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Sharing the Learning: Efficiencies Delivered Across Acute, Primary and Community Healthcare
31 July 2019
We are pleased to publish a series of resources that encapsulate the unique outcomes and benefits realised by our members. The collection of Efficiency Savings summaries have been developed to offer a concise overview across Primary, Acute and Community Care.
Each resource provides highlights of how Flo has delivered efficiencies in healthcare delivery based on evidence shared with us from members of the Simple Telehealth Community of Practice.
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Community Care:
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Paediatric and Young Adult Member’s Network Launched
30 July 2019
Paediatric and Young Adult Member’s Network Launched
To launch the Paediatric and Young Adult Member’s Network, we would like to take this opportunity to share with you an overview of some of the inspirational innovation that is being delivered across the Simple Telehealth Community of Practice.
Supporting Children and Young Adults with Type 1 DiabetesOne of the most sustained applications of Flo’s support is for patients with Type 1 diabetes. Children and young people diagnosed with Type 1 diabetes can find adapting to and managing their condition particularly challenging, as it often happens at a time in their life of already increased physical, psychological and social change. Much like with adult diabetes pathways, Flo is on hand to provide additional support to help children and young adults: engage with their health, feel more in control of their condition and improve their education early on via an accessible and effective tool; their mobile phone. Flo has proven to be particularly effective within younger cohorts due to their familiarity with technology and the fact that they find that receiving simple SMS text messages is discreet, uncomplicated, and does not interfere with their wider use of their handset e.g. using data.Two patients who have benefitted from Flo’s helpful messages are Naomi and Erin. Naomi had struggled to manage her diabetes throughout her teens resulting in raised HbA1c and the development of diabetic bulimia due to concerns over weight gain. But with Flo’s support she was able to significantly reduce her HbA1c, which improved her long-term health outcomes. Similarly, Erin was struggling to manage her diabetes, and had been unfortunately previously admitted to hospital with ketoacidosis. Following her admission, Erin was introduced to Flo and was also able to reduce both her HbA1c from 112mmol to 83mmol, and also the risk of long-term complications due to poorly controlled diabetes. | Supporting Early Years Practitioners to embed changes in their clinical practiceNHS Highland have integrated Flo as part of their “Words Up” initiative. Words Up provides training to Early Years Practitioners, Teachers and Pupil Support Assistants to ensure that adult-children interaction is of a high quality to help to improve language and communication skills. The team have harnessed Flo via a unique and interesting approach by providing support to practitioners in reinforcing key elements of their training. Practitioners interact with Flo around the topics covered, which in turn refreshes and compounds the key messages shared during their training. Practitioners are also asked how easy or difficult they are finding making changes, which allows them to reflect and seek additional support if needed. To find out more about Words Up, take a look at this blog.Improving Compliance with Inhaler Regime for Children and Young Adults with AsthmaFor patients with asthma, ensuring compliance with inhaler regimes is key in controlling the condition and symptoms. For younger children with asthma, parents or carers usually take on the responsibility for ensuring that inhalers are taken as prescribed which can sometimes be difficult due to the competing priorities of family life. As a helpful prompt for parents, Flo has been recruited as a timely nudge to administer their child’s inhaler. You can find out more by watching this short video of Dr John Alexander from the University Hospital of North Midlands talking about how Flo has been helping his patients and the benefits she brings to patients, parents and his team. | Children’s Community Nursing - Enabling Remote Enteral Feeding and Blood Pressure MonitoringThe Children’s Community Nursing Team within Shropshire Community Health Care NHS Foundation Trust developed two innovative pathways around supporting parents whose children undergo enteral feeding, and also those whose children require scheduled blood pressure monitoring. Around enteral feeding, parents are prompted to send Flo their child’s weight, instead of having to arrange their schedule around a visit from a member of the Children’s Nursing team. For children requiring BP readings to be taken at regular intervals, Flo prompts parents to take them and reply with the reading. For both pathways, augmenting the patient’s normal shared management plan, if any child’s readings are outside of the desirable range, the Children's Community Nursing Team would be notified, and be able to take appropriate action.The implementation of Flo into these pathways has benefitted both staff, children and their families. For families, sending readings into Flo gives them the freedom to not have to plan around visits from the Children’s Nursing Team. Flo also reassures them that if there is cause for concern, a member of the team can pick this up when reviewing the readings, and initiate any required action. For clinicians, Flo is helping to reduce the number of home visits required by some patients, enabling them to better manage their caseload and allocate resources to other patients who may require additional support. A summary report by Children’s Community Nursing Team found that across only 7 patients, a total of 795 clinical hours were saved, which released the same capacity as an extra 1.0wte nurse working for over 21 weeks. To find out more about these pathways, take a look at the following blog. |
