website, workshops and conferences to discuss and disseminate learning around priority areas in health informatics. We will also support educational initiatives to enhance health informatics knowledge and research programmes that will transform the delivery of healthcare services.
Challenge identified and actions taken :
Despite an initial surge in membership of clinicians and academics following the development of the network, growth decreased considerably. In order to address this, steps were taken to ensure that the reach of WIN extended beyond those initially deemed relevant:
 
  • Widened geographic reach to include and individuals / organisations that may wish to do business within the West Midlands
  • Increased industry engagement to include different forms of health provision
  • Increased local authority engagement to address aspects of integrated health and care
  • Development of public sector, industry and academic databases for targeted communications
  • Updated Advisory Group terms of reference to incorporate multi-stakeholder representation
  • Formalised policies and processes, with professional marketing material.
Impacts / outcomes: 
  • A continually growing membership of 644 members as of December 2015
  • A dedicated website with online discussion forums and events
  • Active engagement from the informatics community across healthcare, academia and industry
  • A health informatics educational needs assessment has been undertaken
  • An elected advisory group now established
  • Significant reputational benefits to WMAHSN by successful, well-attended regional events and presentation at national events, including EHI Live
  • Over 250 attendances at WIN events in 2014/15: WIN National Conference in December 2014 with 81 delegates, WIN industry event in January 2015 with 78 delegates and 95-100 attendees at the November 2015 event
  • Raised profile through membership and social media presence (Twitter, LinkedIn).
Which local or national clinical or policy priorities does this innovation address:
Harnessing the Information Revolution
Supporting quote for the innovation from key stakeholders:
Professor Theodoros N. Arvanitis, Head of Research, Institute of Digital Healthcare, WMG, University of Warwick and Co-Director of the Digital Theme, West Midlands Academic Health Science Network: “The West Midlands Health Informatics Network (WIN) is passionate about health service improvement, education and research in the health informatics domain. Our aim is to support the NHS and affiliated healthcare organisations in adopting information technology solutions in order to provide effective, efficient and high quality healthcare for patients/carers. We do this by connecting health informatics experts, professionals and enthusiasts across geographical, organisational and professional boundaries to work towards the goal of achieving in West Midlands and beyond. This is an independent network, with a culture of reciprocity, mutual respect, sharing good practice, support, equal access and shared responsibility.”
Plans for the future:
  • New website to allow members to access knowledge and expertise within the network.
  • Consideration of implications of digital health / justice
  • Increased networking activities to promote best practice and innovation.
Contact for further information:
Theo Arvanitis
t.arvanitis@warwick.ac.uk 
02476 151341
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Sarah Millard 28/01/2016 - 17:42 Approved
Overview summary:
The co-occurrence of mental and physical health problems is common, leading to poorer health outcomes and increased healthcare costs. Birmingham and Solihull Mental Health NHS Foundation Trust developed the model for liaison psychiatry services as a pilot in Birmingham. The Liaison Psychiatry multi-disciplinary team assesses A&E attendees/inpatients 24/7 who might have mental health problems, and provides e-training. There is now a service in every hospital in Birmingham and Solihull and 27 organisations nationwide have taken up the service. 
Challenge identified and actions taken :
The co-occurrence of mental and physical health problems is very common among patients, often leading to poorer health outcomes and increased healthcare costs. People can face lengthy waits before being referred on to the relevant service.
 
Birmingham and Solihull Mental Health NHS Foundation Trust developed the model for liaison psychiatry services in December 2009 as a pilot in City Hospital in Birmingham, with an investment of £0.8 million. The Liaison Psychiatry team, comprising nurses, psychiatrists, psychologists and physicians assistants, will promptly assess anyone 24/7 attending A&E or who is a hospital inpatient, who might have mental health problems.
 
