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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
The bespoke training programme aims to increase mental health awareness and increase skills in identifying and managing mental health crisis with emphases to referral pathways that can be applied in operational practice by frontline professionals.
Overview of Innovation:
Rapid, Assessment, Interface and Discharge Plus takes a more localised training approach and has identified priority front line services that frequently coming into contact with those suffering from mental illness and potentially at risk of crisis i.e. Police officers and Community healthcare professionals who are working with individuals with both physical and mental health difficulties.

The training aims to increase knowledge and understanding of mental illnesses as well as support early referral and appropriate management of individuals who are experiencing deterioration in their mental health. The overall aim is to build confidence and competence in front line professionals and generate a supportive and informed approach when working with those in mental health distress.

The training modules are as follows:
  • Understanding mental illness: Signs and Symptoms of mental health
  • Effective de-escalation and communication skills
  • Understanding Mental Health Act (1983) and Mental Capacity Act (2005)
  • Crisis Prevention and Management (including risk assessment of suicide and self-harm)
  • Dementia
The training package offers provision to tailor elements of the content to suit the locality’s policy and services available, should organisations wish to implement the training. For example, the 'Crisis Prevention and Management' module explores referral pathways and services available within Birmingham and Solihull Mental Health Trust. These could be easily amended to reflect the organisations services to ensure the training maintains its bespoke, localised approach. The training can be customised but would generally take a full day to cover all modules.

This allows for local frontline professionals that come in contact with mental health patients to be able to identify and prevent patients going into crisis by referring patients to access appropriate mental health support in a timely manner.

