KSS AHSN Innovate issue 05

Innovate Issue 05

Winter 2015

Powering healthcare innovation

Inside 2 3 4 6 8 12 14

Focus on Funding opportunities Insight Innovation that flies

Focus on Medicines optimisation

Focus on Out of hospital services for older people Focus on Digital innovation

Focus on Join the Q – the Q initiative is growing Showcase Community hubs for greater independence

I N N O V A T I O N 16

Ready to launch Expo 2016 innovation special!

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Insight

Innovate Issue 05

Funding opportunities i4i Product Development and Challenge awards National Institute for Health Research

Product Development awards support research and development of medical devices, active implantable devices and in vitro diagnostic devices in any area of existing or emerging clinical need. Challenge awards are based on themed calls in areas of existing or emerging healthcare need. Deadline: 13 Jan 2016 More information: http://tiny.cc/ii9l5x

Health Services and Delivery Research funding opportunities National Institute for Health Research

The researcher-led workstream welcomes outline proposals on topics or research questions identified by researchers within the programme’s remit. Deadline: 14 Jan 2016 More information: http://tiny.cc/bn9l5x

HTA commissioned funding opportunities National Institute for Health Research

The HTA commissioned workstream commissions research proposals that address specific topics or themes, as identified by the HTA boards and panels. One of the current calls is for Understanding the influence of NHS Health Check Cardiovascular Disease Risk Assessment Tools. Deadline: 21 January 2016 More information: http://tiny.cc/hud85x

Eurostars

EUREKA and the European Commission Eurostars supports the development of rapidly marketable innovative products, processes and services that help improve the daily lives of people around the world. Deadline: 18 February 2016 More information: http://tiny.cc/a5cx6x

Technology Inspired Innovation - Feasibility Studies Innovate UK

Innovate Issue 05

Innovation

that flies

Last time I promised you more about the Kent, Surrey and Sussex Expo and Awards which are happening on 19 January 2016 at the Lancaster Hotel, London. It’s our biggest, most innovative, most collaborative event yet, brimming with practice worth sharing and a growing network of potential partners to spread innovation further and faster. The focus is on three themes which we know are on the priority lists for network members and partners across the region: Improving out of hospital services for older people Medicines optimisation, and Digital innovation. The agenda for the day is shaped around these themes. For each one, I’m delighted that we will offer delegates the opportunity to hear from a leading national figure: Lord Filkin, Chair, Centre for Ageing Better Dr Keith Ridge, Chief Pharmaceutical Officer, NHS England, and Beverley Bryant, Director of Digital Technology, NHS England. Each theme will also hold its own series of round table discussions, prompted by the national picture and an example of good practice that’s already happening in Kent, Surrey and Sussex. We aim to then build on those discussions to support the further spread and adoption of best practice and successful innovation. At our regional innovation event next summer, we’ll report on the progress made in these areas. Expo and Awards 2016 will undoubtedly be an exciting and inspiring event. It will play a key part in the process of identifying and spreading the types of innovation and new models of care that the Five Year Forward View has signalled as being urgent priorities for us all. I look forward to seeing you in the new year. Best wishes

Innovate UK is seeking proposals that will kick-start the delivery of genuinely new products and services, with substantial and scalable commercial potential. Deadline: 16 March 2016 More information: http://tiny.cc/l3cx6x

Pathfinder Awards Wellcome Trust

The scheme funds pilots to catalyse innovative early-stage applied research and development projects in areas of unmet medical need. Deadline: 20 June 2016 More information: http://tiny.cc/7pam5x

Guy Boersma Managing Director KSS AHSN


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d n a o p x E

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Medicines optimisation is a national priority. It’s also a focus for our regionwide Enhancing Quality and Living Well for Longer programmes, as well as the Kent Surrey Sussex Patient Safety Collaborative. The current national agenda is focused on faster spread of developed solutions.

Medicines optimisation At Expo 2016 the medicines optimisation innovation huddle will explore the scale and scope of the issues within this area, share ideas, best practice and opportunities for future work between stakeholders. It will connect a range of people who work in this area to provide potential future work projects and collaborations.

There are already a number of areas of work including:

Best practice and better outcomes in Medway care homes In a great example of integrated care, a multi-disciplinary team in Medway is improving quality of care for care home residents, reducing A&E attendances and cutting costs.