The Liaison Pschiatry network, which is supported by WMAHSN, was established to strengthen links between Liaison Psychiatry  services to facilitate collaborative working on research and innovation projects, facilitate adoption of the model and improve and expand the overall service provided by Liaison Psychiatry across the NHS. 
Impacts / outcomes: 
  • Following the success of Liaison Psychiatry in City Hospital, the trust now has a Liaison Psychiatry service established in every acute hospital in Birmingham
  • 27 organisations nationwide have now taken up Liaison Psychiatry
  • In its 2014 document Achieving Better Access to Mental Health Services by 2020, the Department of Health highlighted strong evidence that the model can deliver clinically and cost-effective care to patients with a range of mental health problems
  • A paper published in The Psychiatric Bulletin (2013) uses data from admissions to all 600 beds in City Hospital between December 2008 and July 2010. The paper showed that the main direct effect of the model was on time to readmission:
  • The rate of readmission in the Liaison Psychiatry group was four for every 100 patients, while in the pre-Liaison Psychiatry group it was 15 for every 100
  • Including the Liaison Pschiatry-influence group, the total reduction in readmissions is estimated to be 1,800 over 12 months. This equates to a saving of 8,100 bed-days per year
  • There is also a strong indirect effect resulting from the broader influence on those not referred to the service, in the form of reduced lengths of stay: the Liaison Psychiatry-influence group demonstrated an average length of stay 3.2 days shorter than that of the pre-Liaison Pschiatry group. This corresponds to a total saving of 13,935 bed-days per year
  • The Liaison Psychiatry model is estimated to save between 43 and 64 beds per day, which is equivalent to two-three wards
  • Most of the savings were accrued by geriatric wards
  • The study estimates the potential savings to be £4-6 million per hospital by reducing both admissions and length of stay
  • The service won a prestigious HSJ Award for innovation in mental health in 2010
  • Liaison Psychiatry was highlighted in 2011 in an NHS Confederation Mental Health Network briefing paper which documented the benefits of liaison psychiatry
  • An independent economic evaluation of the original Liaison Psychiatry service was produced by the London School of Economics and Centre for Mental Health in 2011
  • Liaison Psychiatry was cited in an a 2012 HSJ article, “Liaison psychiatry can bridge the gap”
  • An economic evaluation of the Liaison Psychiatry roll-out across Birmingham was produced in 2013 by the local Commissioning Support Unit, Midlands and Lancashire CSU
  • Further liaison psychiatry service guidance which discusses the range of potential models was produced for the South West Strategic Clinical Network for Mental Health, Dementia and Neurological Conditions in 2014
  • A review was commissioned from the University of Birmingham’s Health Services Management Centre, with six West Midlands implementation sites involved (2015)
  • Dementia and self-harm e-learning, tailored for acute trust staff, has been delivered to more than 60 staff in each module across two acute trusts
  • A national Liaison Psychiatry Network has been established to support organisations and individuals who are using or planning to use Psychiatric Liaison models. To date two meetings have been held, the second of which had Geraldine Strathdee, National Director for Mental Health, as a key speaker. The Liaison Psychiatry network’s first event attracted delegates from across the region, along with people from across England and the wider UK. 61 people from 24 organisations attended the first event, and 64 people from 31 organisations registered for the second event. In total, representatives from 41 different organisations registered to attend, with 17 new organisations coming to the second event. This has created a mechanism for sharing best practice for liaison services nationally. In addition, the network’s long term funding has been secured by BSMHFT in partnership with East London NHS Foundation Trust
  • The national Liaison Psychiatry Network is supported by a website and newsletters
  • Two academic organisations, two acute trusts, two mental health trusts and three industry bodies were involved in project delivery.
Which local or national clinical or policy priorities does this innovation address:
• This is a priority area for the government, with a £30 million targeted investment in effective models of liaison psychiatry in more hospitals announced in October 2014 as part of its aspiration to put mental health care on an equal footing with physical healthcare • The NHS Five Year Forward View emphasises proper funding and integration of mental health crisis services, including liaison psychiatry.
Supporting quote for the innovation from key stakeholders:
John Short, Chief Executive at Birmingham and Solihull Mental Health NHS Foundation Trust, said: “Liaison Psychiatry has a track record of improving quality of care for patients and also saving money and has been independently evaluated and highlighted nationally as a best practice model for liaison psychiatry. We are delighted to host this network in order to bring together teams from across the NHS to share knowledge and learning and further develop and improve the model for the future.”
Plans for the future:
The Liaison Psychiatry review will be used to drive consistency and to support the tailoring of Liaison Psychiatry services regionally, to local needs and context while remaining true to the core principles which enable successful delivery. 
Tips for adoption:
  • Innovative new approaches can make an important contribution to improving outcomes and relieving pressures on other parts of the health system – but there are unlikely to be ‘magic answers’ or panaceas. Even where a new model appears to have significant early success it is unlikely to be something that can simply be imported/bought in in order to solve all problems locally
  • Many participants felt that Liaison Psychiatry had delivered (or had the potential to deliver) real benefits. However, the way in which Liaison Psychiatry was planned, resourced, staffed and supported were perceived to be key factors influencing its success
  • New services do better when they receive the support of senior managers and where the service is sufficiently resourced – a number of participants talk of a ‘critical mass’ that was needed to instigate real change
  • Liaison Psychiatry was more favourably evaluated by participants when services included a focus on older adults and where the service addressed the needs of inpatients, in addition to having a role in reducing waiting times in A&E
  • The Liaison Psychiatry service, designed to operate across a number of different services, could not be sufficiently evaluated by using single outcome measures i.e. reduced waiting times or cost savings
  • New models are designed in a specific way for a reason, and there needs to be a degree of fidelity to the underlying model if the successes of early service models are to be replicated. Only partially implementing a new approach is unlikely to work. Certainly, those Trusts that have taken the model and implemented only a proportion of the new approach shouldn’t be surprised if it doesn’t deliver what a full model might
  • At the same time, new ways of working need to be designed and implemented in ways that are appropriate within the context of existing local services, personalities and relationships. This means that models cannot be imported wholesale, but that there is a legitimate process of adaptation (which may take time to plan and implement)
