Two NHS Integrated Care Systems (ICSs) – ‘Our Dorset’ and the ‘Lancashire and South Cumbria Health and Care Partnership’ – are piloting a new digital health Elective Care Toolkit designed to support overstretched NHS staff.
The elective backlog is one of the most pressing challenges the NHS faces – and with digital technologies now confirmed as an NHS 2022/23 priority, digital leaders are rolling out proven technologies that can ease the pressure.
The Elective Care Toolkit has been curated by ORCHA, the Organisation for the Review of Care and Health Apps, which supplies digital health libraries in 70% of NHS regions. It is being offered free of charge to all ORCHA customers and focuses on digital solutions which match the main NHS backlog priorities: ophthalmology, musculoskeletal conditions (MSK), cardiology and dermatology.
The toolkit differs from existing approaches in that, rather than suggesting a single solution in each pathway, it offers guidance on the best tested technology that can be used at every stage of the elective care process. It includes technologies that are proven and able for quick deployment and greatest impact. For example:
Crystal Dennis, head of Digital Services at Home with Our Dorset ICS, said:
“Elective care has a large challenge in its recovering journey and digital health technologies can help provide support and assistance to patients, and their carers whilst waiting, during treatment and post treatment. Given that a motivated patient can expect to actively manage themselves, both in the period leading up to elective care and through their recovery period, digital has significant application throughout this process, one which has historically been a more passive experience for the patient.
“Working with a toolkit like this is an excellent way forward for us. It helps focus our busy clinicians on just the apps they need – along with the assurance that they have been purposely selected by their peers and undergone an evaluation process to demonstrate that the tools are fit for purpose/DTAC-approved – and sets the patient up for success.”
Linda Vernon, Digital Culture & Transformation Clinical Lead at Lancashire & South Cumbria Health & Care Partnership said:
“The ongoing COVID-19 pandemic has put both our clinical staff and administrative support staff under extreme pressure. Whilst we’re dealing with the impact of new COVID variants, our waiting lists for routine elective care continue to grow. We are trialling ORCHA’s elective care toolkit because want to be absolutely sure that our teams have access to the very best digital tools to help them transform the delivery of the many high-volume and low-complexity tasks associated with supporting patients through some of our elective pathways. We know that ORCHA-approved apps will be clinically safe, responsible with patient data and easy to use.”
ORCHA’s managing director, Dr Lloyd Humphreys, said: “We know that digital solutions are low on the priority lists of many NHS staff, which is why only 2% of people are getting recommendations for tech from nurses and 3% from hospital consultants.
“Therefore, the rationale for the toolkit is that overstretched staff don’t need more technology, they need the right portfolio of technologies that can embed within their existing pathways and support traditional care. During the pandemic, digital technologies were used to good effect but often as a blanket and untargeted approach to replace other forms of care and ease pressures. Now, we need a more strategic and targeted approach. Technology needs to have a ‘force multiplier’ effect for the NHS in the wake of staff shortages, where it complements, enhances and supports health and care workers and helps patients at each stage of their treatment journey.”
Read more about the Elective Care 2022/23 Digital Health Toolkit here
South West Yorkshire Partnership NHS Foundation Trust is an integrated and partnership-based provider of community and mental health services to a population of more than 1 million across Barnsley, Calderdale, Kirklees and Wakefield. Its 4,200 staff work from 56 main sites, and with people in their own homes, or in community-based locations.
The Partnership’s four strategic objectives are to improve health, improve care, improve resources and make the organisation a great place to work. To achieve these, one of the organisation’s big ambitions is to be innovative.
This drive to create new ways of working can be seen across the organisation and Yorkshire Smokefree (YSF), its stop smoking service, is the latest example. YSF provides stop smoking support to people living in Barnsley, Calderdale, Doncaster, Sheffield and Wakefield. Faced with all communities displaying higher than national average levels of smoking the service looked to see how technology can better engage with people, to improve care and improve health.
The service already offered face to face sessions, telephone support, and an online quit program. But as COVID-19 required all staff to work from home, and all face to face consultations be replaced by telephone and video consultations, the service saw that digital health could play a big part. This thinking was also in line with NICE guidelines, as it too advises to consider digital health to help stop smoking as an adjunct to existing services.
Looking across the organisation, the service saw the Partnership had already adopted an ORCHA Digital Health Library in other areas of care, and so planned to embed this into its stop smoking service. The Library provides access to digital health products that have been assessed against clinical assurance, data privacy and usability standards. Adapting this Library for smoking cessation would allow the service to offer a new set of tools to clients. Knowing services can trust the apps featured, would help when introducing the service.
Firstly, the service worked with ORCHA to build a curated list of ‘Yorkshire Smoke Free apps’, easily accessed in the Library’s carousel. This was built within days and the service really liked that the selection can continuously be updated, so if a product launches or improves it can be added, or if an app isn’t used, it can be removed.
