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Idea Description
Supplementary Information
Detailed Submission Data
Innovation 'Elevator Pitch':
FREED is an innovative, evidence-based care package for 16 to 25-year-olds with an eating disorder of up to 3yrs duration. It reduces waiting times for treatment, tailors treatment to the needs of young people, and improves outcomes at low cost.
Overview of Innovation:
Eating disorders are severe mental disorders with high levels of disability and mortality. The first 3 years offer a critical window for achieving recovery. Beyond this, outcomes are much poorer.

FREED (First episode Rapid Early intervention for Eating Disorders) is an innovative, evidence-based, specialist care package for 16 to 25-year-olds with a first episode eating disorder of less than 3 years duration. FREED overcomes barriers to early treatment and recovery and consists of a service model (incorporating rapid screening and assessment protocols) and a care package that can be adapted to service needs (including print and electronic patient resources that specifically attend to the needs of young people and their families). It was developed to be compatible with any existing evidence-based eating disorder service, and complements rather than replaces existing eating disorder treatments.

FREED was developed at the Maudsley hospital (South London and Maudsley NHS Foundation Trust) with support from The Health Foundation and has since been scaled to 3 additional sites in London and Leeds. These cover a population of approximately 7 million from urban, sub-urban and rural catchment areas. The Maudsley has provided a consultancy model with access to protocols and tools plus expert coaching in implementation and ongoing supervision.

Evaluation data show that FREED reduces waiting times for treatment by approximately 50%, compared to matched audit patients. It also improves treatment uptake (100% with FREED vs. 73% with audit) and, once in treatment, mean symptom scores for FREED patients reduce below clinical cut-points by 6 months. For patients with anorexia nervosa, 60% of FREED patients may be expected to reach a healthy weight by 12 months vs. 17% of audit controls.

FREED is also low cost, as all implementation material is available free of charge. The cost to services is that for a band 7 FREED champion, at 0.6FTE (£20k/yr) for a large service seeing 100 FREED patients/year. In-year savings are feasible due to the 35% reduction in day-care and inpatient care seen with FREED compared to treatment as usual / audit data. This translates to a cost of £112k per 100 patients seen through FREED. Modelling analyses suggest longer term savings of £2-5 per £1 spent, due to reduced treatment re-presentations and early achievement of full recovery.

FREED is scaling around England in 2018 with support from the NIA.
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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Innovation 'Elevator Pitch':
ProReal was built using 3D gaming technology, this evidence-based immersive platform helps people create a visual representation of how they experience a situation so they can explore different perspectives, visualise futures & solve problems
Overview of Innovation:
ProReal’s innovative technology provides its users (clients, service users, patients) with a safe, secure & confidential visual way to describe how they experience the world. With support & facilitation users can label strong feelings & name issues, as well as articulate hopes & concerns all of which are critical for building resilience & supporting recovery.

Independent research shows that the use of the software is associated with emotional & cognitive responses, reductions in psychological distress & building of empathy & insight.

The ProReal platform helps people create a visual representation of how they experience a situation so they can explore different perspectives, visualise futures & solve problems. Clients enter a secure, virtual landscape & add avatars & props to create representations of real-world scenarios.

Clients experience increased self-awareness & rapid empathy building leading to improved relationships. Costs are reduced by enabling faster & more effective change & communication without the need to travel. Its use is associated with significant reductions in stress & self-criticism & is being used by a growing number of health & social care organisations.


ProReal features:
  • Avatars: unlimited number of avatars available
  • Symbols: a selection of symbols/props to represent various aspects of a client’s world (eg elephant, minefield, clock, mirror etc)
  • Environment & sessions: naming function provides meaning & context
  • Views & functionality: views from avatars & roaming camera provides different perspectives
ProReal benefits:
  • Faster & more effective change
  • Actionable insight
  • Reduces costs
  • Increases self-awareness, self-confidence & self-expression
  • Increases engagement
  • Associated with reductions in stress & self-criticism
  • More effective communication of vision, priorities & values
  • Rapid empathy building & improved relationships & trust
  • Convenient
  • Secure, password protected login & encrypted data

ProReal continues to work with clinicians & academics & in particular NIHR MindTech to explore the use of its software with a range of disorders & clients including adults with personality disorder, young people with anxiety, depression, trauma & eating disorders.