The training is delivered by a registered mental health professional to ensure that the full potential of learning amongst participants is achieved. The experience and understanding of such an individual will aid questions posed throughout the training and allows them to draw to from previous experiences/scenarios from real life mental health practice within the delivery.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
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Innovation 'Elevator Pitch':
We connect people with a mental crisis to practitioners using a smartphone in an instant. Irrelevant of culture, language, or geography, instant access to counselling will be swiftly available, affordable and secure.
Overview of Innovation:
The launch of TOSPS (The One Stop Psychotherapy Shop) as an online secure platform from which therapy can be both sought & delivered lends itself to a real opportunity to revolutionise the way face-to-face crisis mental health therapy is delivered to people in need, in any location via the introduction of a crisis care platform.
It is vital that people have an opportunity to be assessed as quickly as possible before a crisis point is reached, therefore the development of a minimum interaction app to compliment the TOSPS web site is vital to ensure that people in (or approaching) a crisis are connected to a therapist quickly.
Background applications can enable complicity with NHS, Local Authority & 3rd sector mental health service provider’s requirements & interact with the digital systems records, booking systems within one application. An affordable application that is nondependent on any particular proprietary platform.
Early detection trigger guidelines allow quick diagnosis & referral to treatment for the client. Alerts to service users, carers & professionals when risks of crisis within individuals are elevated, prompting a call from a therapist or practitioner where applicable.
This app ensures that getting help & or treatment is as simple as ordering a pizza, To assist users, all of our registered therapists display our unique “on-line” light showing that they are available right now to provide instant help. The app can analyse stress triggers & alert people to potential looming issues, & seek early prevention treatment & can link to applications such as iHealth & S Health.
Payment modules can be adapted for pre-booked appointments or after event payments. Some people may wish to approach things methodically & be directed to the Mother web site, others who are in advanced crisis can be connected to immediate help via the app. The security protocols are already developed to reach current IGSoC compliance HIPAA & peer to peer security is established.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Reduce waiting time within the NHS by providing a pool of therapists across all sectors and specializations to be available at all times for emergency crisis intervention therapy and early diagnostic triggers.
Doctors and emergency services would have a central point of call with said pool of therapists who are available to provide face to face online counselling sessions in real time, day or night .
Reduction of waiting time has a positive effect on the reputation of local NHS facilities. The introductions of a central point of contact for therapy online would complement and provide the newer and more modernised NHS with a natural extension to its future modernisation programs in the deliverance of new methods for client access to crisis therapy, using the technologies the public already use on a day to day basis, phones tablets etc.  
Early intervention will reduce cost of treatment in the short and long terms. People can effectively access counselling from home thereby freeing up seats and room occupation.  Effectively the client pays for their own cyber space as opposed to the costs of the provision of therapy rooms and space.
Emergency room on call crisis mental health teams can see a relief from the growing numbers of people needing mental help assistance in the A & E. A triage type system implemented directing those in need of counselling either direct to a practitioner online or to a hospital department will streamline priorities. Cancellation time loss can be recycled. Run over time can be reduced as the client’s portal closes as soon as the session allocated time has finished. 
Safety to staff and clients is enhanced as there is no physical presence. Holiday and sickness schedules would no longer impact on the availability of counsellors, The pool of available therapists can expand and decrease to meet demand.
Geographic boundaries are removed and a greater pool of therapists are available. Therapists with free time can instantly be available to work. Language skills and multicultural issues can be less hindrance, as availability of specialized counsellors with extra skill sets can be found instantly.
Emergency triage of crisis mental health care can be portable, particularly in suicide situations. A seamless way to integrate private and NHS staff to provide counselling in times of public crisis and emergencies such as acts of terrorism or acts of God will be in place. 
Initial Review Rating
4.40 (2 ratings)
Benefit to WM population:
The West Midlands is a densely populated area; the residents are very diverse, multicultural with wide ranging needs. 
TOSPS has counsellors and therapists with a wealth and bounty of specialisms bringing with them an abundance of different language skills, English to Swahili, African, Asian, and European languages, a wide range of backgrounds, cultures, skills and knowledge would open counselling up to ethnic minorities who might shy away from help due to cultural inhibitors, fear of violence, shame or adversity.
The availability of therapists to meet their own cultural requirements without fear of prejudices is a key for some minority groups.  
The system caters for multiple needs, the 24/7 availability means that shift workers or people who experience crisis at all times of day and night will have access to someone who will help them.
Interactions with the app, intentional or unintentional, can act as a conduit to signpost people in crisis to the correct people for help. The socio-economic effect on work place downtime figures will improve as time away from work travelling to and from appointments can be removed.
Calibration with the Police and other social help associations like suicide watch will offer a portable crisis care that will assist them in their roles on the ground. The domino effect of assisting individuals take control of their mental health will filter through to the family environment.
Push notifications will remind people of follow-up appointments, and assure them that their practitioners have been notified of current or prior episodes.  
Large exhibition centres and train stations will be able to send push notification advising mentally vulnerable people registered on the system what to do in times of crisis, terrorism.  Alleviation of waiting times within NHS will promote a real improvement which will be noted by the people.  The app will empower those who often feel powerless and deliver an element of control back to those patients and can act as a buddy system bringing comfort to the mentally ill.  
A more settled and happy community who will support their NHS when they can see or hear that real progress has been made in the reduction of waiting times and costs to their NHS.  Instant access gives them control and boosts confidence. Portability of the app means counselling can be physically brought to the client any place. 
Current and planned activity: 
To grow the numbers of therapists currently registered to provide counselling online both mainstream and crisis care intervention to a start headcount of 400 therapists initially. This would provide scope to have 6 teams of 66 therapists online in 4 hour shifts across a 24 hour period. Training is already underway to ensure that each therapists IT equipment is cyber safe and certified on an  annual basis to protect data and patient confidentiality.
To develop a single point TOSPS app that can deliver all the benefits previously detailed whilst allowing the NHS to track patient costs / usage / progress automatically and work on a NHS agreed pricing and invoicing schedule for covered therapy. Additional therapy could be purchased directly by the patient or family members to supplement NHS treatment and referral fees could be offered back to the NHS to fund research into the benefits of online therapy to further promote the services and reduce overall costs of care
What is the intellectual property status of your innovation?:
TOSPS own all the rights to the name TOSPS and the delivery platform. The TOSPS app will be owned by TOSPS and their developer Proxicon who will continue to develop and maintain the app. 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
The model can be classified as Simple scalability : 
Measures:
Due to the nature of the service we will be able to provide in depth reporting on the number of referrals received which have had a successful outcome in terms of delivery, we will be in a position to deep dive data which will show the number of therapeutic hours being delivered over any given time period and relate these back to specific NHS referrals.
We also believe that by engaging with NICE and IAPT and inviting them to independently monitor the quality of service and outcomes, we can confidently report on the successes and the learnings as TOSPS moves forward with the NHS.  TOSPS.com will also commit to working with other external agencies within the NHS and beyond to further understand the outcomes of its service with a view to continued development its services, feedback will be essential not only from clients but also from referring partners and charitable organisations.
 