  • Taken together, the two bullet points above suggest a tricky balance between being clear on/remaining true to the key elements of a successful model, whilst also being flexible about how best to implement in different local contexts. Adaption of the model needs to be mindful of existing services that are in operation and of local populations
  • ‘Soft’ outcomes matter too – even if they are harder to measure. It may take time for all outcomes to be produced because of “teething difficulties” as a service establishes itself and because an attitudinal change towards mental health is hard to achieve
  • Paying attention to practicalities is important (for example, access to IT and appropriate accommodation/space near to linked services). In order to have an integrated service, teams need to be physically close to each other and be able to access joint notes
  • Developing new ways of working takes time, and is as much about developing new relationships as anything else. By definition, liaison is a two-way process, and attention needs to focus on the host organisation as well as on the new service
  • Above all, we need to be clear about the outcomes we are trying to achieve by looking to a new service. Improving patient experience is a different type of outcome from trying to hit a 4-hour access target, which is different again from raising awareness of mental health issues amongst hospital staff, facilitating swift discharge, preventing readmissions and/or freeing up staff time to focus on other priorities. While it may be possible for one approach to do a number of these things at once, being clear about what success would look like seems to be an important precursor to knowing whether or not something has actually succeeded in practice.
Contact for further information:
Katie Saunders
katie.saunders@bsmhft.nhs.uk
0121 371 8061
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Sarah Millard 28/01/2016 - 17:36 Approved
Overview summary:
Newcastle upon Tyne Hospitals worked with North of Tyne Local Pharmaceutical Committee (LPT) and Pinnacle Health to develop an electronic referral template using PharmOutcomes. Hospital pharmacy staff used the system successfully in the North of Tyne area to refer patients to their community pharmacist if considered beneficial after leaving hospital. 
Challenge identified and actions taken :
Evidence shows that 5-8% of unplanned admissions are due to medication issues and when patients are prescribed a new medicine, a third are non-adherent after 10 days and 30-50% of medicines are not taken as intended.  However on-going community pharmacist support has been shown to improve medicines adherence. 
In an attempt to improve medicine adherence, improve patient safety and improve patient outcomes, Newcastle upon Tyne Hospitals worked with North of Tyne Local Pharmaceutical Committee (LPT) and Pinnacle Health to develop an electronic referral template using PharmOutcomes. Hospital pharmacy staff used the system successfully in the North of Tyne area to refer patients to their community pharmacist if considered beneficial after leaving hospital. The AHSN NENC supported the development and implementation of this framework across the region. The project is now gaining traction nationally.
Impacts / outcomes: 
Through active communication and participation in the national AHSN Medicines Optimisation network this work has been established as an exemplar model of communication between secondary care and community pharmacy.
  • Seven acute trusts are now making referrals to a potential 504 community pharmacies for follow up support with their medication after discharge from hospital;
  • Over 750 patients have received follow up support since the initiation of this service in July 2014;
  • Community pharmacists have reported nearly 90% of patients had a better understanding of their medicines as a result of their consultation and would be therefore more likely to adhere to their prescribed medicine regimes.
  • The project team have won two prestigious HSJ awards in 2015, in the categories for  ‘Enhancing Care by Sharing Data and Information’ and ' Most effective adoption and diffusion of best practice'
  • The work has directly contributed to the production of a Hospital referral to community pharmacy toolkit, distributed nationally by the Royal Pharmaceutical Society;
  • The Transfer of Care work initiated in the AHSN NENC has attracted national interest and has been adopted in a number of areas throughout the country.  
Which local or national clinical or policy priorities does this innovation address:
Health and well-being; patient experience.
Supporting quote for the innovation from key stakeholders:
At the HSJ Awards the project was described by judges as a "beautiful, simple solution that works...developed by clinical leaders who saw potential in existing functionality". The judges went on to praise how the Trust “genuinely demonstrated adoption and diffusion of innovative practice across the region” and that "Every hospital should be doing this."
Plans for the future:
  • Outcome measures collected through PharmOutcomes will help inform the direction and development of the project.
  • Further rollout of the project nationally will continue
  • The e-referral system is being further developed to involve GPs, doctors and nurses as well as pharmacists.
  • Development of Trust systems will facilitate the auto-population of the referral form, further speeding up the process.
  • The evidence base will be further enhanced through publication to the BMJ of research being undertaken by academics at Durham and Manchester Universities.
Tips for adoption:
Trust staff need the buy-in of community pharmacies.
The NENC region uses PharmOutcomes for E-referral and it helps if systems are complementary across regions but this is not a pre-requisite for the methodology to be adopted across Trusts.
Contact for further information:
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Anonymous 22/01/2016 - 12:52 Approved
Overview summary:
This Programme will support primary care to reduce the burden of AF-related Stroke in our population through achieving the following clinical aims: Where appropriate, to increase rates of anticoagulation use in AF patients identified as high risk of AF-related stroke not currently receiving appropriate anticoagulation; Optimise anticoagulation of AF patients unstable on Warfarin through transfer to NOACs where appropriate.  The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Challenge identified and actions taken :
The UK sees 150,000 strokes per year of which 20% are attributable to AF (Ball 2013) giving a figure of 30,000 AF-related strokes. Extrapolating the results from phase one may result in approximately 15% fewer strokes in high risk patients across the UK.
  • Quality Improvement: Create an approach that will enable clinicians to re-evaluate how identification, diagnosis and treatment occurs and consider NOACs alongside traditional anticoagulants
  • Strategic: Create an approach that will enable a CCG to sustainably drive implementation of the above (including appreciation of risks (financial and otherwise) of implementation).
Impacts / outcomes: 
Phase One: Across eleven partner practices in phase one, 2,688 patients with AF were identified. Of these, 335 patients were rated as being at ‘high risk’ (i.e. had a CHA2DS2Vasc score of greater than one); over a three-month period, 131 patients were reviewed with regard to optimising their management.

