Innovation Case Studies 2016

June 2016

Introduction Lilie

Additional information is available on a selection of the case studies. To find out more please go to: http://www.england.nhs.uk/ innovationconnect Click on the Innovation Exchange web link. If you have an innovation case study you would like to discuss further please contact the Innovation team on:Phone:- 0113 825 1105 Email:- [email protected]

The case studies captured in this document provide a comprehensive list of exemplar innovation projects from across the NHS. These innovations have been carefully selected to represent a range of ideas from medical technologies through to service and pathway re design. Each case study provides background to the innovation and a contact point for further information. The case studies have also been published on NHS England Innovation Exchange - Case Studies

June 2016

Refer-to-Pharmacy allows the hospital pharmacy team to refer eligible patients to their regular community pharmacist for post-discharge support with their medicines. There was no easy and reliable way to inform community pharmacists which of their patients were coming out of hospital, and ensuring they had all the information to carry out an effective consultation. This project aimed to:  Refer patients electronically to their community pharmacist, allowing viewable access to discharge letters  Improve medicines adherence through patients understanding and taking their medicines as intended  Reduce re-admissions to hospital and Emergency Department attendances  Reduce the cost of wasted medicines (by informing community pharmacists on admission that their patient won’t be requiring medicines during their hospital stay and updated medicine details automatically being sent on discharge) A wide group of stakeholders have supported the project including:  Webstar-Health (a software provider worked with ELHT IT department to build and test the IT interfaces),  Lancashire Local Pharmaceutical Committee (LPC) support which kick-started the whole development,  The Royal Pharmaceutical Society backed the system (and subsequently produced a referrals toolkit to help other health economies www.rpharms.com/referraltoolkit)  North West Coast AHSN provided support to raise awareness of the scheme locally and nationally, and produced evaluation of Refer-toPharmacy,  The Centre for Postgraduate Pharmacy Education has produced an online training package to help pharmacists and technicians with referrals and interpret discharge letters https://www.cppe.ac.uk/programmes/l/transfer-e-01/. They also helped develop a local training package to support the launch with evening training sessions and Manchester University School of Pharmacy to carry out a service evaluation of the scheme Key enablers of success  Having a core of people dedicated to making Refer-to-Pharmacy a reality in East Lancashire, and setting out from the start to create awareness  Training events for local community pharmacists to help them utilize the system more effectively, interpret discharge letters and gain improved consultation skills

PROJECT CONTACT [email protected] www.elht.nhs.uk/refer

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AliveCor Atrial Fibrillation is the most common heart rhythm disturbance in the UK and Ireland: it affects around 2 million people each year and is responsible for one third of all strokes. AF and AF-related illness costs the NHS over £2.2billion each year - and rising. Reduction of strokes caused by Atrial Fibrillation (AF) is a key shared priority for all AHSNs, with the Innovation Agency, Oxford, Imperial College Health Partners, UCL Partners and North East & North Cumbria AHSNs championing this area. • • • •

AliveCor is a simple and highly effective handheld ECG. This programme is an example of cross-AHSN collaboration: scaling is supported by five AHSNs and AliveCor EU General Manager, Francis White, a NHS National Innovation Accelerator fellow. The device supports effective AF diagnosis in primary care; speeds up diagnosis & reduces outpatient appointments It is inexpensive for patients to buy (£100), supporting self-management.

Impact so far • Support from the AHSNs has helped increase the number of GPs and patients using the device by over 300% - from 1,600 to 5,100 active users • The device was used to record over 1million ECGs • Around 72,000 AF recordings were captured via ECGs What’s next? • Community pharmacists will be delivering a pan-London AF screening programme, supported by the AHSNs, during 2016 • The AHSNs will use their networks to support NHS Innovation Accelerator Fellow Francis White to raise awareness of this innovation • An evaluation is being undertaken to establish the economic potential of the innovation, by avoiding unnecessary admissions or cost avoidance to secondary care / A&E

