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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Mush is a free app and social network for mums. It enables mums to instantly become part of their local mum community, to seek advice, arrange meet-ups and to make friends for life.
Overview of Innovation:
Mush was created by two mums, Sarah and Katie, who met in a rainy playground and bonded over the challenges of having two children under two and a shared feeling of isolation from the shift in their lives since becoming parents. It turns out they weren't alone in feeling like this. 92% of mums admit to experiencing intense bouts of loneliness, and 1 in 4 suffer from poor mental health through pregnancy and after birth. They knew just how transformative this new friendship had been for their mental health and wellbeing. They wanted to create an easy and fun way to find local mum friends, and Mush was born.

Mush ignites communities for all mums, placing a 24/7 support network at their fingertips. Users create profiles and can find other mums going through the same thing, to reach out to for advice and support, to arrange meet-ups and to spark friendships. Friendships that for hundreds of thousands of mums have become a complete lifeline.

Our 'Topics' allow users to engage with one another and gain real advice from fellow parents around specific subjects, anything from: pregnancy to breastfeeding to being a single parent. Furthermore, Mush takes a unique place in the parenting landscape by providing an honest, safe and friendly voice to its community. Our Guides, written by top journalists who also happen to be parents, provide a funny, non-judgemental take on the everyday trials of parenthood.

Every month 100,000 mums in the UK use Mush. What this means to our users is that wherever you are in the country, there are local mums waiting to meet you. Used by the Government as one of the Case Studies in their first ever 'Loneliness Strategy', Mush is helping to connect communities together again to quash the sobering statistics around maternal mental health and loneliness. We believe that no mum should feel like they're doing it alone.

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':
Feeliom prevents anxiety & depression by helping people stay in touch. Our mobile app's unique Sensory Language tackles loneliness, enabling emotional expression without the need for words, and generates continuous insights into wellbeing using AI.
Overview of Innovation:
Feeliom is a mobile app that empowers people to intuitively express emotions through technology; without the need for words. It does so by emulating our sense of touch.

Touch plays a prominent role in sharing emotions. and has many positive effects on health. A gentle stroke can increase the release of oxytocin and serotonin, which improves wellbeing and positively regulates affection and social behaviour.
 
A science known as haptics lies at the intersection of touch and technology. By blending haptics with sound and visual feedback, Feeliom creates a tangible representation of how we feel that can be easily shared with others.

Not only does its patented Sensory Language create an immersive communication experience, Feeliom allows us to quantify and analyse a single emotion across over 10,000 data points.

This quantitative data is brought together with Artifical Intelligence (AI) to analyse feelings shared on a continuous basis. This enables Feeliom to contextualise emotions across the entire spectrum of one’s wellbeing; determining variance, trends and profundity of risk for mental health problems on a personalised basis.
 
These insights are subsequently used to help the individual gain a continuous understanding of their mental health/wellbeing, including recommendations for improvement, and to proactively connect them with the appropriate care: Whether that’s from family and friends, colleagues at work or healthcare professionals.


                                                                       
There are several modules within Feeliom that can be used to communicate emotions, enabling the app to gain an evermore well-rounded understanding of one’s state of mind. These lie in stark contrast to the verbal methods for sentiment analysis upon which most methods currently rely.

Feeliom will help to identify symptoms of stress, anxiety & depression and prevent them, however, all diagnoses must be carried out by a qualified professional. Patients may allow healthcare professionals to access their data in real-time, particularly in the case where the app plays a supportive, as opposed to a preventive role.

Specific Applications:

1. People with impaired verbal communication - such as those with learning disabilities or dementia - often face disproportionately higher rates of depression linked to loneliness. Feeliom overcomes this through touch.

2. An emerging body of evidence demonstrates that depression and physical disorders, including diabetes, are commonly comorbid making it an increasingly important clinical and global health issue.
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
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 / Clinical trials and evidence / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Depression and anxiety are two of the heaviest burdens on health in the UK and worldwide. The effects of depression and anxiety cost the UK £32 billion each year and, while depression accounts for 33% of the burden of disability, it attracts just 2% of Public Health Spending. According to the King's Fund, only 0.1% of NHS spending on Mental Health services in 2007 went towards prevention, despite the fact that it represents good pay-back in the long-run both for people’s health & wellbeing and for NHS finances. In the case of suicide prevention, for every £1 spent, the return on investment from such interventions is estimated to be around £39. Prevention is the only way to achieve lasting change in mental health and end the stigma, particularly in the case of depression; the greatest risk factor for suicide. Overcoming stigma is at Feeliom's core, enabling people to self-express without the need for words.

In most parts of the UK, waiting lists for therapy are over nine months, or there is no waiting list at all because there are no therapists. As a result, patients are often provided with medication prescribed by the GP but do not receive sufficient counselling to tackle the roots of the problem.
 
Tackling depression and anxiety, particularly from a preventive perspective, requires we overcome one of the few subjects more stigmatised than mental health: Loneliness. Marked cross-sectional associations exist between loneliness and Common Mental Disorders (CMDs), including depression and anxiety for people of all ages.