As a consequence, it has been estimated that between five and six strokes were prevented over this period.

Investigations into the potential financial implications of a stroke have suggested an associated cost of £23,315 per stroke (National Audit Office, 2010).  Applying this principle to the findings of the innovator phase could suggest costs between £116,575 and £139,890 may have been avoided.
Which local or national clinical or policy priorities does this innovation address:
Enhancing quality of life for people with long-term conditions
Supporting quote for the innovation from key stakeholders:
The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Plans for the future:
 It is anticipated that accredited online training resources will be available by Q1 16/17.
Tips for adoption:
Project management resource; CCG Leads (clinical; managerial; pharmacist); Other CCG support (comms; finance; project sponsor; primary care team); Resource to deliver training (clinical updates and quality improvement); quality improvement mentoring and coaching; caseload audit resource; availability of practice support pharmacists to work with practices; informatics (to enable quantitative evaluation of impact). Online tools to support patients and practices in shared decision-making, implementing a quality improvement project are already available.
  • Clinical Champions (both at strategic and project level)
  • Modelling of Health Economic impact of adoption
  • Building a community of practice (with regard to both clinical case for change, as well as creating a shared language and experience underpinning the quality improvement element)
  • CCG also included this clinical area in their primary care offer.
It is critical that the health economic impact of the project and associated changes in prescribing costs should be explored with each CCG during initiation. We have a local health economic modelling tool that could be adapted to suit local needs.
Contact for further information:
Anna Burhouse, Director of Quality (anna.burhouse@weahsn.net) Stephen Ray, Programme Manager (stephen.ray@weahsn.net).

www.dontwaittoanticoagulate.com; Phase one evaluation (full version and executive summary) available; Health economic modelling tool.
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Joanne Mewis 20/01/2016 - 13:48 Approved
Overview summary:
The Solihull Approach, an NHS based team of health professionals, have developed an exciting online course for parents, carers and professionals. ‘Understanding Your Child’ includes 12 modules (20 minutes each) and follows 5 other families. The focus of the course is  how our emotions affect our relationships and behaviour. It looks at brain development, play, styles of parenting, sleep, temper tantrums, communication and more and is based on the nationally and internationally acclaimed face to face course.
Challenge identified and actions taken :
Unlike antenatal support, there is a stigma around accessing parenting support.
We know a great deal about preventing mental health problems in future generations. We know that the brain develops in response to its environment and is especially sensitive to the quality of relationships with caregivers, particularly in the first three years of life.
There is “floor to ceiling” evidence that intervening early and preventatively pays both economically, emotionally, and cognitively and achieves life long impact.
A trial of universal parenting support was undertaken by the coalition government (CanParent trial 2012-15). The Solihull Approach was a provider in the trial. The range of courses on offer were very popular with those who took them but the trial reached only a fraction of the intended audience, less than 3000 out of an intended 20,000. A CanParent survey revealed that most 98% of parents would be interested in a course, but the difficulty is accessing one.
The Solihull Approach developed the online coures in response to this finding.
The Solihull Approach face to face course and online course were  the first in the country to be awarded the DfE’s Quality Mark.
The Solihull Approach is offering multi-user licences to corporates, schools, NHS trusts, local authorities, public health, and prisons.
 