Adoption target:
Currently the infrastructure to deliver this service is in a state of readiness; We believe that in order to launch effectively for WM NHS we will need in the region of 400 additional therapists. We will need some support from the NHS in the form of internal marketing to NHS therapists and referring agencies,
Rejection Reason:
Suitability of model to NHS
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Innovation 'Elevator Pitch':
CaDDI provides ‘live’ capacity and demand information across the Mental Health Urgent Care Pathway through an internet based dashboard. This provides a realistic resource and bed capacity and referral demand across the urgent care pathway and beyond.
Overview of Innovation:
The Midlands and Lancashire Commissioning Support Unit (MLCSU) , in partnership with Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT), have developed a live Capacity and Demand Dashboard Information (CaDDI) system for use across the mental health urgent care pathway. It delivers improved patient pathways by providing managers and operational staff instant access to ‘live’ patient flow information, allowing them to make more informed decisions on staff deployment and onward referrals based on data-led assessments. 

The CADDI package consists of two elements:
  • A mobile APP solution to collect ‘live’ data from operational teams, on their current capacity, and progress of their patients’ journey throughout the referral process;
  • A ‘live’ dashboard providing an overall capacity and demand summary status across the Urgent Care pathway, with drill down functionality to a service/team level.

The CaDDI system can be populated from any source that can send live structured data or can use the app developed to enable the live gathering of data.

Currently the data capture systems options include:
  • Rapid, Assessment, Interface and Discharge teams (In-reach service hosted within another organisations)
  • Decision Unit (location based service, with defined number of places available)
  • Place of Safety (specialised location based service, with defined number of places available)
  • Street Triage Team (Out-reach service in partnership with Ambulance and Police Service)
  • Bed management (populated through PAS) – Inpatient demand and capacity, key metrics on patients waiting for a bed, occupancy rates, patients waiting for discharge, and patients out of area.
The CaDDI mobile app enables urgent care teams to access an ‘at an glance’ worklist view of the referrals currently open on their team, including at which point each patient is in within the referral process. The staff can then record timely information in the app any action taken, what is the next action and if patient is waiting for services. This chronological record of the steps from when the patient enters the system until departure helps in the completion of the patient’s clinical record and can be can be accessed by all team members until patient has been discharged.
 
The 'live' dashboard will then display this information obtained by the mobile app and bed management system, providing a holistic and comprehensive view of capacity and demand across services. 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wealth creation / Digital health / Innovation and adoption
Benefit to NHS:
The CADDI system aims to streamline the way in which patients move through the Urgent Care pathway. The new system will be able to demonstrate realistic capacity and demand across the Urgent Care system. The information team will be capturing the data delivered by theRapid, Assessment, Interface and Discharge Plus CADDI mobile app and using this data to better understand the way in which the Urgent Care teams deal with increasing demand.
 
Expected Outcomes

The system will be able to provide an overview of the urgent care system in real time which will allow proactive realignment where required. It will also help capture data that can be used to inform decisions on the ground.
 
Patient experience:
  • Reduction in waiting times
  • More timely response from services
  • More clinician time to ensure appropriate placement that meets needs
  • Reduction in out of areas placement
  • Reduction in overall in-patient admissions
  • Safer care for patients as a result of a more efficient system
  • Improved patient focused services leading to improved patient and carer experience
Operational Effectiveness
  • The availability of valuable structured quantitative data that has not been collected before
  • Increased ability to monitor and plan across the system
  • Better decision making and improved use of system resources
  • Live data on demand allowing for prioritisation
  • Reduction in duplication and waste within the referral process
The CADDI system has been developed so it is scalable to regional and national requirements. The system can be adapted to an organisations patient administration system and the dahsboard can also collect data  using an alternative system, if available, as long as data is available in real time. 
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
The CADDI system will provide the most realistic and timely method for assessing the capacity of Urgent Care mental health teams across Birmingham and Solihull. As a result, potential savings can be made by  utilising resource effectively to meet demand. We expect to see a reduction in acute hospital waiting times as a result of more efficient staff deployment.

Our RAIDPlus test bed partners West Midlands Ambulance service and West Midlands Police will be better informed about the more appropriate pathway to bring patients experiencing mental health crisis. Unnecessary pressure on staff will be evidenced by the CADDI system and will lead to a precise reporting system examining capacity and demand across the system in a way that is not currently possible.

RAIDPlus has links with the MERIT Vanguard programme, the project aims to spread the experiences, learning and opportunities identified through the development and implementation the CADDI system throughout the partnership.
Current and planned activity: 
The MLCSU and BSMHFT are working on new ways to populate the internet dashboard directly from the patient administration system as an alternative for using the mobile app.
 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
2
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Innovation 'Elevator Pitch':
This is a risk stratification model that aims to predict and prevent crisis by segmenting the mental health patient population by risk and likelihood of an acute mental health crisis.
 