A pharmacist, two advanced nurse practitioners, two end of life care facilitators and a consultant geriatrician.

During the weekly ward round, all patients needing specialist input are discussed and action is taken accordingly. This multidisciplinary forum is novel for community healthcare because it allows holistic patient care. The team exemplifies integrated care as it brings together colleagues from both primary and secondary care.

The care

Impact

The team

The team visits each care home on a weekly basis for early identification of potential problems. This proactively reduces the likelihood of preventable conditions such as urinary tract infections and dehydration. The pharmacist conducts in depth medication reviews for all patients, ensuring the drugs each resident is taking are appropriate and necessary for their health and condition at that time.

the current respiratory programme work with community pharmacists, and

The team also provides support for residents to ensure they are able to die in their place of choice.

the medication errors workstream within the KSS PSC.

+ PHARMACY

Novel approach

Lasting change

Regular training and education is provided to nursing homes to manage common medical conditions so that knowledge and experience is shared. Following medication reviews and changes, pharmacists and nurse practitioners make follow up calls to ensure no harm has been done by doing so and that the changes made were understood.

Pharmacist led medication reviews have resulted in a reduction of inappropriately prescribed medicines and polypharmacy totalling approximately £110K.

Good practice from individual nursing homes is shared on a regular basis at the care home forum to encourage positive change in the sector.

Unnecessary A&E attendances have reduced which in turn has also reduced the chances of prolonged admission to hospital.

Find out more

Coupled with a prompt review of patients referred to the care home team, the service is very effective at delivering efficiency savings.

Contact Dr Sanjay Suman, Consultant Physician, Medway NHS Foundation Trust, [email protected] Prina Sahdev, Care Home Pharmacist, NHS Medway CCG, [email protected]

It all revolves around the resident

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Expo and

awOWaCrdASsE SH

Over the past few months we’ve engaged with our stakeholders and members to shape and inform the Living Well for Longer (LWfL) programme. A significant focus for the programme is supporting the shared ambition across our communities to avoid unnecessary hospital admissions for older people and, to that end, consider new and innovative models of care to help achieve this goal. Colleagues in health, social care and the voluntary sector all face monumental funding challenges.

Innovate Issue 05

Out of hospital services for older people But LWfL isn’t just about money … it’s about ensuring that older people have the treatment and support they need in the right place and at the right time. And we know that, more often than not, hospital becomes the place of choice because of the absence of alternatives. That’s why we are delighted to be working in partnership with Age UK. They are creating the conditions that enable older people to stay out of hospital. It’s about supporting older people to access the person centered care that enables them to live more

Many of the people who use our programme say their volunteer made the biggest difference to their wellbeing

independently for longer. Volunteers play a major part in delivering this initiative. As we pull together our refreshed strategy for Living Well for Longer, we are moving towards a place where we can support our partners to contribute to communities in which more older people can flourish, enjoying better health, care and wellbeing.

Living Well in Guildford and Waverley Isolated older people living with long term conditions can be at greater risk of ill health and unplanned hospital admissions. An innovative project run by Age UK Surrey is tackling the source of the problem with an integrated service that promotes independence and builds confidence and wellbeing. “Living Well in Guildford and Waverley” was set up in August this year and is a partnership with Guildford and Waverley Clinical Commissioning Group and the national Age UK team.

Why was Living Well in Guildford and Waverley set up?

A similar project with an integrated care approach was trialled in Cornwall to help address the issue of avoidable hospital admissions. It showed that by addressing older people’s personal and emotional needs - such as loneliness, lack of confidence and isolation unplanned hospital admissions could be dramatically reduced.

What makes it different?

The project looks at the whole person and supports people to get reconnected to their communities. Its person centred approach focuses on what makes them who they are.

“By being part of multi-disciplinary team and working closely with GPs, the voluntary sector is playing an important role as a change agent, challenging how support can be provided in a more person centred way.”

Anne visited him at home to talk about the project undertake a wellbeing scale assessment and then start the process with a ‘guided conversation’. Guided conversations enable the PIC to find out more about the older person, what they enjoy and their goal. It became clear that Mr Brown wanted to walk his dog again and cook healthy meals. He was missing the social contact of meeting up with other dog walkers for a chat.