PROJECT CONTACT [email protected] Oxford AHSN

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‘Flo’ Telehealth Over 15 million people in the UK live with a long term condition (LTC) and “Flo” offers a simple way to increase self-management, resulting in fewer visits to GPs, a reduction in hospital admissions and decreasing reliance on home visits. • Florence (‘Flo’) Simple Telehealth uses SMS to communicate with patients, for example reminding them to take readings or medication. • NHS owned, at just 8p per text (free for patients) it is highly cost effective to administer across a wide range of LTCs; driving down costs and enabling bigger caseloads to be managed within existing resources East Midlands, North East & North Cumbria and West Midlands AHSNs have adopted this approach Key learning • With support from the three AHSNs this telehealth innovation is now being used by over 70 health and care organisations • 33,000 patients are registered to use Flo for a wide range of conditions using clinically approved pathways, a 300% increase in just 12 months • The East Midlands have demonstrated: – Monitoring of oxygen saturation levels resulted in a 40% decrease in expected hospital admissions in one setting – Heart failure nurse team home visits reduced by over 30%; one home visit costs £67 compared to an annual cost for Flo of just £70 including all equipment What’s next ‘Flo’ is being considered for adoption by all 15 AHSNs during 2016-17 to support nationwide availability. Following the success of the initial pilots, some sites are integrating cancer patients into the mainstream cardiac rehabilitation programme and incorporating other cancer groups, which will effectively reduce further NHS burden and costs. Opening up the service to lung cancer patients both pre and post-surgery is now planned linking with the Liverpool Health Lung Project.

PROJECT CONTACT [email protected] East Midlands AHSN

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‘Activ8rlives’ self care The NHS spends around £4.7 billion annually on treating lung disease. Hospital admissions are disruptive, particularly for older patients who can lose independence during a hospital stay. People with long-term respiratory diseases are susceptible to chest infections; each episode damages the lungs, resulting in prolonged treatment in hospital. A self-administered sputum test gives patients with long term respiratory disease early warning of chest infections, enabling home treatment and reducing hospital admissions. SBRI funding supported the company (Aseptika) to extend its system, which tracks and analyses blood oxygen, heart rate, temperature, blood pressure, body mass and lung function

The company was supported by Eastern and Wessex AHSNs as part of the SBRI programme and clinical trials Impact so far • Exacerbations are predicted up to 21 days before the patient would typically seek help • Ease of use supports adherence rates of up to 99% • Patient lung function during trials improved by up to 20% • Since 2015 over 80,000 people have signed up to monitor their health using the Activ8rlives website • If scaled nationally, estimates are that the technology could save the NHS in excess of £50 million each year What next • Aseptika was involved in Eastern AHSN’s Test Bed bid & is an innovation partner in Sheffield’s Test Bed site; it will integrate the self-monitoring package into new respiratory pathways • Aseptika is capitalising on emerging technology to develop a range of products to support self-enabled care; the AHSN’s support has been critical to supporting the company to grow

PROJECT CONTACT [email protected] Eastern AHSN 6

STarT Back – stratified care for low back pain Back pain is the commonest reason for middle-aged people to visit their GP, representing an estimated annual cost to the NHS of £10 billion. It is the second most common reason for sickness absence, persistent disability and work loss in the under 65s. Current approaches mean that a substantial proportion of patients are over-treated, while a significant number fail to get the right care. West Midlands AHSN have adopted a stratified care approach for low back pain (LBP) that improves clinical outcomes, patient satisfaction and care pathways; reducing disability, sickness absence and physiotherapy waiting times. The Keele STarT Back approach utilises an innovative risk stratification tool to identify patients’ at risk of persistent LBP disability. Low risk patients are supported to self-manage in primary care, medium risk patients receive evidence based physiotherapy, and at high risk patients are treated by up-skilled physiotherapists to provide a psychologically informed approach. Impact so far • An Arthritis Research UK funded trial demonstrated that STarT Back is clinically and cost-effective, saving £34 per patient in health costs, e.g. GP visits, MRIs, medication and £675 per patient in societal costs e.g. reduction in absence from work. • West Midlands AHSN is supporting scaling within and outside the region: 15 physiotherapy services within the West Midlands and a further 16 across the UK have adopted the approach. • The STarT Back tool has been embedded into the EMIS GP clinical system enabling easier identification of patients and matching to evidence based care pathways. • High quality patient information has been embedded into patient.info for GPs to easily access during the consultation. • The STarT Back approach has been adopted internationally with the tool formally translated into 12 languages (8 validated). • Physiotherapy teams report: reduced wait times &; high patient satisfaction Next steps • Work is progressing to embed the tool into additional GP clinical systems and further clusters of Trusts, GP practices and CCGs are integrating this approach into their pathways • A new NIHR trial led by Keele is developing and testing a general practice risk stratification approach for other common musculoskeletal pains

