Serving a population of 1.3 million, Surrey and Borders Partnership NHS Foundation Trust is an ambitious provider of mental health, drug and alcohol and learning disability services for people of all ages. It achieves ‘Good’ across all five domains assessed by the CQC.
Having listened to clinicians, people using services, and digital steering groups, the Trust set out its ambition to create the best personalised experience and outcome for people, leveraging the potential that technology presents to do things differently and in an individualised way.
This includes three main goals:
As part of this journey, the Trust looked to establish key digital foundations, including a library of health apps. The focus on apps reflected the growing use of health apps as an additional source of support, both within the Trust and among the general population, and sits well within the Trust’s early intervention strategies within CYPS (Children & Young People’s Services) where the platform is under pilot.
The launch of such a service requires a robust system to minimise risk, with particular reference to the clinical environment where apps may be used as part of professional practice. Areas of concern included clinical effectiveness and data protection along with a requirement for the chosen solution to be kept up to date.
The Trust chose to work with ORCHA. With a track record in assessing health apps for mental health Trusts, ORCHA offers a comprehensive app review service and uses a closed-loop process for quality. The Trust would benefit from the many thousands of app reviews carried out by ORCHA to date and would seek to be an active partner in driving future development of the project.
The Trust’s implementation of ORCHA has been led by the Digital Healthtech team and has been designed with young people in mind, reflecting the CYPS focus. Although the site is primarily intended for the local population to access independently, the Trust are also piloting the use of Pro licences, which allow clinicians to recommend apps from the platform directly to the young people they are working with, either by phone or email.
A small team of clinicians were included in the pilot, as digital champions, including Child Wellbeing Practitioners based in schools across the county. These practitioners are a key part of the Trust’s CYPS early intervention strategy, working 1:1 directly with young people. Working with the project team, the ORCHA champions have identified key points in the young person’s treatment journey where apps may offer a good fit. Following training provided by the SABP Healthtech team, the Child Wellbeing Practitioners are trialling the pro accounts in their daily practice.
The team have created a list of favourite apps, in consultation with ORCHA, and this is being rolled out to all team members, giving them a common baseline to work from and streamlining the process of recommending apps to young people. The Digital Healthtech team form a vital link between the clinicians and supplier, offering regular check-ins, further training and articulating requests for change.
In addition to the work with the clinical team, the Healthtech team have been actively engaged with promoting ORCHA with partner organisations and the wider population of Surrey. Most of the promotion has been digital, although focus groups with young people suggest they prefer traditional promotional material such as posters and business cards in A&E waiting rooms and GP surgeries – things that are simply not possible under current restrictions. Instead, the Healthtech team have had to find other approaches – listing the site on local council and charity directories, as well as making direct contact with schools, other NHS organisations, youth organisations and charities. A QR code linking to the ORCHA site has been added to the footer of all referral letters and a paid social media campaign is in the pipeline.
The promotional campaign was underpinned by the fantastic selection of digital comms materials created by ORCHA from graphics supplied by the Trust. The pack includes materials for Facebook, Twitter, Instagram, etc., and features the cast of characters from our ORCHA site, providing a striking and accessible digital comms package.
The Trust now has a library of rated and approved apps, removing much of the risks previously associated with including unregulated apps in clinical practice. Any update or change to an app automatically triggers a re-review, ensuring the platform is always up to date and governance standards are maintained.
Before the ORCHA implementation, informal lists of top apps were circulated by well-meaning individuals and were unverified – some were found still circulating two or three years later, leading to increased risk of inappropriate apps being recommended or of apps no longer being available. Implementing the ORCHA platform has enabled a culture shift, directing people using services, clinicians, and the wider population, to a selection of apps that is always current and underpinned by the assurance offered by the ORCHA review process.
Early feedback has been positive both from focus group participants and clinicians alike. Clinicians appreciate the pro functionality as it includes a favourites list, enabling lists of favourite apps to be saved and quickly accessed in order to make recommendations directly from the platform in just a few clicks. The platform automatically logs activity, such as recording recommendations made.
The most engaged clinicians are acting as champions, recommending to others.
Elzbieta Vitkauskaite, Child Wellbeing Practitioner, and health app champion said:
“Young people are always on their phone. So, apps are a natural additional tool to be able to offer young people to help them to encourage to engage with their support. Apps offer more control and flexibility over when and where clients can engage, and many say they prefer an app to writing in a worksheet.
“We have found apps work really well as an additional support option at certain stages of our client’s treatment. When on a waiting list, after their first assessment and at the start of their review period – giving them tools to use when increasing their independence. There are some fantastic apps that have worked very well.”
Through listening to the needs of young people, their carers, and the clinicians that support them, the ORCHA apps library is becoming an established tool, empowering individuals to access high quality apps as part of our overall ambition to create the best personalised experience and outcome for the people we support.