How does it work? Illustrative case study

Together they drew up a support plan that involved exercises to build up balance and stability and arranging any mobility aids he needed. These first steps helped to build Mr Brown’s confidence to go out. He was then matched to a volunteer to support him over a 12 week period to achieve his end goal. Over the following weeks, he started to cook healthy meals, walk Rufus with his volunteer and meet up again with his dog walking friends.

Di Cheeseman

Mr Brown is 70 years old and has diabetes and a heart condition. His wife has passed away so he now lives alone with his dog, Rufus. Mr Brown has had a couple of falls which resulted in him being admitted to hospital. Since returning home Mr Brown has lost confidence and is no longer walking his dog. He has stopped eating properly and is no longer managing his diabetes well. During one of numerous visits to his GP, his doctor suggested a referral to the Living Well in Guildford and Waverley team at Age UK Surrey. Within a couple of days, Mr Brown had been contacted by an Age UK Surrey Personal Independence Co-ordinator (PIC) Anne.

Find out more

Contact Di Cheeseman, Community Support and Development Manager, Age UK Surrey [email protected]

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Member showcase

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d n a o p x E

s d r a w a OWCASE SH

Digital technologies have the potential to deliver significant benefits to patients and help overcome some of the major challenges facing the NHS. They have a crucial role to play in the new models of care which are seen as essential for improving health, care and value in the Five Year Forward View published by NHS England. Our Expo 2016 will profile some of the areas where digital innovations are making a big difference across KSS and beyond - on themes that include: sharing and interpreting data and patient information tele-health health apps assistive technologies computer modelling clinical decision support use of smart devices.

Digital innovation The project has delivered real results, but it hasn’t always been an easy ride. Clinical Director Dr Laura Hill, and Project Manager Bharti Mistry talked to us about their journey and highlighted the top 10 things they wish they’d known at the start.

The programme embraces digital innovation using a risk stratification tool to identify patients have a high risk of admittance to hospital in the next year. The tool (Artemus Intelligent Commissioning System) is provided by Docobo UK Ltd.

What is the PROactive care programme in north west Sussex?

Once patients are identified then a multi-disciplinary team (MDT) agrees a plan with each individual to support them to manage their own care as well as identifying other sources of help.

It’s a method of supporting people who have long-term health conditions, or complex health and social care needs, and who are at risk of their condition worsening. As the name implies, the key objective is to shift away from reactive care.

PROactive care data for year 2014/15 More than

2,600

20% Work with South East Coast Ambulance Service meant

The PROactive care approach

Digital innovation has been central to North West Sussex’s much vaunted PROactive care programme. Crawley Clinical Commissioning Group and Horsham and Mid-Sussex Clinical Commissioning Group have worked closely with digital health experts Docobo on a risk stratification tool to target at risk patient groups.

Since April 2013, there have been nearly

of the referrals from risk stratification profiles which identify patients at high risk of hospital admission

666

8/10 patients strongly agreed that

patients have benefited

conveyances to A&E and

6,000

Average reduction of 2 unplanned bed days for more than

220

admissions were avoided, saving

staff listened to them and treated them well

they felt supported and managed, and

they were provided the information needed

they knew how to seek help from the right professional at the right time

referrals

400

high risk patients cared for by MDT

£0.6m

Patients reported improvements in respect to motivation and confidence to self care, their social network, emotional well being and physical health.

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10 things to think about before you start your digital innovation project

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Cast your net wide

The Clinical Commissioning Groups knew they wanted to take an innovative approach to risk stratification, but the best technical solution wasn’t obvious to them at the start of the programme. “There was a fairly limited range of options even just a couple of years ago. By the time we had gone to formal procurement we had already done a lot of ground work looking at what technology was out there.”

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Start small but think big

Faced with sceptical stakeholders, complicated governance rules, and an untested technological solution, the Clinical Commissioning Groups focussed on just primary and acute care data to start with. It wasn’t until those approaches were embedded that they started looking at mental health and social care data. Now they are looking at some complex areas like using the data to identify socially isolated individuals.

