Developing new care pathways for cardiac rehabilitation delivered by hospital administrators
Care City is one of seven Test Beds selected for Wave 2 of the innovative health and care programme, focussed on tackling the challenges laid out in the NHS Five Year Forward View.
Long term conditions and lack of staff are the NHS’s biggest priority right now and Care City will respond to three East London STP challenges1, which are also present nationally. Care City’s ambitious programme will work to transform how we identify, treat and manage long-term conditions; increase skills and work force productivity; remodel areas of the workforce and service pathways across East London; and to scale these models nationally.
John Craig, Chief Executive, Care City, is delighted to lead another successful Test Bed opportunity:
“Our aim for this Test Bed is to use innovation to enhance the work and productivity of junior health and care roles. Domiciliary carers, healthcare assistants and hospital administrators represent around one million people across our health and care system. Enhancing their productivity is urgent for them and their careers, for patients and for the system as a whole. For Care City, it is a perfect focus, combining our twin aims of enabling healthy aging and helping to regenerate East London.”
The Test Beds programme run by NHS England and the Office for Life Sciences tests combinations of digital technologies with pathway redesign in a clinical setting with real patients. It harnesses the potential of innovations to help transform the way in which healthcare is delivered; empowering staff to deliver care that improves the quality of life for patients and carers.
Care City will work in partnership with eight innovations2 comprising of diagnostics, smartphone applications and management tools which are already making dramatic contributions to people with long-term conditions. Currently, there are barriers to their wider use caused by varying types of digital exclusion faced by patients, staff, organisations and systems. Care City will look at the power of junior members of the workforce to overcome those barriers, in partnership with patients.
Jane Milligan, Executive lead, East London Health and Care Partnership, is excited about the potential for the Care City Test Bed:
“We are delighted to support this Test Bed. We are excited about the chance both to improve outcomes for people with long-term conditions and to enhance the roles of vitally important junior members of our workforce, who too often remain hidden. We will learn with Care City and its partners, and are keen to rapidly grow successful solutions across East London.”
One way Care City will achieve this is by supporting Administrators to use digital tools TickerFit and DrDoctor to support patients to change their lives. These latest digital innovations will make pathway management in heart failure more personalised and efficient, which will save transactional time for administrators, and use the time saved to support them to encourage and support patients, capture data and shape the pathway around their needs. Testing will be in partnership with Barts Health’s heart failure service.
Avril Copeland, Managing Director, Innerstrength Health, believes the Test bed partnerships will drive positive change for patients and the workforce:
“We believe collaboration is key in developing sustainable pathways that will truly make a difference in patient care, so we’re delighted to join forces with Care City on the Test Bed Programme. Our goal is that TickerFit will be provided to all patients living with cardiovascular disease and we believe being part of the NHS Test Bed programme can help us realise this vision.”
1Care City’s Test Bed will respond to three East London STP challenges, which are also present nationally
- Primary Care - 26% of primary care services in NEL are rated 'inadequate' or 'requires improvement' by the CQC versus 13% nationally
- Right care – Low reported vs expected prevalence rates for long-term conditions with high rates of hospital admission
- Workforce - There are 1,769 patients/GP in East London compared to the London average of 1,660. These are challenges locally for East London, where there is a 14% turnover rate and 11% vacancy rate in adult nursing.
2The Eight Test Bed Innovations are:
Cardiac Rehabilitation (CR) is offered to patients who have suffered a cardiac event or undergone heart surgery, and is proven to reduce five-year mortality by 27% and hospital readmissions by 40%. However, only 51% of eligible patients receive this life saving treatment in the UK. Innerstrength Health’s first product, TickerFit, enables healthcare providers to deliver cardiac rehabilitation programmes to patients remotely, allowing them to scale their programmes to many more patients. TickerFit is personalised for patients, supporting behaviour change and focusing support on those likely to benefit from it.
DrDoctor transforms the way hospitals and patients communicate, automating processes and reducing costs. The platform improves appointment scheduling, reducing no-shows and filling vacant appointments. Currently deployed across 22 major hospitals around the UK including Guy's and St Thomas' & Great Ormond Street, DrDoctor has already saved the NHS millions of pounds and 3000 years' worth of missed appointments. DrDoctor’s pathway management product shifts their focus from transactions to transformation, collecting outcome measures and using this data intelligently – in partnership with clinicians – to personalise pathways around patients’ needs.
Whzan Digital Health provide digital equipment to record vital signs and photos, and deliver assessments and questionnaires, reporting to a cloud triage system. The tools are used by community nurses, care home staff, and some chronically ill and post-operative patients. Whzan enables staff to assess temperature, blood pressure and pulse, and other devices can be added. Case studies from the ~10,000 patients being monitored show NHS resource savings of up to 71% alongside significant improvements in patient lives.
Heathy.io is the first company to be CE accredited for using the smart phone camera as a clinical grade diagnostic device. Their first product is digital urine testing, which has multiple uses. The most significant for Care City is ACR (albumin to creatinine ratio) screening in people with hypertension and diabetes to identify chronic kidney disease (CKD). People with diabetes and hypertension should have their urine tested for protein (albumin) annually. Nationally, adherence is poor (66% for type-2 diabetes) and we believe that locally perhaps 10% of over-65s with diabetes have undiagnosed CKD, which Healthy.io can help to identify quickly and inexpensively.
Echo is a simple, free digital service that delivers medicine to patients’ doors. Many Echo users are young, but they are focusing on a new segment – older patients with more complex needs for whom getting to a pharmacy is more difficult and comprehensive support important. Echo recently introduced a service for patients’ representatives, which can be used by paid carers and which is being used by 250 patients today. Almost half of all adults take a repeat prescription, but 40% of medication isn’t taken as directed, costing the NHS billions. Echo removes the barriers to adherence, providing nudges through their app to take and re-order medication. Echo’s data suggests that its users’ adherence is much higher than the average.
Metric: Improvement in medicinal adherence and reduction and medicine wastage
Our Mobile Health helps healthcare organisations to navigate health apps, assessing and curating apps according to the NHS standards, enabling providers to recommend and prescribe them to patients. Appropriate apps suggested for a patient will be displayed alongside medications, encouraging the GP to suggest an app-based therapy for appropriate conditions in place or alongside medicinal therapy.
Sleepio is a self-guided, six-week digital CBT package for insomnia developed by Big Health. The application includes sleep hygiene, a sleep diary, sleep scheduling, and a variety of cognitive behavioural sleep interventions. Sleepio has been evaluated in seven randomised controlled trials, and endorsed by NICE in a Health Application Briefing. Evidence suggests that Sleepio not only improves sleep but can help to relieve depression, anxiety and risk factors for psychosis. Sleepio is currently free of charge to Londoners via a partnership with Good Thinking, a pan-London digital mental wellbeing service, aimed at population-wide prevention of poor mental health.
LIVA Healthcare’s platform facilitates ongoing personalised lifestyle support through an intuitive app, building on a strong bond between coach, patient and healthcare professionals. Its focus is to improve outcomes for those with or at risk of chronic illnesses by driving lifestyle behaviour change. Liva is proven to be effective across all socio-economic backgrounds, with over 9,000 registered users to date, and is capable of engaging older patients. It is based upon nine to 18 months of continuous patient engagement to make new habits and behaviours stick.