PROJECT CONTACT [email protected] West Midlands AHSN

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Point of care CRP testing for respiratory infections in primary care Historically, antibiotics have been prescribed for many patients with an acute uncomplicated respiratory tract infection (a cough). Evidence from studies suggests minimal benefit is achieved from the prescription of antibiotics, but it can be dangerous to delay antibiotics for a significant bacterial infection that won’t clear up naturally, so doctors have a big challenge in identifying who needs antibiotics. The Attenborough Surgery in Bushey, Hertfordshire is aiming to tackle that by testing patients in the GP surgery for a biochemical marker of bacterial infection called C-reactive protein (CRP). The use of CRP testing is included in the 2014 NICE guidance on the assessment of patients with suspected respiratory tract infection. The clinical assessment together with a finger prick blood test for CRP (with results in 4 minutes) using the Alere Afinion analyser is used to assess patients and helps decide whether antibiotic prescribing is appropriate. It is wide spread practice in many other countries to use CRP testing to help decide on appropriate clinical management. Since November 2015, the surgery has offered CRP testing for all eligible patients who visit with an acute cough, if clinically appropriate. They have already demonstrated a significant reduction in their antibiotic prescribing compared to last winter. Impact so far

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The scheme has reduced antibiotic prescribing by 25% and sharply reduced repeat appointments for coughs, with the proportion of patients re-attending from 24% to 4%. Presented the work at two workshops in parliament on 25 May, hosted by Maggie Throup MP showcasing examples of good practice and practical strategies to tackle Anti-Microbial Resistance. The workshops were open to all MPs, peers and their CCGs

Next Steps  Use the Challenge Prize funding to further raise awareness of the scheme, extending the scheme to a further 10 practices and developing the business case for roll out across the CCG,  Building up training, mentorship and project development programmes.  Implement the second stage of the project – testing for lower respiratory tract infections in primary care.

PROJECT CONTACT [email protected]

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Breathe Magic Intensive Therapy programme Hemiplegia (paralysis of one side of the body) affects approximately 1 in 1000 people but many of the traditional treatments fail to engage the young people sufficiently. Research shows at least 65% of people with hemiplegia could benefit from intensive motor therapy and, crucially, 44% suffer from psychological and social difficulties as a result of their condition. Breathe Magic intensive therapy programme is aimed at children and young people 7-19 years of age. The programme brings together specialist occupational therapists and academics in the field of neuro-rehab together with magicians to deliver a fun and effective therapy programme. Key Learning • High levels of engagement and retention have been achieved with children and young people through the programme compared with more traditional therapeutic interventions, and parents reporting better psychological wellbeing and requiring fewer hours of care and support • Participants on the programme have shown up to an 80% improvement in hand and arm function on completion, and clinically significant motor skills improvements maintained at 6 months,; Next steps  Working to develop a pan London programme for 2016-17 onwards, and working with Yorkshire and Humber Academic and Health Science Network to extend and test the programme further in a rural location outside of London  Exploration of programme being extended to other groups, such as children and young people with mental health conditions; • Identification of an appropriate clinical lead / mentor to work with Breathe Arts on development and adoption of the programme to other sites over the next 2 years. • Breathe Arts is a social enterprise and has developed steadily with high levels patient and carer engagement in the development of the programmes offered, together having secured 3 year support from Lambeth CCG and also Wandsworth CCGs