Our product development is underpinned by extensive & ongoing clinical & corporate research & end-user input.

This means the benefits of our software are evidence-based by independent & rigourous evaluation & meet the needs of our users. Discover more about our evidence-base here.


 
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 / Digital health / Innovation and adoption
Benefit to NHS:
£9.49 billion was planned to be spent by CCGs on mental health services in 2016/17 – up from £9.15 billion in 2015/16. This amounts to 13.1% of planned CCG spending, up from 12.5% in 2015.16 Figures for individual CCG areas can be found using NHS England’s Mental Health Five Year Forward View Dashboard.  This does not account for all spending on mental health services, because specialised mental health commissioning is the responsibility of NHS England rather than CCGs.
 
Independent research shows that the use of the software is associated with emotional and cognitive responses, reductions in psychological distress and building of empathy and insight.
 
ProReal tailors its services to a wide range of organisations and service user needs to help them to find the right digital solution to accelerate change and improve engagement.
 
ProReal’s avatar-based therapy is a flexible and cost-effective solution. Having completed two research studies funded by SBRI Healthcare (an NHS England funded initiative to develop products that address unmet health needs) it has been proven to be effective with adults and young people. Click here for more information. As at March 2018, South London and Maudsley NHS Foundation Trust and Mersey Care NHS Foundation Trust are using/have commissioned ProReal for use with service users.
 
The software has been designed to be very easy to use - most clients learn how to use it in the first 5-10 minutes. For those using it with others in their work, most people require 15-20 hours of training, much of which is practice time. Online training is delivered via three webinars, reading material, reflective practice/assignment work and a formal assessment at the end. Face-to-face training is also offered for groups.
 
A suitable laptop or desktop computer (Windows or Mac are fine), an unrestricted internet connection and permission to install the software on your device is required. ProReal can be accessed 24/7 online via a secure login providing flexibility, convenience and increased access for clients to do self-help online.
 
ProReal provides many benefits from accelerated insight to better engagement of all which help to reduce costs.

Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
There are an estimated 4.032 million people in 2014–15 living in the West Midlands Combined Authority (WMCA). The population is culturally diverse with over 22% from Black & Asian Minority Ethnic communities, ranging from 2.3% in Cannock Chase to 42% in Birmingham.
 
Nearly a quarter of adults living in the WMCA are experiencing a mental health problem at any one time. The risks of poor mental health are not uniformly distributed across the WMCA population. They are influenced by social, economic & physical environmental factors & social inequalities in particular.
 
The aggregate economic & 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 of population.
 
Mental ill health is estimated to cost the NHS nearly £2 billion a year in the WMCA. Only about half of this represents the direct costs of treatment & care for people with diagnosable mental health problems. The other half arises mainly because large numbers of people with long-term physical conditions such as diabetes & asthma, also suffer from depression or anxiety & this greatly increases the costs of physical health care.
 
Following the successes of the use of our software in commercial settings we had long been of the opinion that it could be beneficial in a healthcare capacity as well. To begin our investigation of this theory we secured funding from NHS England’s SBRI Healthcare programme as part of their initiative to find new technology solutions to unmet mental healthcare needs. This ‘Phase 1’ contract allowed us to conduct a pilot study using the ProReal software with a small group of adult offenders who were residents of a therapeutic wing of a category B prison in the north of England.
 
Over the course of 7 weeks our therapeutic intervention at this Serco managed prison consisted of 6, hour-long, group sessions lead by a qualified counsellor on the prison staff who we trained in the use of the ProReal software.
 
Results indicated that using our software improved participants’ capacity to elicit emotional responses & initiate further cognitive processing – both fundamental aspects of improved mental health. The study also produced good preliminary indications that using the ProReal software helps reduce psychological distress & improve general wellbeing. In addition participants reported enhanced levels of self-expression, new insights, development of empathy & the ability to build stronger relationships.
 


Current and planned activity: 
We would like to connect with the WMAHSN Mental Health Innovation Network to help to drive the adoption of ProReal across the region.
 