Capturing the Benefits: Evidence-Based Hypertension Micro Business Cases
18 July 2019
Developed from evidenced pathways across the Simple Telehealth Community of Practice, a series of short micro business cases are available in support of understanding the benefits derived from Flo’s integration. The micro-cases are a resource for community members to use to demonstrate savings when using Flo compared to normal care, and also as a model to adopt for local engagement and planning. The tables within the document are editable, so can be adapted to match your local costings or pathways. Please note: to edit and input your own costing values, double click on the table within the document which will open an editable Excel spreadsheet. Please be aware that any edits you make will be transferred to the Word document. |
Micro-cases are available within the Member’s Zone on our website. If your organisation is part of the SSHC Community of Practice, but you are not able to access the Members’ Zone, please contact Hannah.Mountford@simple.uk.net or Kylie.Dentith@simple.uk.net to get you started. If you would like to learn more about developing your own local micro-cases, please do not hesitate to contact one of the team. |
Digitally Transforming Primary Care – Making it Happen at Scale
Karen Moore
Advanced Capability Lead SSHC
27 June 2019
The event was hosted jointly by Facebook and the NHS Stoke-on-Trent and Staffordshire CCG Digital Nurse Ambassador Programme. Who following a hugely successful pilot, were granted funding to embark on a series of action learning events to support the spread and adoption of technology and social media tools across Primary Care Networks in England.
The agenda for the day was led by Dr Ruth Chambers OBE, Clinical Lead for Technology Enabled Care Services in the Staffordshire STP, and offered valuable insight and practical advice for NHS Leaders, commissioners and clinicians about how technology and digital tools can be used at scale to support the care delivered to patients.
Delegates were also given the opportunity to ask questions of the Digital Nurse Ambassadors and heard from both clinical teams and patient groups across the UK who shared their enthusiasm and experiences; with examples of where they have been able to successfully incorporate technology in their local practice to improve outcomes, and engage with patients with education about their health and wellbeing.
Phil spoke about the need for a reality check before engaging with any of the thousands of digital ‘solutions’ being promoted for healthcare and talked about how today’s market is rife with ‘snake oil’. He went on to encourage delegates to look for technologies with substantial independent evidence of efficacy and to be clear about how and why they will use digital. Phil endorsed the Digital Nurse programme with it’s clear and uncomplicated agenda and it’s aim of helping patients to help themselves in the simplest of ways, which consistent with the researched evidence base behind Simple Telehealth, can consistently deliver better and faster clinical outcomes. Ann Hughes, who is a Digital Nurse Ambassador from Stoke-on-Trent and is part of the team facilitating the National Action Learning Event programme, joined Phil for his session to share her own personal experiences of using Flo to support her patients. Ann had an elderly patient who needed to have cataract surgery, however disappointingly the surgery was cancelled due to a high blood pressure reading taken at her pre-op appointment. To determine whether this patient had hypertension or white coat syndrome, Ann signed her up to Flo and the patient sent in her BP readings. With Flo, the patient’s BP was shown to be within the normal range which then enabled the surgery to go ahead despite the white-coat readings at pre-op. “.. by the middle of the week I’d got enough readings to be able to print them off and fax them over to the pre-op team...and they did the operation based on those readings.” More from Ann: “.. I use Flo extensively in my practice… it’s just so easy to use and saves time..” “.. the impact for this lady was massive… it changed her life.” “.. that’s as simple as it is. It’s so easy to use, patients feel at home with it… and trust in it.“ We’d like to thank Facebook for their hospitality and congratulate Ruth and the team on a really fantastic day, hopefully the first of many! You can find out more about the event and view the presentations from the day via this link Digitally Transforming Primary Care – Making it Happen at Scale Conference. To keep up-to-date with the latest news, blogs and case studies in our community, you can follow us on Facebook @Simple Telehealth |
Flo continues to grow: Mental Health
21 June 2019
Mental health use and diversification with Flo maintains momentum into 2019
Members of the Simple Telehealth Community of Practice have received recognition for their application of Flo in their delivery of mental health care. In 2015, the Primary Care Mental Health Service in Tameside and Glossop were recognised as winners of a national Health Business Awards for Innovation in Mental Health, while in 2016 East London Foundation Trust were selected by The Health Foundation to be part of a £1.5 million innovation programme, focussing on integrating Flo to support mental health recovery and self-care for those with severe mental illness.