Good Thinking is London’s Digital Mental Wellbeing Service, backed by the London Mayor’s Office, Public Health England, London Councils, NHS and Thrive LDN. It was developed in response to repeated studies that demonstrated that mental health difficulties were common but accessing support was complicated.
Intensive user testing with over 450 Londoners with mental health charity Mind revealed that people do not always fit into categories for, or want, traditional treatment options, and committing to a course of therapy is not always an option. However the research also revealed that people are willing to use online wellbeing resources about the four most common mental health concerns: anxiety, sleep, stress and low mood. There is also a desire for trusted interventions that are accessible 24/7, private, secure, online and where possible free. And people want to avoid stigma by being able to access services in private and at any time.
These insights led to a model of service for Good Thinking that is agile, responsive and hugely flexible. The elements of the service include using digital marketing to help reach people, a comprehensive self-assessment, clear urgent support information, support in finding offline support, a quiz to find personalised support and relatable helpful content.
Alongside these elements, it was also identified the programme should feature NHS-approved, class-leading Apps that offer choice and a range of ways of improving mental health and well-being, that are based on best-evidence, are safe and secure, and are free for users to use. But the team realised that trust in digital health may be an obstacle to progress and that trust and confidence must be earned.
To address the trust concerns, the products would need to be completely free, without any in-app purchases and they would need to be fully assessed for compliance with the latest regulations for safety.
To help identify the best in class apps, the team developed a Standard Operating Procedure, to ensure the programme would meet the health priorities, reduce inequalities, and ensure people are offered the best options safely, with an expectation that use will improve health and well-being.
To ensure the programme was best informed, Good Thinking chose to work with the Organisation for the Review of Care and Health Apps (ORCHA). Experts in health app review and accreditation, ORCHA worked closely with Good Thinking to advise on each step of the process.
It was decided that rather than offer a long list of options, the site would instead provide one best app for each health priority, accompanied by a clear usage explanation. This would enable people to quickly spot the most relevant apps for them.
Good Thinking identified a short list of the best apps for each health priority. ORCHA then identified which standards each app had to meet and conducted the relevant assessments of every app. This enabled Good Thinking to select the final class-leading apps.
Examples of apps selected that provide support to a distinct user group include:
As standards evolve and apps regularly update, unlike traditional approaches, ORCHA’s unique platform conducts ongoing monitoring, automatically identifying when an app requires a new review and conducting this. This enabled the programme to put in place an important governance step of identifying when an app needs to be decommissioned and removed from the platform.
Alongside the other support services, the Good Thinking site includes a best in class app for a range of situations for adults and children, all of which when tested, exceed quality thresholds.
Since its launch in November 2017, Good Thinking has attracted 500,000 users, or one in twelve of the region’s adult population. They’ve visited the service over 650,000 times, 24 hours a day, every day of the week, including national holidays.
Alongside all digital health services, it saw an increase in use during COVID, and especially during the first lockdown period. Since in-person services started to open-up, visitor numbers have dipped, but the team expects to see an increase in use of digital services over the next five years, much as we might expect in the retail sector.
Over the past year, there has been a great deal of work to ensure Good Thinking can complement other care pathways and services, and assist with demand management. For example, the apps that Good Thinking hosts can be prescribed directly by GPs.
In this webinar, Dr Sam Shah, FDSRCS, Chief Clinical Digital Advisor, ORCHA, will be joined by:
Register for free here.
During the webinar, we will discuss:
There will also be time for a Q&A session with the speakers.
This webinar will be recorded. All registrants will receive a copy of the slides and the recording following the webinar, along with key resources.
Read our latest report, Digital and Mental Health Recovery Action Plans, here.
About ORCHA
Founded by NHS clinicians, ORCHA is the world’s leading digital health evaluation and distribution organisation. We provide services to national health bodies across three continents, including the NHS in 50% of UK regions, delivering national accreditation frameworks, bespoke Digital Health Libraries, and professional recommendation tools, specific to the needs of our clients. ORCHA’s unique Review Engine assesses digital health solutions against more than 350 measures across Clinical/Professional Assurance, Data & Privacy, and Usability & Accessibility, plus additional criteria depending on needs.
With mounting evidence that mental health problems have become even more prevalent since the pandemic, in the UK, the government has developed a Mental Health Recovery Action plan. Backed by £500 million, it aims to respond to escalating mental health issues, specifically targeting groups which have been most impacted including those with severe mental illness, young people, and frontline staff.
During lockdown, services turned to digital, switching from in-person help to a range of digital services, such as patient-to-clinician platforms, digitally-enabled treatments, mental health and wellbeing apps, chatbots and social support networks.
As services deliver against the mental health recovery action plan and COVID-19 restrictions lift, we ask what is the role for digital now?
Click on the PDF icon below to download our report, and discover:
If you are experiencing any issues with downloading the report, or want to know more, please get in touch with us at hello@orcha.co.uk or on +44 (0) 1925 606542