Think big

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Get on top of the guidance, so it doesn’t get on top of you Any digital project involving sharing of data immediately brings you into contact with a huge amount of red tape, national rules and guidance. The guidance is there for a reason, but it needn’t restrict you when you are looking to innovate. “Know what the guidance is and start with what you can share and go from there. You don’t always need to be able to identify the patient, it’s about finding populations.”

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At the end of the day, it’s about winning hearts and minds

The solution might be a technological one, but it is the goodwill of people across the health and social care system which will mean the success or failure of your project. Don’t neglect the battle for hearts and minds. Better communication is really important. The Clinical Commissioning Groups used infographics, videos, and patient stories.

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6 Small can be beautiful

Think carefully about the type of provider that will work best with you to create a solution. For the Clinical Commissioning Groups, working with a small, locally, based team meant that they could build a custom solution, and experiment with different options. “Other providers we spoke to only had a set product but the people at Docobo liked to innovate and were quite open to adaption. That is why we chose them.”

Positivity

The technology supports the service, not the other way round

It might seem obvious, but it is easy to get carried away with your technical solution and to forget to develop the services that the technology is designed to support.

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Utilise the SBRI process to bid for funding to develop innovative solutions The CCGs used the Small Business Research Initiative (SBRI) competition to fund changes to the risk stratification tool to pilot the inclusion of social isolation. The resulting innovation has ensured this high-risk group can be identified more effectively.

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Involve patients from the beginning

Involving patients not only ensures the solution you are building is the right one, it also helps you build support around your ‘case for change’. “From early on we were already involving the patients and consulting them and getting their input. And there were other people who started wanting it so there was a little bit of patient pressure as well.”

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And finally… don’t be afraid to fail

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Try to move beyond the traditional commissioner/ provider relationship Innovation requires proper collaboration between all parties. Don’t manage your digital provider at arms-length. Work closely with them from the start, and keep the conversation going. “Flexibility and the adaptive nature of the relationship has taken us forward. It’s a symbiotic relationship. Docobo can’t do without our expertise as clinicians and we can’t do without their technical expertise.”

Remember that failing is an important part of the process of implementing something new. “Our digital solution came off the back of similar project that had not quite worked. People were sceptical but we didn’t let that stop us coming back with the next iteration until we had something that worked.”

Experience

Courage

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Where do the participants come from?

Join the

Sign up to join the Q KSS PSC co-ordinated the founding cohort appointment process for our region.The founding cohort has been appointed to help design and test Q during 2015, which will inform wider recruitment to Q in 2016. KSS PSC is now developing a new Safety and Quality Improvement Network which will work alongside the Q Initiative. Future Q members will be selected from this network, so if you are interested, experienced or trained in safety or quality improvement work, we want you to join. Sign up at www.kssahsn.net/Q

is an initiative, led by the Health Foundation and supported and co-funded by NHS England, connecting people skilled in improvement across the UK.

Tony Kelly

will make it easier for people from all parts of the health and care system with expertise in improvement to share ideas, enhance their skills and make changes that bring tangible benefits for all patients.

Jennifer Bayly

is bringing together a diverse range of people to form a community working to improve health and care. These people range from frontline staff, managers and researchers to policymakers and ‘patient leaders’. The aim is connect a critical mass of people in order to radically expand and accelerate improvements to the quality of care.

Liz Fisher

Nial Q uiney

n Jo Habbe

Watch our Q video at www.kssahsn.net/Q

Kate Cheema

Webb Michelle

Anna Van der Ga ag

Sarah Leng

The Kent, Surrey and Sussex Q Initiative founding cohort

Ursula C larke

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Member showcase

Innovate Issue 05

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Multi-disciplinary services, personalised patient plans

Community hubs transforming care in Surrey

G Ultimately we want to make it possible for more people to have access to care at home and stay independent for longer.

lenda Vella, Clinical Lead in Adult Community Hub, Queen’s Nursing Institute Nurse at First Community Health and Care, speaks to Innovate about Community Hubs and takes a transformational look at how care can be more effectively delivered in our communities.

These are the sort of improvements we need to make now if we’re going to keep in step with changing patient needs. In Surrey, over the next 7 years the rate of increase in over 85s is projected to be greater than that for over 65s, so we need to act quickly to be prepared for these generational changes.

What is a community hub?

OK, so give us an example of how this project can help older people maintain their health, independence and wellbeing?