Flo’s use in mental health has continued to grow, and by 2017, the number of patients had increased by 16x those in 2012. While such an increase is worth celebrating, the real change to note is the diversification in the innovative approaches that clinicians are developing to integrate Flo into their care delivery. While medication and appointment prompts make up around 9% of usage in 2017, a number of new applications are now in use. These include:
Course & group support pathwaysThe latter group of pathways now accounts for almost 90% of the use of Flo within mental health. They represent an increasing trend towards a holistic approach to mental health, aiming to treat the patient’s well-being as a whole. For example, patients with depression have traditionally been medically treated via antidepressant medication, but many patients are now being referred to CBT courses or other talking therapies. These treatment pathways aim to address the root cause of any mental health issues the patient may have, and in doing so, encourage proactive steps to change the patient’s behaviour; Flo is now being used to maximise the impact of these treatments to further support and encourage positive actions by the patient. For example, South Tyneside Foundation Trust have been seeing promising results using Flo to support patients who attend appointments with Gateshead Talking Therapies.Health authorities are increasingly looking towards online courses to do this, as they are both time and cost efficient, as well as convenient for patients. One such standout example being used by members of the Simple Shared community is “Beating the Blues”. | NHS Lanarkshire has had great success using Flo to further support those patients who they have been referred to “Beating the Blues”. You can read more about their approach here. Lanarkshire’s success using Flo alongside the “Beating the Blues” programme has been noted, and community members from Powys are now looking to implement a similar approach to help patients with their mental health. It is exciting to see community members sharing their success and best practise with members from other areas, as this continually improves services for patients. A personalised approach to mental health with Flo:Flo has also been used in Nottingham to support patients attending CBT sessions. Patients joined a “Stress Spiral” pathway with Flo, where Flo would ask the patient how they were feeling, and then reply with a response dependent on this. For this pathway, the patients worked with their talking therapy clinicians to devise their own personalised stress spiral that identified certain personal behaviours as their anxiety and stress increased, and the responses Flo sent were also written by the patients. Ensuring that Flo’s responses were personalised is an innovative approach, it made Flo’s replies even more impactful and helped patients to further reflect on their progress during therapy.East London Foundation Trust (ELFT) are another organisation who have incorporated Flo into their mental health pathways to great effect. Flo is used in ELFT’s REFRAME telehealth project, which aims to support patients with severe mental illness, including chronic psychosis, self-manage and maintain independence. Flo prompts patients to take their medication as prescribed, as well as enquiring about their well-being indicators, which are personalised measures developed by the patient and clinician to recognise behaviours specific to the individual to indicate a decline in their mental health wellbeing. Similar to the Stress Spiral protocol in use in Nottinghamshire, this personalised approach ensures that the messages have meaning and impact for each individual. For more information about ELFT REFRAME, click here. |
Scotland Scales Up Flo with 1.2m investment
07 June 2019
Scottish Health Secretary Jeane Freeman visits Hunter Health Centre in East Kilbride to formally launch Scale Up BP nationally across Scotland. Backed with £1.2m investment from the Scottish Government over the next 2 years. “ This technology brings significant benefits to patients. It enables them to have more control over how they manage their condition, and greatly cuts down on the number of appointments they have to attend… By investing in improved technology across health and social care, we can improve patients’ experience and outcomes, and free up capacity in the system at the same time. ” Jeane Freeman - MSP, Cabinet Secretary for Health and Sport | Scale up BP is part of the wider