If you would like copies of our completed evaluation reports or to find out about our ongoing research please contact us.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
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Innovation 'Elevator Pitch':
TPT is a new delivery platform for CBT offering easily accessible pre-recorded therapy sessions using a customised interactive phone system. Patients call TPT free - anytime, anywhere. Healthcare providers reduce treatment costs & cut waiting lists
Overview of Innovation:
TPT is a personalised, guided self-help psychological therapy delivered over the telephone in a range of pre-recorded modules for the treatment of mild to moderate anxiety-based mental health problems. It uses modern telephone technology to achieve vastly reduced costs with no waiting lists and is designed for use in NHS primary or secondary care settings.

Easy to prescribe, easy to use
TPT is available 'on prescription' to patients from their GP or other healthcare provider. The therapy can then be regularly accessed by the service-user making a simple free telephone call. An interactive, intelligent computer controlled telephone system using voice recordings of therapeutic scripts and questionnaires will then guide the service-user through a psycho-education, treatment and recovery programme that is responsive to the patient's individual presentation and circumstances. Patients will typically complete the programme in 8 to 12 weeks.
Instant access
Psycho-education, guidance and structured self-help for managing their condition are available to service-users wherever they are and at all times of the day and night. This immediacy of access is of particular benefit to patients with conditions that require help managing situational responses to emotional and environmental triggers or developing and maintaining impulse control strategies.
 
Choice of treatment modules for different presentations
A range of TPT modules is available for the treatment of different mild to moderate anxiety-based mental health problems such as generalised anxiety disorder, OCD and agoraphobia. Although each module is written with the specific presentation in mind there is a broad commonality of structure. A typical TPT module will have some of the following elements delivered by spoken scripts and using targeted questionnaires:
  • Introduction to anxiety and its effects
  • Description of the symptoms and causes
  • Psycho educational quizzes and self assessment measures
  • A range of anxiety management strategies
  • Instant-access session for managing acute symptoms
  • Cognitive techniques for overcoming negative thinking
  • Text messages which are sent to service-users to give feedback, reinforcement and reminders
  • Tailored sessions to inform and support friends and family
For a quick introduction to TPT, its operation and its benefits visit our 3 minute video at: https://vimeo.com/145905041
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: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Lower costs
  • TPT costs are 80% less than the cost of a course of therapy by a psychological wellbeing practitioner
  • No need for staff training or regular patient supervision by a therapist
  • No extra capital investment
  • Secondary prevention reduces need for further treatment
  • Reduction in demand for consultations by 'revolving door' patients
Instant access
  • Presenting service-users can leave the consulting room with a prescription giving immediate access to a suitable treatment offered in the 'language of their thoughts'.
  • Ease of use – familiar telephone dial in system for patients to access the session they require.
  • Help is available 24/7 whenever the patient needs support
Cuts waiting lists
  • High-level IAPT and secondary care services are freed up for more seriously ill service-users
Reduced dependency
  • Opportunity to reduce risk and cost of service-user dependency on prescription drugs
Reduced benefits bill
  • Patients can get back to work without deteriorating on a waiting list for other treatments
Fully translatable for the BAME community:
  • TPT modules can be translated once and used by many, reducing the cost for conventional translators
Meeting the Government agenda
In the face of growing numbers of people with common mental health problems and in an environment of increasing costs and reduced budgets the Government is directing commissioners to look for new ways of improving accessibility to treatment. TPT falls in line with many of these objectives, such as:
  • Cost reductions in the NHS
  • Increased patient choice
  • Flexible delivery of services
  • Access by minority groups
  • Use of new technology
  • Innovation programmes
Quality Assurance
The Cognitive Behavioural Therapy delivered by TPT is well researched, evidence-based, and commonly practiced in the NHS. The therapy scripts have been peer reviewed. The technology of the delivery platform has been exhaustively tested to ensure reliable operation in the face of intensive and unpredictable use.