Overview of Innovation:
Currently, the response to mental health crisis is mostly reactive. To address the increasing pressures faced by the urgent care services by patients presenting with mental health crisis, prevention and early intervention must be prioritised. This will not only alleviate pressure of several emergency care services but will also improve patients’ prospect by ensuring  timely interventions that avoid patients’ mental health deteriorating further.

The Rapid, Assessment, Interface and Discharge Plus project, in partnership with Telefonica Alpha, aims to achieve this by developing and validating a risk stratification model and algorithm to predict mental health crises. The risk stratification model will use four years of pseudonymised clinical and sociodemographic data to capture potentially robust predictors from a wide range of sources to provide an overall indication of a patient’s risk of experiencing a mental health crisis.

By applying the model onto the Trust’s mental health population, we can stratify the patients into different risk groups and subsequently target the highest risk segment of the population for preventative early intervention with improved accuracy. This information will be provided to clinicians who will determine the necessary measures required to prevent the progression from high-risk status to actual mental health crisis. This will act as a ‘clinical support tool’ for clinicians in making their decision and does not replace the clinicians decision on how to manage patients.

The project will look at how the risk stratification model can be implemented into practice, working with Community Mental Health Teams (CMHTs) to pilot the model. The model will be refined, tested and validated by a team of data analysts, clinicians and to embed it into systems for routine clinical care. Using this tool can help improve patient care by avoiding unnecessary admission, presentation at A&E, or potentially prevent an escalation in the worsening of a patient’s mental health state.
 
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption
Benefit to NHS:
In a pressurised financial environment, faced continually with greater challenges to meet quality objectives, this innovative product can simultaneously improve patient outcome by reducing intensity and/or preventing mental health crisis as well as reduce costs by stopping the over saturation of emergency services.
 
The use of technology systems and data is at the centre of the NHS Five Year Forward View. It highlights how the use of data and technology will transform outcomes for patients and citizens. The insights derived from the risk stratification model will help the NHS explore how the information/ data they hold could be used in clinical settings to benefit patients. It will highlight patterns in the data that can be used to develop proactive preventative measures to support mental health patients.  The ability to stratify risk and predict those who might be at risk of mental health supports frontline mental health clinicians to de-escalate situations before crises arise. This leads to improved patient outcomes by avoiding the further deteriorating on mental health and potential saving where the intervention has prevented an entry to the crisis care system.
 
The reduction in demand for emergency and inpatient mental health services will relieve the pressure from the crisis care pathways resulting in enhanced patient experiences, improved staff support and morale, and greater efficiency and effectiveness within urgent care mental health services to respond to current and future patient needs.
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
Mental health crisis is a significant and increasing problem across Birmingham and Solihull. The number of crises in the region has increased by an average of 7% year on year for the past 5 years and is projected to increase further in the future, according to the Midlands and Lancashire CSU. Therefore, this places increased level of pressure on urgent care services and it is important to be able to introduce proactive measures to stop at risk patients from going into crisis.

The redesign of the crisis care pathway is a key NHS England target for CCGs and a central theme within the STPs. Within the Birmingham and Solihull STP, one of the key mental health objectives is to ‘Manage – preventing mental health crises and managing them better when they do’. Identification of at risk patients and supporting them by intervening sooner fall in line with the STP objective and while this tool doesn’t directly prevent the onset of crisis, it helps refine predictions and manage at risk patients proactively. The use of data-informed decision making leads to better clinical outcomes for West Midlands patients and can potentially release both capacity and resources across the emergency and urgent care system
Current and planned activity: 
The risk stratification model was developed collaboratively between BSMHFT and Telefonica Alpha as part of the Rapid, Assessment, Interface and Discharge Plus NHS Test Bed. The pilot work testing is being supported by The Health Foundation.
 
The tool is planned to be tested in real time by Community Mental Health Teams (CMHTs) in Birmingham and Solihull from September 2018. The CMHTs were identified to be in the most suitable position to be able to utilise a predictive model for crisis presentation into their working practice. The patients at risk will be flagged in real time and this will be reviewed by the CMHTs and an effective intervention put in place to avert the crisis. A robust evaluation is being conducted by the CSU looking at the effectiveness of the tool in supporting clinician’s decision making.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
3
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