Common Approach To Children’s Health (CATCH) (#2772)

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Innovation 'Elevator Pitch':
Common Approach To Children’s Health (CATCH) is a free-to-users healthcare app aimed at parents/carers of children aged 0-5. The app gives users confidence to know when their child needs medical treatment or when self-care would be more appropriate.
Overview of Innovation:
The concept of a Cheshire East health app was originally borne out the council's Annual Report of the Director of Public Health, 2013/14 which among other findings determined that large numbers of young children in Cheshire East are being taken to A&E & are sent home with advice rather than treatment.

There could be many reasons why A&E attendance for children aged 0-4 in Cheshire East is higher than the national average but one explanation could be that some parents lack the confidence & knowledge to self-care when appropriate.

To remedy this Public Health Cheshire East, NHS Eastern Cheshire CCG & NHS South Cheshire CCG came together to jointly commission the CATCH app.
Users of the app create a profile for their child/ren to receive regular guidance & advice tailored to suit them as they grow. Once the child’s information is inputted to the app the Home section will provide users with NHS guidance that is highly relevant to their child’s age.

The Learn section contains a multitude of health information that is split by age, e.g. ‘0-6 months’ or ‘4-5 years’ to help parents & carers determine which information is relevant to their child. Learn also includes sections such as ‘Making your home safe’ & ‘Parents corner’.

Information about what to do in an emergency, such as if a child swallows a battery or button can be reviewed at any time, ensuring parents & carers are prepared if a health emergency were to occur. General announcements for subjects like seasonal advice, local news & health warnings can also be received.

The app contains highly localised information about healthcare services/support groups available in the region and an explorable map of local health services such as GPs, dentists & pharmacies. Users can set timely reminders about key health dates such as childhood immunisations.

The Emergency section contains information about emergency situations, such as allergic reactions, how to help a choking child & head injuries. The idea is for users to review this section when they have some free time rather than during an emergency itself, meaning they will be more confident to take action should an emergency occur.

CATCH uses NHS approved advice, better informing users on a range of conditions by providing advice from a trusted source - directly from NHS choices.

To view more information, videos and download the app for iOS or Android go to the website...
http://catchapp.co.uk

And watch the video...
https://youtu.be/G3bFBlC8l8M
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)
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Overview of Innovation:

Common Approach To Children’s Health (CATCH) is a free-to-users healthcare app aimed at parents (and carers) of children aged 0-5. CATCH utilises a unique method of NHS Choices or custom information delivery that builds confidence in self-care and the knowledge to recognise when medical treatment is required.

CATCH has helped to reduce A&E attendances and GP Visits in the Cheshire East region of the UK. Cheshire East CATCH users were surveyed and a majority (52%) of participants, who required medical attention for their child, have used CATCH to self-care for their child rather than using an emergency service. Similarly, a majority (64%) reported that the app helped to treat their child at home instead of using GP services.  

Early Eastern Cheshire CCG cost findings are in line with the user survey and for the four months to 31 January 2016/17 show that the number of 0 to 5 year olds discharged from A&E with nothing but basic information and advice was 538 or 155 fewer than for the same four months in 2015/16 – before the app was launched.  The figures cover all A&E departments in which Eastern Cheshire children were seen, not just Macclesfield District General Hospital.

CATCH is ready to scale and has been taken up by the Innovation Agency and Halton CCG.  This version 2 of the app will be unique in allowing supported CCGs to have complete control over the information held by their section of the app.  The service also includes online marketing and an admin site that delivers analytics on a per postal-destrict basis that conforms to Information Governance rules. 

To view more information, videos and download the app for iOS or Android go to the website...
  http://catchapp.co.uk

And watch the video...
  https://youtu.be/G3bFBlC8l8M
 
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Innovation 'Elevator Pitch':
WaitLess is an app for patients, combining A&E & MIU real-time waiting times, numbers waiting, traffic & routing helping patients make better decisions about where to go for minor emergencies. In east Kent, it reduced minor A&E attenders by 11%.
Overview of Innovation:
WaitLess is an innovative new app for patients. This reduces A&E attendances during busiy times by showing patients the quickest place to be seen, simply. It proves patients can be treated faster and closer to home by highlighting alternative services, driving activity away from busy A&Es. It's free for patients to download and was designed by patients for patients, funded by CCGs and STPs. Our charging model is 25,000 per CCG, or 3p per person based on population.

It's priced delibarately low to make WaitLess accessable to all, and can be deployed in less than two weeks. WaitLess was independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to achieve an 11% reduction in minor attendances. 

Various studies undertaken since 2009 have found A&E attendance reduction schemes to be difficult to achieve. This is thought to be due to a number of factors incuding that patients find urgent care pathways confusing and hard to navigate. Various studies have identified that patients make a relatively quick decision about where to access treatment minor injuries. Once patients have arrived in A&E, evidence shows that they are committed to waiting to be seen and often reluctant to move. WaitLess applies an effective three second nudge to patients, by showing the quickest place to go and using real time routing options to help avoid traffic and overcrowding busy units during peak times. 