Technology Enabled Care (TEC) Programme established in Scotland in 2015/16 and to date, more than 150 practices have used Flo to support patients requiring blood pressure monitoring either to diagnose hypertension, monitor BP or titrate medication, with over 10,000 patients benefiting so far. Simple Shared Healthcare are thrilled to offer our congratulations to the NHS 24 TEC Programme along with all of the teams and clinicians who have been involved in the fantastic success of their Scale Up BP programme. We’re delighted that Flo with her #TotallyUnique methods and patented technology has already supported so many and we’re really excited to see her continue to offer support to many more patients across Scotland in the future, supported by this fantastic investment from the Scottish Government. To find out more about the Health Secretary's visit you can access the full news item on the Scottish Government’s website here. |
Urgent Care Coping: Supporting Patients with Severe Health Anxiety
14 March 2019
In June 2018, findings from the study ‘Helping Urgent Care Users Cope with Distress about Physical Complaints’, lead by Professor Richard Morriss of the University of Nottingham, were first presented and then subsequently published in January 2019. The purpose of the study was to compare the clinical and economic outcomes of using remote cognitive behavioural therapy (RCBT) to treatment as usual (TAU) for repeat unscheduled care users with severe health anxiety. Dr Sam Malins, Clinical Psychologist at Nottinghamshire NHS Foundation Trust, integrated Flo as an additional support tool to the RCBT group following their participation in the study. What is Health Anxiety? “Health anxiety is an anxiety condition that is often housed within the Obsessive Compulsive Disorder (OCD) spectrum of disorders. Those affected by health anxiety have an obsessional preoccupation with the idea that they are currently (or will be) experiencing a physical illness.... the person experiencing health anxiety may fixate on any type of illness…. Those who are affected by health anxiety/illness phobia are convinced that harmless physical symptoms are indicators of serious disease or severe medical conditions. For example, if a person experiencing health anxiety feels their chest is getting tight, they may believe that they are having a heart attack. Those with health anxiety frequently misinterpret physical symptoms of anxiety as a sign of an impending physical health problem.” | We were delighted to hear about Flo supporting the provision of RCBT in Nottinghamshire by providing additional support for participants in the study. Following prompts asking how they were feeling, Flo interacted with participants around how they felt by sending personalised messages. The messages were written by the participants themselves to maximise the impact of interactions. The inclusion of Flo within the study aimed to reinforce positive changes made during RCBT sessions and to support long-term behaviour changes amongst those with Health Anxiety and as a result, reduce the number of contacts with unplanned/urgent care providers. In total, 156 participants were recruited, half of whom received treatment as usual, while the other half received RCBT. For those in the latter group, CBT sessions took place either by phone, or through a WebEx video call. It was found that those in the RCBT had significantly improved outcomes for generalised anxiety, depression and overall health at 12 months when compared with those receiving treatment as usual. The findings from this study were officially published in BMC Medicine in January 2019 and is available to download here (Membership required). |
For more information please contact Sam Malins at Sam.Malins@nottingham.ac.uk
#Mental Health #Health Anxiety #RCBT #TAU #University of Nottinghamshire #BMC Medicine #TotallyUnique
Community of Practice Members feature in new NHS Education for Scotland Workforce Stories
28 February 2019
We are excited to share with you that five of our Simple Shared Health Care community members have been featured in the Home and Mobile Health Monitoring section:
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Each workforce story provides an personal insight into the commitment that our community members make to improving the quality of care delivered to their patients, such as fewer appointments, improved confidence and self-management, and improved clinical decision making.
To take a look at other workforce stories, please click here.