Impacts / outcomes: 
Data analysed so far: 121 parents highly significant reductions in conflict and increases in closeness in the relationships between the parents and their children on the two subscales and overall score on the Child Parent Relationship Scale (Pianta, 1992).
Published research demonstrating effectiveness of face to face course:
 
  • Johnson, R., Wilson, H. (2012) Parents’ evaluation of Understanding Your Child’s Behaviour, a parenting group based on the Solihull Approach. Community Practitioner, 85: 5, 29-33.
  • Vella, L., Butterworth, R.,  Johnson, R.  and Urquhart Law, G. (2015) Parents' experiences of being in the Solihull Approach parenting group, ‘Understanding Your Child's Behaviour’: an interpretative phenomenological analysis. Child: Care, Health and Development 41:6, 882–894.
  • Baladi, R., Johnson, R., and Urquhart Law, G. (in progress) A pre, post and follow-up evaluation of Understanding Your Child’s Behaviour (UYCB): A parenting group intervention based on the Solihull Approach. Child: Care, Health and Development.
Which local or national clinical or policy priorities does this innovation address:
National Institute for Clinical Excellence (NICE) Guidelines for conduct disorder: ‘Antisocial behaviour and conduct disorders in children and young people: recognition and management’ NICE guidelines [CG158] Published date: March 2013 http://www.nice.org.uk/usingguidance/sharedlearningimplementingniceguida...
Supporting quote for the innovation from key stakeholders:
“The most amazing and immediately life changing course I have ever been on! And that’s after 5 years in childcare!” (Parent)
“Really enjoyed doing it and found it useful. Yes it made a difference. Was going to make a referral to the MAT team. Children's behaviour problematic at home, being managed at school, but a problem. Saw an improvement after the parent took the course. We could see a difference in school. Children much, much better. The mum was being more positive, a bit more confident, she seemed able to see things from their point of view, and had  changed the way she spoke to the children.” (Pastoral Lead at a Primary School)
 
Plans for the future:
To engage with corporate partners, health, education and social care. Develop implementation kits  to assist organisations to launch the course to employees and customers. Reach the whole population thereby elevating the emotional wellbeing of future generations.  
 
Tips for adoption:
Multi-user licences are available. Implementation kits are in development.
 
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Rebecca Johnson 11/01/2016 - 17:43 Approved
Overview summary:
By negotiating a new business model with our laundry service provider, we were able to introduce a more dignified patient robe, as well as make a cost saving on laundry. This new arrangement could now be exploited by other organisations wishing to improve on patient dignity.
 
Challenge identified and actions taken :
Patients undergoing imaging are asked to undress and wear a traditional hospital robe. This ensures no metal is present in the MRI scanner, and that quality images can be achieved without any artefacts.
The robe ties around the patient, but does not completely cover the naked skin. Patients have complained about their loss of dignity. To address this, patients are offered two robes; one to tie around the front, the other round the back. However, this creates two new issues. Firstly, patients with restricted mobility find it difficult to tie fastenings around their back. Secondly, use of two robes per patient doubles our laundry costs.
As per our innovation development process, we searched the market to see what solutions may already exist. The 3-armed robe was identified as the best choice. This design ensures patients are completely covered. There are no fastenings; closure is provided by the garment having three arms (see attachements). Walsall Healthcare NHS trust had already introduced these robes and reported good patient feedback, so we decided to adopt the same. It was not viable for us to purchase the robes outright and then pay out again for the special return-to-sender laundry service.  Instead, we needed to negotiate a new business model with our laundry service provider. 
Impacts / outcomes: 
Since HEFT is a large trust, the large volumes required for the imaging services meant that it made good business sense for the laundry service provider to have the robes manufactured, and then provide them to us on the usual rental basis. The improved design enables us to provide each patient with one robe rather than two, and so as well as improving the dignity of our patients, we have also achieved a cost saving on laundry. We are waiting for delivery of the new robes and anticipate the same positive feedback experienced by our neighbour.
Which local or national clinical or policy priorities does this innovation address:
Adoption of innovation
Supporting quote for the innovation from key stakeholders:
Patients attending Walsall Healthcare NHS Trust have said they much prefer the three-armed gown because it allows their dignity to be preserved.
 