PROJECT CONTACT Yvonne Farquharson, Managing Director [email protected] 9

Harnessing digital technology FARSITE – rapid searching web application Greater Manchester AHSN and the Greater Manchester Clinical Research Network (GMCRN) are accelerating health innovation through helping researchers and clinicians improve the way data is handled and studies are planned and conducted. FARSITE was developed by NorthWest EHealth, a partnership between the University of Manchester, Salford Royal NHS Foundation Trust and Salford CCG. The tool confidentially finds and contacts groups of patients in a population. It can be used to gauge the feasibility of and to recruit for clinical trials, medicines reviews, and also used for risk stratification. Results • Operational across the four northern AHSNs, covering over 1.3 million patients. • Greater Manchester outperforms all other regions of the country for recruitment to life sciences trials as a consequence of FARSITE, for example, more than 4,500 people from 33 GP surgeries with were recruited to a care evaluation programme within 16 weeks with FARSITE. • Hitachi is building FARSITE into their large-scale diabetes prevention programme, as it can rapidly establish which patients should be targeted for preventative therapy. • Currently reviewing whether FARSITE could be used to screen high-risk patients and help GPs target therapeutic interventions for stroke prevention. • In the last 12 months, the GMCRN has completed more than 250 feasibility searches for industry and academia studies in primary care. • After rolling out in Lancashire, FARSITE is being extended across the North West’s geography (7 million) over the next two years.

PROJECT CONTACT [email protected] Greater Manchester AHSN 10

Transfers of care using e-referrals and medicines adherence – improving patient safety and outcomes We know that things can go wrong when patients need to move between hospitals and their homes, sometimes leading to readmissions, poorer outcomes and poor patient experience. Good referral of care regarding medicines from hospital to community pharmacy is helping to change this. An electronic referral template using PharmOutcomes is resulting in readmissions being halved, and on average four beds saved per medicines review in Wessex AHSN. AHSNs collaborated to agree a common data set for referrals and data collection to support evaluation of these new pathways, which have now been endorsed by the Royal Pharmaceutical Society. In the North East and North Cumbria AHSN, hospital staff are using the system successfully to refer patients to their community pharmacist and the project is improving communication and assisting patients with their medicines. Results • Six acute trusts are now making referrals to a potential 700 community pharmacies for follow up support with their medication after discharge from hospital. • More than 750 patients have now received follow-up support and community pharmacists reported that nearly 90% of patients had a better understanding of their medicines as a result of their consultation, and would be therefore more likely to adhere to their medicine regimes. • The project team has won two prestigious HSJ Awards in 2015, in the categories for ‘Enhancing Care by Sharing Data and Information’ and ‘most effective adoption and diffusion of best practice’.

”Without your input, this service most definitely wouldn't have been as dynamic as it now is, and goes far beyond what I had anticipated at the start of this journey so thank you.” Matt Harvey, Chief Officer, Somerset Local Pharmaceutical Committee

This work has been taken on and adapted by the South West AHSN, where existing services are being used in community pharmacy to support patients with their medicines following discharge from hospital. They are working with Yeovil Hospital and Somerset Local Pharmaceutical Committee on the implementation, funding them to help develop a package that can be shared across the South West and supporting The Royal Cornwall Hospital to move to electronic referrals.

PROJECT CONTACT [email protected] North East & North Cumbria AHSN

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Virtual Fracture Clinic Brighton and Sussex University Hospitals NHS Trust’s innovative virtual fracture clinic is proving a big success - cutting the number of times injured patients have had to come in for hospital appointments and saving more than half a million pounds in two years. The clinic has meant patients who were treated in A&E with a broken bone no longer have to come to hospital for face-to-face assessment. The project was developed as a way of improving patient care but it has also had the added benefit of reducing costs. Impact so far  Since launching in 2013, the clinic has managed over 8,500 patients, with specialist physiotherapists assessing X-rays online to make a decision on the next steps of care and the clinic has also saved £558,000.  Over a one year period, just 36% of patients referred to the virtual fracture clinic needed a follow up appointment with a consultant and six per cent needed a specialist physiotherapist.  The basic cost of a new patient attending the fracture clinic is about £128 but the cost for a virtual clinic is just £64. Next steps  Complete six month mentoring programme through NHSE and 3M, including review of deliverables and the new mentoring programme.  Complete roll out of the Virtual Fracture Clinic model to St Richards Hospital, Chichester and develop an accessible ‘how to’ toolkit to support the 32+ Trusts that have expressed interest in adoption of this model.  Complete work with Microsoft on a ‘plug and play’ platform.  Presenting at Expo 2016 and exploring the NIA programme to help support wider adoption.

PROJECT CONTACT [email protected] 12