It’s a long term vision to offer a single point of access to multidisciplinary services in the community. We aspire for it to be an integrated approach across health and social care that is designed with the patient to create a personalised plan.

How’s this different from the current model?

First Community Health and Care’s current services provide a high standard of care to patients. Often the care is delivered by multiple services which can sometimes create unnecessary obstacles for patients trying to access care. The objective of the Community Hubs project is to reduce duplication caused by multiple assessments and to reduce the burden on the acute sector in emergency admissions through community delivered care. We work closely with community nurses, therapists, primary care, social care, mental health, carers support, therapies services and the voluntary sector to deliver this new service.

So this has been created as a response to high hospital admissions?

In part - acute hospital care accounts for almost half of the entire NHS budget and admission rates to hospital are increasing. However there is also a need for people to be supported to stay well and for patients to receive care at home or as close to home as possible. The Community Hubs focus on “what good looks like” and aspires to create community services that better serve the patient. We scoped the work with stakeholders in the local community to understand where gaps were in their own services and across the local health economy to develop this programme.

People living with diabetes on insulin is a great example. In the UK, the number of patients diagnosed with diabetes continues to grow. The increase in people needing assistance to administer insulin to maintain safe blood glucose levels has resulted in additional demand on community nurses. Before the hub redesign it was an increasing challenge to accommodate patients’ insulin at a time that fitted with their lifestyle. The evening nursing had very limited capacity between 18.00-20.30 as they had a full caseload of patients requiring insulin or clexane administration. By changing the service times for community nursing, we’ve created capacity for an unscheduled care in evening service and we are able to support insulin administration at a time that supports patient choice.

How can people find out more?

There’s more information at www.firstcommunityhealthcare.co.uk or contact [email protected] Thanks very much Glenda for taking the time to speak to us here at Innovate. We wish you the best of luck with the future of Community Hubs.

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Heart failure: evidence based clinical measures save lives

Leadership, benchmarking, collaboration

KSS AHSN Improvement Manager Jen Bayly leads the Heart Failure collaborative in our Enhancing Quality programme. She has created a process in which strong clinical leadership, benchmarking and collaborative learning is used to identify and reduce variation in heart failure care.

Heart failure affects

550,000

people currently diagnosed in the UK

Heart failure is the leading cause of hospital admission in

O V E R

65s

Find out more

Connecting acute and community teams

Heart failure care has improved continually over the last seven years; that’s according to the National Heart Failure Audit. The audit has shown prolonged survival and better outcomes for heart failure patients every year.

The work brings together Heart Failure specialist teams from acute and community settings to benchmark the quality of care being provided, measure improvement of that care and provide regional and international comparisons. It aligns the Best Practice Tariff and the Acute Heart Failure guidelines, using the National Heart Failure Audit data and NICE Quality Standards.

Projectio ns indicate that hosp ital admissions for heart failure

50%

are set to rise by

in the ne xt 25 years due to an ag eing population

Our approach uses regional monthly dashboard reports, at trust and service level, to enable commissioners and providers to understand how they can deliver better care and outcomes for people with heart failure. It also addresses the considerable variation that currently exists in the management of heart failure and associated outcomes.

Contact Jen Bayly, Enhancing Quality Heart Failure and Atrial Fibrillation Programme Lead, KSS AHSN [email protected] kssahsn.net/heartfailure

5-year survival rate for

heart failure is

worse

than breast or prostate cancer

We aim to improve outcomes, reduce variation and save the lives of people living with heart failure

NATIONAL HEART FAILURE AUDIT shows improvements in each of the last

7 years

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Events

Innovate Issue 05

Innovate Issue 05

Pressure damage is everybody’s business The KSS PSC ‘Pressure Damage is Everybody’s Business’ conference in October attracted more than 250 delegates from health and social care services in Kent, Surrey and Sussex. The conference provided opportunities to hear patient stories and share best practice, as well as to learn from, and network with, national patient safety and pressure damage experts. Delegates also found out more about the new innovative devices and tools industry partners are developing to help reduce pressure damage and improve patient experience. Workshops delivered by leaders in their field included key learning from litigation and serious incident reviews, nutrition and hydration, and pressure mapping and positioning.