Plans for the future:
Our large volume requirement (purchasing power) has enabled the laundry service provider to source a manufacturer and provide the robes to us on a rental basis. Other trusts wishing to improve patient dignity can now benefit from this arrangement.
Tips for adoption:
Whilst the majority of patients put the robes on correctly, it may be useful to provide patients with photographic instructions. 
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Vicki Ensor 08/01/2016 - 14:26 Approved
Overview summary:
Technology Enabled Care Services (TECS) can transform the way people engage in and control their own healthcare. One method is Florence Simple Telehealth (Flo), a mobile phone text service. WMAHSN has supported Flo as an exemplar of technology in healthcare, providing resources and training for participating organisations.
Challenge identified and actions taken :
The UK’s diversity means that traditional methods of communication between clinician and patient are changing. Technology Enabled Care Services (TECS), such as telehealth and self-care apps, have the potential to transform the way people engage in and control their own healthcare, allowing citizens to monitor their health and activity levels by themselves, so the need to take up valuable clinician time is no longer necessary. One TECS method is Florence Simple Telehealth (Flo), a mobile text service to communicate with patients. A free mobile texting service, it is easy to use and was designed by NHS professionals to provide support and advice for patients to manage their own health conditions. Flo give prompts and advice and helps to monitor vital signs. Flo is being promoted to the whole population of West Midlands via all 22 CCGs and some acute and community trusts, alongside other forms of TECS:
  • CCG intelligence packs
  • Staying Independent online checklist
  • apps (COPD, asthma and diabetes type 2)
  • Skype and social media online toolkits (with some direct expert support)
  • general awareness of Flo with some support and resources for COPD and asthma.
Impacts / outcomes: 
  • Integrated care development continues across participating organisations and now with other interested organisations e.g. interest from community pharmacies in Flo protocols to support the delivery of their New Medicines Service and Medication Use Reviews to support patients, better medicines optimisation and improved patient experience, and avoided healthcare usage
  • A vision of how TECS underpins integrated care has been published (Tackling Telehealth 2) which describes different definitions of integrated care and how Flo and other TECS fit in. The draft paper received broad acknowledgment from clinicians around the country and key TECS leads at NHS England. This paper covers the transformative role that TECS can play in creating integrated health and social care systems based around the patient
  • Since organisations (CCGs/trusts) took out WMAHSN-related project licences - between April 2014 and March 2015 - 2,489 patients had signed up to Flo, with some CCGs and trusts initially piloting Flo on Stoke-on-Trent CCG’s overall Flo licence prior to their own project licence being funded
  • The service hosted events across the West Midlands region - Stafford, West Bromwich, Coventry, Shrewsbury and Worcester - to raise awareness of the range of technology that can support common long term conditions, including COPD, asthma and diabetes, and redress adverse lifestyle habits, using social media, apps, Skype and telehealth. The events were aimed at general practice teams (practice managers, practice nurses and GPs), CCGs and acute and community trust staff. The events covered creating TECS in the NHS and digital delivery in workplace. The events were attended by more than 200 delegates from a wide range of health professionals, GPs, practice nurses, CCG managers and trust representatives. The project team was also pleased to have received the support from the Managing Director of the WMAHSN, who attended the Shrewsbury event
  • Heart failure (HF), diabetes and community pharmacy Flo protocols are ready for use. The HF protocols are related to an integrated care project between acute and primary care to upskill GPs in the titration of HF medication. Flo protocols have also been developed with a mental health trust and are now being deployed for pre-vascular dementia, mood management and depression. Pilot protocols being evolved or used are pre-bariatric surgery weight loss, multiple sclerosis, community and secondary care pharmacies– new medicine and medication review services, wound fluid discharge, enuresis and informal carers’ stress.
  • There is a wealth of additional interest and further innovations:
  • primary care interest in proactive/preventative monitoring of acute HF patients through monitoring of patient submitted data, blood pressure, weight etc.
  • wound fluid discharge monitoring in a community setting, alleviating time for clinician to attend patient home purely for this purpose
  • acute pharmacy interest in stratifying patients through A&E attendance due to medication issues and using Flo to support the patients with their medicines regime for a period of time post discharge
  • anxiety/stress management for carers to support their wellbeing, therefore reducing the chance of failure of care
  • Matched funds from Stoke-on-Trent CCG has supported the evolution of the TECS Staying Independent Checklist, a resource to allow health and social care and other professionals, during assessment of an individual’s support needs, identify what TECS are available and suitable for them
  • Organisations are keen to learn about broader work around TECS and the programme provides a good opportunity to share, promote and relate learning including Skype, child and adult asthma avatar apps, the TECS referral pathway and other WMAHSN projects including STarT Back, the Manage Your Health app and COPD primary care training, so the Flo programme has developed a wider TECS scope
  • The extensive networking undertaken created further interest, links and opportunities in the Flo exemplar project and related TECS
  • The capture of patient outcomes has been included in the evaluation with standard feedback captured at point of patient sign up to Flo and at termination and determined points in the Flo protocols.
  • The team is also working with each participating organisation to capture and evaluate their patient case studies to build a body of qualitative evidence to share and use to promote further the benefits of Flo
  • The Flo data will be used to review patient adherence to protocol/pathway and, dependent upon the LTC, determine any sustained patient outcomes e.g. blood pressure, improved inhaler use
  • There is a focused evaluation underway.
Which local or national clinical or policy priorities does this innovation address:
From the NHS Five Year Forward View: • Incentivising and supporting healthier behaviour • Targeted prevention • NHS support to help people get and stay in employment • Empowering patients • Out-of-hospital care needs to become a much larger part of what the NHS does • Services need to be integrated around the patient • We should learn much faster from the best examples, not just from within the UK but internationally • As we introduce them, we need to evaluate new care models to establish which produce the best experience for patients and the best value for money.
Supporting quote for the innovation from key stakeholders:
Jeff, Flo service user: “FLO resembles a friendly, good natured and trusted member of the family. I feel more able to cope and more confident about the future. Most importantly, it helps me cope with my situation.”
 
Sarah, Lead Nurse for respiratory medicine (general practice): “The app has excellent content, is quick to download and ensures patients have their asthma management plans with them all the time, rather than at the back of a drawer. Inhaler technique is key to managing asthma and the avatar demonstrates this perfectly. This app could help prevent hospital admissions and deaths.”
 