A reiew undertaken by encompass MCP found the following observations, which were confirmed as statistically significiant by the behavioural insights team and the University of Greenwich:
  1. Improved patient experience as patients are signposted to units with the lowest wiaiting times
  2. Reduction in A&E minors attendances by 11%
  3. An overall reduction of 5% in attendances across A&E and minors as more patients choose primary care.
  4. Quick and responsive, nudging patientstowards facilities with lowest waiting times.
  5. Takes pressure away from A&E and flattens activity
  6. Quick to deploy
Business cases for WaitLess are currently being considered across a broad range of regions, inclduing the South West, Greater Manchester, Yorkshire and the Humber, Surrey and Sussex. Given the benefits to the NHS, we are seeking to significantly accelerate this rollout across the NHS and to explore alternative uses for WaitLess (such as Primary Care). As a proven autonomous decision aid, WaitLess is a key pillar to any urgent care strategy.
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: 
Wealth creation / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
WaitLess has been independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to deliver reduced activity, waiting times and save money for the NHS. The headline benefits are:
  1. Reduced minor injury attendance profile across the whole health economy. The total number ofcases (including A&E and MIU) shows a significant decrease (5% less, p=0.024).
  2. The total number of A&E cases shows a significant decrease (11% decrease, p<0.001).
  3. The proportion of cases (MIU out of (MIU+A&E) shows a significant decrease (the effect size varies by day of the week, but is approximately 3-4%, p<0.001)
  4. Reduction in A&E minors attendances by 11% within six months against an end of year target of 5%.
On days where there is significiant pressure on majors, it is  common for waiting times in minors to increase. As waiting times increase in one facility, patients choose alternative locations where waiting times are improved.  This has the net effect of spreading activity across A&E and UTC settings much more effectively.

As patients choose A&E because they are unaware of level 3 & 4  A&E units (UTC), nationally Hospitals are facing an increase of circa 5% year on year in A&E attendances. Peak attendances are predictable, occuring in the early evening and at weekends. WaitLess acts as an autonomous patient decision aid, helping to reduce pressure without impacting on surrounding UTCs. In addition to the benefits to patients, operational and performance benefits, WaitLess also saves money for Commissioners.

It is common for Urgent Care Centres to have much ower waiting times than A&E departments. By using real time data, WaitLess influences patients to choose the facility that willsee them fastest, giving improved overallexperiencefor patients and encouraging more competition among providers of urgent treatment services.

With many UTCs commissioned on block arrangements, overheads are already paid for. In these scenarios, each A&E attendance saved is equivalent to 85.00 per episode saved. Where UTCs are commissioned on PbR, the standard tariff is 65.00 per episode. in thesecases, WaitLess saves 20.00 per episode. The PbR savings alone equate to 100,000.00 per CCG. 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Activity analysis has highlighted over the years that A&E is seen as a  trust brand by patients. Commissioning of alternative facilities with different names, such as MIU / UTC / Minor Injury Cinic / MIIU has created a significant confusion among patients about which services are  available and what they offer. A number of self help apps have been developed to support patients, however these have nationally had a limited impact on emergency attendances to A&E. Since 2004, the UK has seen A&E attendances grow by 5% year on year. A&E Departments are now widely reported to suffer from overcrowding, leading to sub-optimal conditions both for clinicians and patients. The majority of A&E attendances are from patients who choose to self present to Hospital, most with Ambulatory and more minor conditions. As an ex Urgent Care Commisisoner and General Manager for A&E and Acute Medicine, I knew prior to the build of an app that patients make a quick decision about where to access urgent care services, which was recognised by the behavioural insights team in 2015. In many other parts of healthcare planning, autonomous patient decision aids have been found to be highly effective in terms of both influencing behaviour and flattening demand. This can be seen in the NHS rightcare guides. WaitLess provides this for Urgent Care services. It helps the local population in the following ways:
  1. Encouraging people to access care services closer to home
  2. Reducing avoidable A&E attendances
  3. Improving the patient experience
  4. Empowering patients to mae a better decision about where to go to be seen
  5. Reducing pressure on overstretched A&E departments
  6. Savng money for the local health economy to re-invest in pathway changes that are sorely needed to improve urgent care flow.
Current and planned activity: 
We are currently enagaged in discussions around WaitLess with Nene and Corby CCGs, Yorkshire and the Humber and Greater Manachester. As part of the National Innovation Accelerator, we have ensured WaitLess is built on a platform that is simply scaled. Patient feedback has highlighted a need to provide WaitLess at scaleas patients commute for work and leisure and come to rely on the information. Our diffusion plan is outlined in a 12 week programme per CCG which can run in parralel with up to 26 CCGs per cycle. As WaitLess technology is bespoke, it has been built with scaling in mind. Our 12 week programme can be accelerated to 2 weeks, depending on each health economies informtion capabilities and appetite.
What is the intellectual property status of your innovation?:
As a developed and deployed product, we have IP rights  to our innovation
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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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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