Download

All of the presentations and workshop resources from the conference are available on the pressure damage resources section of our website www.kssahsn.net/pressure

Kay Mackay, Co-Director, Kent Surrey Sussex Patient Safety Collaborative “I’m more certain than ever that by working together we can achieve our ultimate goal of reducing pressure damage in all care settings.”

Kieran Attreed-Williams, Quality Innovation Manager for Home Support Services, Essex County Council “There needs to be more of this more regularly, it’s brilliant. We wanted to come today to share what we’ve been doing around Essex and for people to take away a little bit of the knowledge we’ve got.”

Clare James, Director, Your Turn “It’s a fantastic environment with everybody cherry picking the bits they want from everybody else and also understanding how they can apply it to where they work and whichever situation they are in.”

Jacqui Fletcher, Clinical Strategy Director, Welsh Wound Innovation Centre “KSS PSC have got nurses, people from patient safety, from commissioning and a whole host of other disciplines here; it’s great to see that level of engagement.”

Caroline Lecko, Patient Safety Lead, NHS England “KSS PSC has been really proactive at bringing together some expertise, some knowledge, some innovation and really engaging with people who are out there delivering care.”

Samantha Gradwell, Patient Safety National Lead Investigator, NHS England “It’s been a really, really innovative day. You can see that the audience are fully engaged and interested in the topic, so it’s very encouraging.”

s t n e v e g n i m Upco Ongoing in 2016 Innovation surgeries ex Kent, Surrey and Suss

ation surgeries for We host regular innov further develop companies wishing to ategies and plans. their market access str e, where the nc We explore, in confide wider health (or S NH peculiarities of the l mechanisms are system) and its financia ir plans and advise likely to impact on the . The surgeries are on potential remedies with products or intended for companies dy for market. They rea services on market or cts of potential interest help us identify produ tions. to our member organisa Next dates are: ary 2016 • Guildford on 25 Janu ary • Crawley on 27 Janu . • Kent on 28 January book, please email To find out more or to .uk [email protected]

3 Feb 2016 re KSS AHSN Heart Failu Collaborative Gatwick

measures data for Featuring the new EQ services across KSS. acute and community re information See kssahsn.net for mo

9 Feb 2016 hout the Integrating care throug ney patient’s surgical jour on W1G 0AN The King’s Fund, Lond

ce will explore how This one-day conferen and collaborative to embed a coordinated health and care n ee way of working betw responsible for professionals who are ring and after major du e, for patients’ care be n deliver the best surgery, so that they ca possible outcomes. http://tiny.cc/w5gm5x

9 February 2015 older people Intermediate care for on W1G 0AN The King’s Fund, Lond and managers Workshop for clinicians -ordination and leading the delivery, co ediate care commissioning of interm , within and ilty fra for older people with re and ca l cia so across health care, e mm gra Pro r. cto the voluntary se r ve Oli vid Da r so includes Profes ks like’ on ‘what good care loo king based on the paper, Ma s tem our health and care sys . ion lat fit for an ageing popu http://tiny.cc/8bhm5x

9 Feb 2016 KSS PSC Medication Errors Gatwick re See kssahsn.net for mo information

24 Feb 2016 ning KSS PSC – Sepsis Lear mmunity Event – Primary and Co Care Gatwick

ctice nurses, care Free event for GPs, pra nurses, paramedics, home staff, community minor injuries staff urgent treatment and (including 111 and and out-of-hours staff e who may need GPs), and anybody els of sepsis in a to recognise the signs community setting. re information See kssahsn.net for mo

Get in touch

t [email protected]

Events

Innovate Issue 05

The fast lane

for innovation Tuesday 19 January 2016 The Lancaster Hotel, London


Main stage speakers include: Beverley Bryant, Director of Digital Technology, NHS England, Dr Keith Ridge, Chief Pharmaceutical Officer, NHS England, and Lord Filkin, Chair, Centre for Ageing Better We will focus on three major themes that are key to achieving better health, better care, and better value: Digital innovation Medicines optimisation, and Improving out of hospital services for older people.

Brought to you in partnership with Kent Surrey Sussex Leadership Academy, South East Coast Strategic Clinical Networks, South East Health Technologies Alliance.

Find out more at www.kssahsn.net/Expoandawards2016 #KSSExpo

Practice worth spreading