Dr Ruth Chambers OBE, GP principal, Stoke-on-Trent, Chair, Stoke-on-Trent Clinical Commissioning Group, Honorary Professor, Keele and Staffordshire Universities and Clinical Lead for Long Term Conditions, WMAHSN: “The importance of what we are trying to help teams deliver cannot be overstated. Demands on our services are continuing to increase. Utilising technology will not only enable us to shape services to suit the needs and preferences of individual patients; embracing it will also help us take on the challenges we face every day.”
Plans for the future:
  • To drive person-centred care through the use of TECs (with Flo as an exemplar) to span patient pathways across different healthcare settings with general practice teams and other providers prioritising applications that best meet the needs of their population, at specific points on those pathways
  • To drive regional spread/deployment of  Flo within organisations to disseminate the knowledge and learning achieved from previous deployment and successes to support the move towards a culture shift/perception of TECS for asthma, COPD, medication adherence and hypertension
  • Development of other Flo protocols ready for 2015/16 to support other LTCs beyond the project’s initial launch protocols.  
Tips for adoption:
To take TECS forward at pace we need to:
  • establish and support leaders and champions of TECS throughout the commissioning cycle to communicate the benefits and drive change
  • enable patient and public involvement and engagement
  • use digital modes of delivery such as Skype, telehealth, telecare, teleconsultations or telediagnostics to drive person-centred, integrated care rather than standalone solutions
  • focus digital delivery of care on areas in patient pathways where enhancing self-care has a substantial impact by improving patients’ clinical outcomes and/or reducing avoidable healthcare usage  
  • anticipate consequence costs such as increased frequency of clinician alerts
  • train health and social care professionals: enhance workforce competences and capabilities for the rollout of technology enabled care
  • match the mode of digital delivery of care to suit the patient population – selected mode or individualised for their needs and preferences
  • rigorously evaluate any implementation or trial of TECS and use this information to underpin any future business cases
  • utilise improvement tools to underpin commissioning and service improvement – leadership, transformational change and service redesign
work closely with all stakeholders to integrate technology in care to improve outcomes for all services; redress ongoing issues in constructive ways before progress with rollout is stalled.
Contact for further information:
Dr Ruth Chambers
ruth.chambers@stoke.nhs.uk
0121 371 8061
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Sarah Millard 07/01/2016 - 18:00 Approved
Overview summary:
Capitalising on a successful e-learning programme, we are developing SCRIPT for nurses. SCRIPT is a suite of 15 modules aimed at developing and maintaining professional knowledge and competence relating to medicines. The platform is generating a significant amount of interest and support.
Challenge identified and actions taken :
Medicines are the most common intervention in the NHS, but evidence suggests that the use of medicines in the NHS is often sub-optimal. Medication errors account for 10–20% of all adverse events in the NHS and preventable harm from medicines costs more than £750 million each year. Ten days after starting a new medicine, nearly a third of patients are non-adherent. To address the training needs relating to medicines management/optimisation, SCRIPT is an established suite of web-based e-learning 15 modules, aimed at developing and maintaining professional knowledge and competence relating to medicines. The modules, agreed as a result of feedback at WMAHSN events, have been authored by specialist physicians, nurses and pharmacists in the region and six modules are currently in final production ready for launch. Planned outcomes were a suite of modules to develop and maintain the professional knowledge and competence of qualified nursing staff relating to the safer use of medicines. This work builds on the established SCRIPT e-learning programme available for junior doctors (www.safeprescriber.org). The modules were scoped and developed as part of a collaboration between Coventry and Warwickshire NHS Partnership Trust, the University of Birmingham and OCB Media. 
Impacts / outcomes: 
  • The scale of delivery has already increased from the original proposal, from nine modules to 15 module categories finalised
  • Specialist physicians, nurses and pharmacists in the region have been involved in the authoring of modules
  • Six modules have been launched (UK Medicines Policy, Evidence-Based Practice, Introduction to Pain Management, Pharmacological Pain Management, and Adverse Drug Reactions, Anticoagulation Part 1)
  • Two modules are currently undergoing final edit (Anticoagulation Part 2 and Medicines Management in Care Homes)
  • One module with author for final review (Respiratory)
  • Two modules currently undergoing edit (Dosing and Calculation and Advanced Pain Management)
  • Nursing SCRIPT User Guide drafted
  • The e-learning platform is available online at www.saferuseofmedicines.org
  • As this e-learning will be available to all nurses across the healthcare sector, it is generating a significant amount of interest and support. In addition, interest is being received from academic institutions in the West Midlands that train nurses at undergraduate level as they are keen to ensure that nursing competencies with regards to medication administration are gained prior to entry in clinical practice
  • Working in collaboration with a number of authors from various backgrounds and trusts across the region, SCRIPT has not only built a network of clients but a wider regional interest in drug safety.
Which local or national clinical or policy priorities does this innovation address:
From the NHS Five Year Forward View: • As the ‘stock’ of population health risk gets worse, the ‘flow’ of costly NHS treatments increases as a consequence • Future models will expand the leadership of primary care to include nurses, therapists and other community based professionals. It could also offer some care in fundamentally different ways, making fuller use of digital technologies, new skills and roles, and offering greater convenience for patients • access to GPs or nurses working from community bases equipped to provide a much greater range of tests and treatments. In partnership with local authority social services departments, and using the opportunity created by the establishment of the Better Care Fund, we will work with the NHS locally and the care home sector to develop new shared models of in-reach support, including medical reviews, medication reviews and rehab services. NICE guidance on medicines management, adherence and optimisation.
Supporting quote for the innovation from key stakeholders:
Dr Jamie Coleman, Professor of Clinical Pharmacology and Medical Education, University of Birmingham: “The administration of medicines occurs in all areas of health and social care, many of which are given by nurses and professional carers. Errors that occur at the administration stage are often not intercepted by others, unless the patient notices an error, and therefore this is an important focus for education and training. The SCRIPT project team are excited to be working on new e-learning modules to provide for the Safer Use of Medicines for the region.” 
Plans for the future:
  • Completion of remaining modules
  • The e-learning platform will be promoted regionally in the first instance, with the ability to expand the scope nationally
  • The first six modules will be officially launched by March 2016.
Contact for further information:
Prof Jamie Coleman 
j.j.coleman@bham.ac.uk 
0121 414 3778
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Sarah Millard 07/01/2016 - 16:51 Approved
Overview summary:
A new and innovative telemed system was implemented in order to improve the quality of service offered to ENT patients, as well as to try and reduce unnecessary referrals. The key objectives were achieved. We now plan to initiate discussions with commissioners in order to assess the benefits of using this system in primary care.
 
