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Innovation 'Elevator Pitch':
SaccScan - a tool for rapid, accurate & affordable diagnosis & clinical management of major psychiatric disorders. Identifies eye movement abnormalities to objectively diagnose illnesses such as schizophrenia, bipolar disorder & severe depression
Overview of Innovation:
The Diagnostic Problem
Delivering an accurate and timely diagnosis remains one of the most pressing challenges of modern psychiatry. 1 in 4 adults suffer from mental ill health during their lifetime but around 50% of cases are misdiagnosed. There are still no objective diagnostic tests to validate the decision. Diagnosis and clinical management are based solely on the patient’s history, symptoms, and behaviour. Treatments are available that allow patients to resume normal functioning in society but clinicians struggle to make accurate diagnosis, match therapy to condition and provide timely care.

It is common in psychiatry to find that symptoms are insufficient to give a clear diagnosis and a lengthy consultation period of several years may be necessary. Delays in receiving a diagnosis can significantly impede delivery of the most effective treatment plan, exposing the patient to risk of further deterioration in well-being, reduction in quality of life leading to job loss, family breakdown, and self-harming.

Ultimately the wider economy shoulders the burden from loss of economic output, commitment of healthcare resources, and out-of-pocket expenses incurred by patients and their families.

SaccScan is a novel eye movement test, designed as an assistive point-of-care tool for diagnosis and clinical management of psychiatric disorders.

Using high specification eye tracking technology, and access to a proprietary clinical reference database, the diagnostic tool utilises eye-movement abnormalities as objective clinical diagnostic biomarkers for illnesses such as schizophrenia, bipolar disorder and severe depression. The test can be completed within 30 minutes in a standard consulting room. A shorter version of the test is being developed for use in primary care settings to assist with differential diagnosis of psychosis from mood disorders, better informing referral of serious mental illnesses to secondary care services.

SaccScan not only reduces the overall cost of managing psychiatric illness but will improve patient outcome.



A Step Change for Psychiatry
SaccScan has been demonstrated to detect schizophrenia with better than 95% accuracy (> 90% sensitivity & specificity) and has been extended with the same precision to bipolar disorder and major depression illnesses. No brain imaging, serology or DNA test approaches this level of performance (sensitivity, specificity and repeatability).
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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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 RAID model for liaison psychiatry services as a pilot in Birmingham. The RAID multi-disciplinary team assesses A&E attendees/inpatients 24/7 who might have mental health problems, and provides e-training. There is now a RAID service in every hospital in Birmingham and Solihull and 27 organisations nationwide have taken up RAID. 
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 RAID (Rapid Assessment, Interface and Discharge) model for liaison psychiatry services in December 2009 as a pilot in City Hospital in Birmingham, with an investment of £0.8 million. The RAID 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 RAID network, which is supported by WMAHSN, was established to strengthen links between RAID services to facilitate collaborative working on research and innovation projects, facilitate adoption of RAID and improve and expand the overall service provided by RAID across the NHS. 
Impacts / outcomes: 
  • Following the success of RAID in City Hospital, the trust now has a RAID service established in every acute hospital in Birmingham
  • 27 organisations nationwide have now taken up RAID
  • In its 2014 document Achieving Better Access to Mental Health Services by 2020, the Department of Health highlighted strong evidence that the RAID 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 RAID model was on time to readmission:
  • The rate of readmission in the RAID group was four for every 100 patients, while in the pre-RAID group it was 15 for every 100
  • Including the RAID-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 RAID-influence group demonstrated an average length of stay 3.2 days shorter than that of the pre-RAID group. This corresponds to a total saving of 13,935 bed-days per year
  • The RAID 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
  • RAID 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 RAID service was produced by the London School of Economics and Centre for Mental Health in 2011
  • RAID was cited in an a 2012 HSJ article, “Liaison psychiatry can bridge the gap”
  • An economic evaluation of the RAID 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 RAID 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 RAID 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 RAID 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 RAID 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: “RAID 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 RAID model for the future.”
Plans for the future:
The RAID review will be used to drive consistency and to support the tailoring of RAID 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 RAID had delivered (or had the potential to deliver) real benefits. However, the way in which RAID 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
  • RAID 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 RAID 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 RAID 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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Overview of Innovation:
The primary aim of this document is to provide an overview of the Rapid, Assessment, Interface and Discharge model and provide an evidence base for the adoption of the  model.  This document provides supporting evidence to the  implementation of the ambitions set out in the Five Year Forward View for Mental Health to introduce evidence-based treatment pathways across mental health services.

It states: ‘by 2020/21, NHS England should invest to ensure that no acute hospital is without all-age mental health liaison services in emergency departments and inpatient wards, and at least 50 per cent of acute hospitals are meeting the ‘core 24’b service standard as a minimum’ to ensure provision of liaison mental health services in all general hospitals 

For more information, please refer to the National Rapid, Assessment, Interface and Discharge Plus Newtork, here.
Initial Review Rating
1.00 (1 ratings)
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Innovation 'Elevator Pitch':
The MyCognition App is co-designed with patients and trialled with academics to monitor, prevent and treat mental well-being by measuring, monitoring and improving cognitive health.
Overview of Innovation:
Cognitive functioning (attention, episodic memory, executive function, working memory and processing speed) are tightly linked with mental health.  Research shows that cognitive deficits are significant predictors and major risk factors for mental illness e.g. depression, anxiety and stress. Poor cognitive health has a negative impact on our emotions, our coping strategies and tendency to ruminate and catastrophise. Alternatively, robust cognitive health contributes to building good psychological resilience, self-management and control, which are major protective factors for prevalent mental diseases. Cognition deficit affects all ages. It is manifest in young children and adolescents affecting school performance and mental well-being. It is also prevalent in preretirement populations where patients present with unexplained symptoms often categorised as psychosomatic.