#Scotland #NHS Education for Scotland #TotallyUnique
National Year 3 Evaluation Report
The Scottish Centre for Telehealth & Telecare (SCTT) have published their year 3 evaluation of Home and Mobile Health Monitoring (HMHM); We’re proud that Florence is formally evidenced as a significant contributor across Scottish Health Boards. “ The most frequently deployed HMHM technology was Short Message Service [Florence] ” We are thrilled to be able to share this evaluation as an example of how Flo’s simple methodology and unique persona continues to improve patients lives. The report also recognises the passion and commitment from Scottish Community of Practice members who are continuing to innovate with Flo, providing high quality care that supports increased self-management and personal responsibility for health. The report takes an in depth look at how the HMHM programme has enabled health care innovation with technology to take place across Scotland, including the challenges faced, learning, and recommendations for continued scale-up and adoption. “ This report draws on evidence and valuable experience from across the TEC Funded partners in Scotland and at national level and reaffirms the important foundations that our national work has delivered to date. The report sets out key recommendations as to how we can continue to shape and inform our future national HMHM activities to support our scaling up efforts over the next few years to achieve wider population health benefits and support at scale service transformation. ”
Partner sites submitted evidence of how resources were being used efficiently and effectively, or how hospital admissions had been avoided. Importantly, patient and service user feedback is also included in the evaluation. | The report highlights evidence gathered where Flo has supported attainment of the desired outcomes. For example:
“ I like that Florence reminds me to do my BP. No improvement needed to the service – more like this are needed to take pressure off the NHS ” “ It was fantastic. It really reassured me because of my family history of high blood pressure ” “ Some people felt that Flo had helped them to stay on track while others said it gave them reassurance, ‘like somebody’s looking over my shoulder just keeping an eye on things. ” Having presented the evidence, the evaluation then goes on to further discuss scale-up and sustainability, with discussion of the implications and recommendations for next steps for the HMHM programme across Scotland as a whole. |
To read the full report, please click here
Direct references to Flo can be found on pages: 12, 13, 16, 17, 18, 19, 20, 21, 23, 24, 26, 30, 35, 42, 43, 44, 45, 46, 47, 48.
#Scotland #SCTT #Scottish Centre for Telehealth & Telecare #HMHM #Home & Mobile Health Monitoring #TotallyUnique
Maternity Network proves a hit with Midwives
30 November 2018
The Maternity Members Network was developed this year as an environment for clinicians to collaborate and share best practice developed locally through Flo’s implementation. The network hosts quarterly calls facilitating members of the wider Simple Telehealth Community of Practice to come together for one hour to share and discuss their experiences, outcomes, ideas or queries to support their maternity patients. The role of peer to peer conversations cannot be underestimated in igniting innovation; being able to chat to a like minded clinician who has already, or may be planning to introduce Flo into their pathway is a valuable part of any clinical redesign, and one that has underpinned the spread of pathways across the Community of Practice so far. | The network has so far heard from Janette, Antenatal and Newborn Screening Lead/ Senior Midwife Sonographer from City Hospitals Sunderland, part of the original team who developed the Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) pathways; to read more please click here. Based on robust early evaluation, these pathways have spread beyond the North East and have now been adopted in several maternity units as a result of the teams innovation and commitment to innovation. Karen McKillop and Ayleen Austin, both Midwives at County Community Hospital within NHS Highlands, also shared their experiences with Flo as a support to Foetal Movement Awareness for their Mum’s to be. The aim of the pathway was to help women to be more aware of their babies movements. NHS Highland’s foetal movement pathway was developed inline with current guidance practiced locally. The team also incorporated bite size messages into Flo’s protocol that shared health promotion advice and also clinic appointment reminders. The pathway commenced when mums to be reached 16 weeks of their pregnancy with Flo interacting through to 38 weeks. 50% of the team’s current caseload were being supported by Flo; patients fed back:
| The calls begin with an overview of the previous call, which is an opportunity for those who were unable to attend, to receive an update and request more information if required. This is then followed by a short update on new maternity pathways developed within the Community of Practice since the last call. The focus is then handed over to the featured team, for them to share their experiences, outcomes and any challenges they have overcome so far. There is also the opportunity for members to ask any questions or request more detailed information. |
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