Feeliom bolsters people's primary care networks to prevent mental health problems, creating both efficiency and financial savings downstream. Friends, family, work and GPs play a key role in reducing loneliness and preventing anxiety & depression by providing value in the form of healthy social relationships where people do not feel embarrassed to admit their feelings.

Not only does Feeliom support people by strengthening their relationships with others, but also by bettering their self-understanding; enabling them to take proactive mental healthcare into their own hands.

Feeliom reduces the burden on the healthcare system through prevention and, in more severe cases, supports people throughout their treatment. By seamlessly integrating health into communication, continuous insights into wellbeing that may otherwise have never been accessible provides professionals with a deeply personalised and broad perspective from which to diagnose and treat.
Initial Review Rating
4.40 (2 ratings)
Benefit to WM population:
The population of the West Midlands is particularly diverse with people from a range of different cultural backgrounds. Often, in the western world, BME populations suffer from a higher incidence of mental health problems than most. In the case of refugees, care is of critical importance.

Feeliom's Sensory Language, based on our sense of touch, provides a unique, cross-cultural approach to the prevention of mental health problems. It overcomes the verbal barriers people so often face when expressing emotions, particularly when they are not speaking their native tongue.

Beyond this, whilst cultures struggle to overcome social stigma around the subject of mental health, Feeliom makes it a thing of the past by merging our wellbeing seamlessly with one's everyday communication. By placing emotions at the centre of how people stay in touch, this creates a sense of empathy amongst individuals, as well as between patients and healthcare professionals who may find linguistic barriers affecting their practice.

Many people, particularly from Asian backgrounds, prefer to take an informal care approach for their loved ones; especially when it comes to caring for dementia in the elderly. Whilst this is admirable, the effect it has on informal carers' mental health and wellbeing is shocking, with over 80% of carers admitting to feeling alone. Feeliom's solution does not focus on supporting individuals, its entire function is based on community. The network effect of communication at its core, provides a valuable resource for these people who are especially vulnerable and yet often entirely overlooked as they fight to protect their loved ones.

In 2009 the West Midlands had the highest proportion of children aged under 16 of the nine English regions, 19.4 per cent compared with an England average of 18.7 per cent. With 50% of mental health problems developed before the age of 18, and 75% before the age of 24, it is critical that when we talk about prevention we are creating something for children too.

Feeliom's sensory interface and free space for self-expression are ideal for children who are, by comparison, more open to new methods for communication. Much of Feeliom's advantages lie in its approach: It is meant to be both intuitive and fun. Mental health has never been viewed in such a light before and, when it comes to bringing children on board, Feeliom sets itself apart by putting interactive engagement at the heart of its solution.
Current and planned activity: 
Feeliom is working with Imperial College London and University College London to carry out clinical trials of its mobile app.

We wish to undertake trials with West Midlands Trusts and would welcome a conversation with interested parties.

We are partnering with Trusts such as Surrey & Sussex Healthcare NHS Trust to define key targets and disseminate Feeliom, so far this will be done through 3 core channels:

1. Providing inpatients with a simple way to stay in touch with their loved ones & preventing mental health problems amongst the inpatient population
2. Providing nurses with a dashboard overview of the wellbeing of their inpatients
3. Providing NHS employees with Feeliom as a preventive tool for their mental health

We are continuously developing Feeliom's mobile app and interface for professionals further. And so with the help of NHS Trusts and learnings from different populations, we will work alongside our partner Trusts to tailor solutions to them and the people they support.
What is the intellectual property status of your innovation?:
Feeliom patented its unique Sensory Language in the UK in 2017.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Our online workshop helps women from all backgrounds in all demographic areas to access positive, factual information to support their birth choices using evidence-based information that can be updated as and when new guidance is released.
Overview of Innovation:
The Real Birth Company’s mission statements are ‘to provide relevant, up to date, evidence based antenatal information that is delivered with a positive attitude’ and ‘to impart our knowledge with confidence to empower women and their birth partners at this very special time’.
 
We have achieved this with our RCM accredited antenatal education training programme that has been developed into an online e-learning antenatal resource for women birthing in the UK & is available in several languages. This e-learning resource is a birth physiology workshop full of important information that supports UK practice & enables women to understand the reasons behind their care, whilst supporting them to make informed choices in labour.


Antenatal education is essential to helping women form opinions & make choices in regard to their pregnancy & birth. There are various types of antenatal education. Hospital accessible antenatal education is dependant on resources, demographics & availability of staff to name a few. Lots of these classes use traditional methods of teaching with limited time to discuss at length the physiology.
 
The Real Birth online workshop is easily updated & uses evidence-based information from NICE, WHO, RCM, RCOG & others. It is holistic, culturally sensitive & can be accessed from anywhere by computer, tablet or mobile phone.
 
The innovation of creating a multi-lingual online e-learning workshop came from the positive birth results that were consistent with women & their partners who had attended a specifically designed positive birth workshop.
 
The workshop was created using techniques that help graduate students revise for exams, this learning technique has been integrated into the imparting of positive birth physiology. The use of non-threatening language & positive birth information helps to normalise birth & reduce fear. When fear is reduced in labour the benefits for both mother & baby are both psychological & physiological.
 