Performance metrics
Standard reports showing patient outcome and experience measures are available from the database which manages TPT. Healthcare providers can monitor their consumption of TPT licences. Cornard Healthcare is happy to work with clients on their reporting requirements in the light of user experience.
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
Prevention of Mental Health Problems
We believe that TPT can address the needs identified under the ‘Prevention of Mental Health Problems’ campaign. It is a simple, easy-to-use delivery platform which gives patients with mild to moderate mental health problems instant access to CBT and gives healthcare providers a cost-effective and flexible treatment option.
TPT is designed to teach people coping strategies for mild to moderate mental health problems. This, in turn, will improve the lives of the friends and family who are supporting them.
Using TPT in a primary care setting such as the Sandwell Model will reduce the burden on GPs and, by improving access to cost-effective treatment, will improve the mental health of the population. With only a few mouse-clicks during a consultation, GPs and other healthcare professionals log in online, prescribe a unit of TPT and print a simple two-page user-guide for the patient to take away.
The modular nature of TPT means it can be tailored to the needs of the population across the West Midlands, thus reducing the number of people directly and indirectly affected by mental health problems. Cornard Healthcare can work with healthcare providers and with commissioners to develop modules to best address the specific needs of the region.
The confidentiality of the TPT delivery platform for CBT and its ready translatability make it specially well suited to the diverse multi-ethnic and multi-cultural population groups in the West Midlands where language barriers and the stigma associated with mental health problems can prevent  patients from accessing the services they need.
Patient data protection
There is no personal data stored within the system as all patients are only referenced via their unique ID number.
Delivery Costs
The cost to the prescribing healthcare organisation is in two parts:
  • The prescribing licence for the organisation
  • A service-user licence for each 12 week course of treatment. These are pre-purchased in blocks by healthcare organisations.
Cornard Healthcare is happy to discuss favourable terms for early-adoption sites.
Patient Cost - None
TPT is free at the point of use. There is no cost to the patient as this covered by the service-user licence, so those on low income or benefits do not need to use valuable mobile credit or incur large telephone bills.
Current and planned activity: 
Cornard Healthcare is currently working with MIND in Suffolk who are using the TPT system to help their clients. The pilot study has already shown the system to be easily accepted and used by patients, popular with clinicians and reliable in use.

Required activity:
  • Procurement / Adoption of TPT across the West Midlands Trusts within both primary and secondary care settings
  • Feedback from clinicians and patients on how to develop the service to best suit the needs of patients and providers


 
What is the intellectual property status of your innovation?:
IP held and owned by Cornard Healthcare Limited.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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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
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 / Wealth creation / Clinical trials and evidence / Digital health / Person centred care
Benefit to NHS:
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
The benefits of early intervention
It is widely accepted that early intervention in psychosis services not only produces better outcomes but is also cost effective.
 
Primary care - nearly 500,000 people are on GP registers for a serious mental illness. (Care Quality Commission (June 2015), Right here, right now)
 
The demographic inequalities in the prevalence and risks associated with mental health problems are reflected in treatment. People who are white British, female or in mid-life are more likely to receive treatment, while people in black ethnic groups have particularly low treatment rates. People with low incomes are more likely to have requested but not received mental health treatment.
Current and planned activity: 
Current
Research and clinical validation towards CE marking through NHS Grampian, Lothian, Tayside, Glasgow & Greater Clyde with Scottish Borders and clinics in Peterhead & Fraserburgh added in April 2017 targeting >1,000 patients & controls.
 
SBRI contract to survey 50 GP surgeries as part to scope introduction of test in primary care

Planned
  • Seeking trial sites in the WM region to pilot the test in clinical settings to support CE marking
  • Ongoing refinement of the value proposition for clinical adoption and to support service user involvement by NHS e.g. final design of diagnostic report template
  • Dr M. Kumar (Consultant Psychiatrist) and ward staff at the Sth Staffs & Shropshire NHS Foundation Trust, has expressed interest in becoming a lead pilot site in WM region for clinical validation studies.
  • Wish to develop projects with MoD on PTSD using SaccScan technology. Require funding to set up St George’s Hospital as field trial site in collaboration with Clinical Trial Unit at Keele University
What is the intellectual property status of your innovation?:
Currently developing technical file for CE mark class I submission.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Simple
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