Challenge identified and actions taken :
Approximately 10% of patients referred to a hospital ENT consultant require surgery; 90% can be managed with medical therapy and/or reassurance and an explanation of their condition. HEFT receives approx. 90 referrals to its ENT service per month, and has a waiting time of 6 weeks, which is typical in England.
The ENT Directorate at HEFT wanted to:
  • reduce the number of unnecessary referrals, and thereby reduce waiting times to see more urgent cases
  • enhance efficiency in healthcare resources using telescopic referrals
  • improve the quality of care it provides to its patients
  • implement care pathways that promote patient-centred care
  • provide cost-effective and secure documentation of digital images
  • support more effective communication at multi-disciplinary team meetings by providing digital images of cases, and thereby reduce the need for patients to attend a specialist referral centre (University Hospital Birmingham)
  • improve medical teaching
The endoscope-i system (www.endoscope-i.com) was implemented for a trial period. This system utilises an iPhone, an endoscope, endoscope adapter and mobile app, and enables videos and images of the ear, nose and throat to be recorded in real-time. The images can then be transferred wirelessly and uploaded securely to the electronic patient record.
Impacts / outcomes: 
The pilot has enabled a number of intangible benefits for both patients and clinicians. Notably, the endoscope-i system enabled an improvement to the quality of the consultation and service provided, as well as enhancing patient safety. As patients are able to view high quality images and videos of their condition, the system has enabled/supported:
  • Reassurance for patients when nothing abnormal was found in their ear, nose or throat, reducing unnecessary repeat appointments
  • Obtaining informed consent for a procedure; patients were able to see the problem and better understand the need for surgery, empowering them to play an active role in the decision-making
  • Emphasis of advice following surgery, for example, the importance of rinsing the nasal cavity; the images demonstrated that this advice was not being followed
  • Capturing images over time has enabled (remote) monitoring and review of disease states, without the need for referral, thereby reducing the amount of referrals to the outpatient department, and saving the patient from the inconvenience and expense of travelling to the hospital (this needs to be quantified).
  • The ability to access stored images remotely, and via videoconferencing, has enabled a more productive multi-disciplinary team discussion of cases; clinicians can see first hand the issue without the need to bring in the patient to the discussion. The risk of misinterpreting sketches, or sketches missing out detail, is obviated.
  • Stored images of the throat of a patient with throat cancer have been used by an anaesthetist to assess suitability for intubation pre-surgery, rather than scoping and creating an airway emergency if the patient is not fit.
Which local or national clinical or policy priorities does this innovation address:
Reducing unnecessary outpatient visits, improving patient experience
Supporting quote for the innovation from key stakeholders:
A patient reported that for the first time in 15 years of attending ENT outpatient clinics, this was the first time he had actually seen a real image of his disease.

 
Plans for the future:
Whilst the system was implemented as a trial, it is now embedded, and there are plans to purchase extra kit so that all ENT doctors can use it. 

We intend to initiate conversations with commissioners in order to test how this system could reduce unnecessary referals to secondary care.
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.
Ensure there is support within the organisation for Apple products.
Contact for further information:
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Vicki Ensor 07/01/2016 - 16:43 Approved

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