Barriers to effective antenatal education can include:
  • time pressures for antenatal classes
  • finding midwives who feel comfortable giving antenatal education
  • update & training costs
  • availability of classes
  • limited spaces for face to face classes
  • cost of interpreting services/availability of interpreters
  • birth terminology used
  • women being unable to attend for social or demographic reasons
Our online workshop works to address these barriers to help women from all backgrounds in all demographic areas to access positive, factual information.

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: 
Digital health / Innovation and adoption
Benefit to NHS:
The Real Birth online workshop is an easily accessible form of evidence-based antenatal education (updated as evidence changes) that is interactive, informative & fun to use.
 
The Better Births Maternity Review says that all women should have access to information to enable them to make an informed, non-bias choice.

Making Normal Birth a Reality states ‘evidence-based information for women about factors that make a normal birth with good outcomes for the mother & baby more or less likely, presented in a format which they understand so that they can plan for the kind of birth they want & make informed decisions’ is an essential part of birth preparation.

WHOs new recommendations on reducing unnecessary births by C-section recommended ‘Health education for women is an essential component of antenatal care’ by using childbirth education workshops that include partners to support women & address fear of birth with methods such as understanding birth physiology, our workshop helps to address unnecessary interventions in labour.

Women with access to antenatal education have a higher chance of normal birth & a more positive birth experience that can help in the postpartum period.
 
The workshop follows a researched learning technique. Written in a style that enables users to learn & retain the information more effectively leading to confidence & understanding of birth.
 
Accessed from 25 weeks of pregnancy via a unique coded card issued by the healthcare provider, users work through 1 module at a time before accessing the next to ensure the workshop is comprehensible. Within the modules are questions, diagrams & carefully designed non-threatening animations.
 
Each language has been translated by first language speakers to ensure the terminology is understandable & animations are culturally respectful whilst explaining a journey of birth. NICE Pregnancy & Complex Social Factors list barriers for women who speak no or little English that include lack of interpreters & knowledge of the maternity service. Our workshop helps address such barriers. NICE also say that with this group of women other methods such as online video clips & audio information should be used.

  
 
Our workshop is factually based giving true & correct information & techniques to practice for labour along with the best positions & why. It addresses subjects like the reasoning behind recommendations for skin to skin & looks at how this can help aid mental health for both parents in the postnatal period.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Antenatal education has a role to play in improving knowledge of, and preparation for parenthood and can lead parents to be, to adopt a range of healthy behaviours that affect pregnancy and birth, improving outcomes and the mother’s experience of birth.
 
The Real Birth Company is committed to supporting all women to access up to date and evidence-based information relating to their birth. We believe that all women should have access to this information and have produced the e-learning modules in several languages to help tackle health inequalities.
 
Tackling health inequalities in infant mortality and infant and maternal health, will not just improve health outcomes today, but lay the foundations for sustainable, long-term improvements in health.
 
At 5.5 deaths per 1,000 live births, the West Midlands has the poorest infant mortality rate in England [2014 data].  The infant mortality rate takes into account the total number of live births and so provides a more accurate indication of trends than just analysing the number of deaths in infancy over time. The West Midlands rates are significantly higher than the England average. (source)
 
Poorer mothers-to-be often do not attend antenatal classes. Almost three-quarters of pregnant women on low incomes do not attend antenatal classes according to new figures. Nearly half are not even offered them on the NHS. (source)
 
The Real Birth Workshop was created because we believe that all expectant parents should have access to positive birth information. It is beneficial for pregnant mums and their birth partners to have positive help with their birth preparation. We support all birthing choices because we believe in empowering women with the right information when they need it.
 
A report by the National Childbirth Trust (NCT) Preparing for birth and parenthood report surveyed 928 expectant parents (first-time mothers and fathers) attending antenatal courses. The research found that while only 3% of women said they felt confident about birth before attending an antenatal course, afterwards 98% said they felt confident or fairly confident. Similarly, among fathers-to-be surveyed, just 1% said they felt confident about birth before their course; afterward 97% felt confident or fairly confident.
 
The Real Birth Online Workshop provides parents to be with the education they need to manage and reduce maternal anxiety leading to improved coping strategies, greater partner support and a better birth experience.
Current and planned activity: 
We believe the workshop shows decreased admission in the latent phase, decreased use of analgesia & an increase in women having a positive birth experience.

We need champions who can apply for NIHR funding with us to pilot The Real Birth Online Workshop with women using their NHS maternity services.  
 
A number of languages are currently active, we want to include more to help all women access valuable antenatal education. Being able to access our online workshop provides antenatal education to women who may otherwise be unable to attend classes for various reasons including social, cultural & demographic.
 
Many proactive measures are being taken to address perinatal mental health. We believe a positive birth experience doesn't depend on mode of birth but choice, understanding & involvement in decision making & empowerment in pregnancy & labour.
 
Our programme can have a positive effect on women’s birth experiences & her birth partners & assist with informed choice & understanding of birth.  
What is the intellectual property status of your innovation?:
100% IPO The Real Birth Company Limited
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
N/A
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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