MyCognition App provides digitally delivered assessment, cognitive training, coaching and behavioural change programmes. It is an easy to use and patient friendly app that can be used with any device. It is a fun and engaging App designed for all age groups for use in everyday settings.
The App has three programmes:
  1. MyCQ™ – a five-domain, 15 minute, cognitive assessment tool based on a clinically validated version.
  2. AquaSnap™ – a fun cognitive training tool, programmed by MyCQ to train all five cognitive domains. The training is personalised, designed to improve and boost an individual’s cognition where they have greatest need.
  3. A digitally delivered coaching programme to raise awareness of cognitive health and to educate and train people in healthy habits encouraging positive behavioural change.
The MyCognition App is a resource which patients can use remotely in their own homes, in residential stay or whilst in hospital. It is scalable across the whole patient community to support cognitive health. It can also be deployed in secondary care environments to support in-patient stays, occupational therapy and rehabilitation patients; and be recommended for use to patients entering step-down-care into the community, e.g. oncology and critical care.
 
The App also provides carers and professionals with personalised reports showing the cognitive health of individuals and of patient cohorts vs the general population, alerts on patients at risk and progression over time. We recommend patients and their family members/carers also use the App to encourage social interaction and shared experiences.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
MyCognition offers a self-care digital solution to assess, monitor and treat mental health and well-being by addressing a person’s cognitive health. The MyCognition App improves cognitive function in as little as eight weeks and improves mental resilience and mental health symptoms across a range of mental health disorders. From studies with patients with conditions, such as Depression, Anxiety, Schizophrenia, Post-traumatic Stress Disorder, as well as Parkinson’s and cancer-related cognitive impairment.
 
MyCognition is a self-care solution that patients can use remotely in their everyday lives to help address their mental well-being. It is ideal for use in patient waiting to be refereed to NHS services where is there is extended waiting time. It is also suitable for patients in residential stay. It is scalable across the whole patient community to support cognitive health in a range of disease areas. It can also be deployed in secondary care environments to support in-patient stays, occupational therapy and rehabilitation patients; and be recommended for use to patients entering step-down-care into the community, e.g. oncology and critical care.
 
Evidence
MyCognition has led five years of research in clinics and local institutions, demonstrating the validity of the assessment and training paradigms adopted and the positive outcomes on users’ cognition, mental health, and consequent quality of life. MyCognition is collaborating with major international universities and clinics, such as Amsterdam Medical Centre (NL), Maastricht UMC+ (NL), UZA Antwerp (BE), McGill University (CA), UCL and the Royal Free Hospital Children’s School in London. We are running studies with patients with different mental health conditions, such as Depression, Anxiety, Schizophrenia, Post-traumatic Stress Disorder, as well as Parkinson’s disease and cancer-related cognitive impairment.
Initial Review Rating
4.00 (2 ratings)
Benefit to WM population:
MyCognition is committed to preventing and treating mental illness. Our strategy is aligned with the West Midlands Mental Health Strategy Boards recommendations in its 2017 report ‘Getting It Right First Time’ Prevention of Mental Illness. 
The 2017 Report by the West Midlands Mental Health Commission states that over 25% of the West Midlands population is suffering from mental illness. It highlights that people with an increased risk of developing mental health problems and/or for whom access to effective help is problematic are:
  • Unemployed people
  • People with long-term physical health conditions
  • Carers
  • Young children of school age*
  • Homeless people and people living in poor quality housing
  • People from Black, Asian and Minority Ethnic communities - Lesbian, Gay, Bisexual and Trans people
  • People with disabilities, including learning difficulties and sensory impairments
  • Young people leaving care
  • Survivors of sexual, emotional and physical abuse
  • People experiencing severe and multiple disadvantage.
*50% of mental health problems start before the age of 14 and 75% before 18
The aggregate economic and social cost of mental health problems in the WMCA is estimated at around £12.6 billion in 2014–15, equivalent to a cost of about £3,100 per head. With 28% being directly attributed to care costs of the NHS and Social Services costs. The employment costs are rising and equate to £4 billion per annum with human cost accounting for £5 billion. 
MyCognition have designed its technology to be integrated with NHS healthcare, social care, educational and workplace systems to help provide accessible self-care support for populations across the West Midlands. We wish to work with stakeholders to ensure there are as many community touchpoints for MyCognitions as possible. And provide adequate prevention and triage for at risk populations so they can reduce their risk of mental health development and deterioration.
MyCognition offers low cost personalised support to help these people deal with their mental illness. Offering them the opportunity to self-care, manage and reduce their symptoms and avoid ‘crashing’ in to the NHS for more serious and costly intervention. And more importantly lead productive and fulfilled lives.
Current and planned activity: 
Current:
MyCognition is working with several AHSNs evaluating the App in various clinical scenarios & patient pathways (rep. early 2019). Plans to roll out these clinical models with AHSNs’ support across the NHS.
 
Engaged in NHS test bed wave 2 programme and in discussions to test suitability for addressing mental health & wellbeing in schools, supporting referral to CAMS and adult mental health services, treatment of medically unexplained symptoms & diabetic self-care.
 
Running UK studies with NIHR, extending evidence base for MyCognition and also contributing to the global evidence base linking cognitive, physical & mental health.

Required:
Wish to test App & Platform’s performance in several clinical settings & pathways with West Mids. partners to generate additional data & build successful business models for NHS
  • like assistance with Procurement/Adoption & contracting with CCGs
  • further studies, seeking research partners to assist in NIHR funding proposals
What is the intellectual property status of your innovation?:
MyCognition is unique in the market place. We have full copyright of the code written for the app.

MHRA CE Marked Medical Device
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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