The service then looked to embed the carousel into relevant touch points. It’s was featured within the online Client Zone, enabling clients to search and find suitable stop smoking apps themselves. Advisors encourage clients to view and download apps from the Client Zone or send a direct recommendation from their ORCHA Pro account. Advisors found the carousel a quick way to go straight to the service’s preferred, relevant apps when on a call with a client. External partners, sub-contracted to provide stop smoking services, were also given access to the library via the on-line Professionals’ Area so they can view and point clients to the carousel.
It was also identified that apps should be recommended throughout the patient pathway. For example, clients are encouraged to download ‘NHS smokefree app’ at the start of their journey. After two weeks, when a client often starts to see the physical benefits of stopping smoking, they are recommended fitness apps such as ‘couch to 5k’. If clients start to have concerns connected to quitting such as putting on weight, stress or trouble sleeping, again they are recommended relevant trusted apps.
A stop smoking advisor engages with clients on a whole range of health concerns and the ORCHA Digital Health Library enabled the service to continue to give this wide ranging support. Such tools, covering a wider range of physical and mental health concerns, were especially helpful, as at this time, due to COVID, gyms were closed, and virtually all existing referral pathways were no longer available.
Steps have also been taken to encourage peer feedback and word of mouth. Clients are asked to share which apps they have found useful with each other in video support groups; and positive feedback is shared on social media. For example, Sarah from Calderdale shared: “When I stopped smoking I put on so much weight, then my adviser told me about the NHS weight loss app. He sent me the link and it was great! Brilliant tips and so easy to follow. Thank you so much.” This encouraged others to use the library.
Response by the public of all ages has been very positive, including the older generation. The service make no judgement on age, as they have 70 year olds who are downloading apps happily.
Since apps have been embedded in the client pathway there have been around 750 sessions, and more than 2,000 page views on the site each quarter. The most common route to finding an app is by the 154 health and care practitioners who now make recommendations to clients, with the most active having made more than 100 recommendations. Alongside this one to one route, the Trust is also seeing success profiling the Health App Library on its website, and through its active social media campaign which features peer recommendation.
YSF believes the addition of apps has added value to the service. The service provides holistic support, signposting to services beyond smoking cessation. For example, with clients experiencing mental health issues, the service will not replace talking therapies, but can give an app to help a client whilst they wait for access to this service. Similarly, although the most common search term in the public facing site is ‘stop smoking’, this is followed by ‘mental health’, ‘sleep’ and ‘anxiety’. As such, the most commonly downloaded apps reflect the breadth of support needs, including not only NHS Smoke Free, and Quit Smoking Now, but also Sleepio, FoodSwitch and NHS Weight Loss Plan.
Bringing change to a service required working in partnership with the marketing and media group for Yorkshire Smokefree. They have worked closely with ORCHA and the service to successfully embed the service so effectively.
Commenting on the move, Chris Keoghan, said:
“we see using apps as a complementary tool which is part of our service. It makes sense to our advisors, and it makes sense to our clients, that we should be recommending apps.”
Since introducing the remote service, including the telephone support, online quit program and health app library, 72% of participants remained a non-smoker after 4 weeks when using the remote services.
The service is keen to build on the successes seen. Each month the service reviews the usage report provided by ORCHA to identify which services and regions need focus. The next step will be to continue to embed the Digital Health Library into more professionals working practice. Work to promote it to our sub-contractors continues and it is hoped that they find the stop smoking carousel useful, but then also look to see how the library may help in other fields.
Loneliness is not just a state of mind. It impacts all aspects of our life, from curtailing social interactions, changing our eating habits, working life and our ability to enjoy day-to-day activities that we once derived pleasure from. It can impact or make worse our physical health, as well as our mental health and wellbeing.
We need to give loneliness the attention it deserves, particularly at this time of year when those sufferers can experience it even more.
There are many forms of help available, including digital health apps.
ORCHA (the Organisation for the Review of Care and Health Apps) has praised the many health app developers who now ensure their apps include opportunities for social interaction.
ORCHA has praised the following apps for recognising that social interaction is a vital part of managing our health and wellbeing:
We’d love to hear about your experiences. If you try one of the apps from our list below, please let us know on Twitter. Don’t forget to tag us @OrchaHealth and use our hashtag, #ORCHACertified.
AFTERtrauma
Connect with patients who have had similar injuries/ experiences so that they can share learnings and model behaviour. ORCHA score 73%. Free. Available for Android and iOS.
BELONG: BEATING CANCER TOGETHER
Using Belong, you will find support groups for every type of cancer such as breast cancer, lung cancer, ovarian cancer and many more. You’ll also get assistance, tips, and support from a vast social network of others with cancer. ORCHA score 85%. Free. Available for Android and iOS.
MUSH
Unite with local mums and mums-to-be in peer-group ‘pods’ of five to learn, share, forge friendships and navigate each week. ORCHA score 74%. In app purchases. Available for Android and iOS.
CALORIE COUNTER + (Nutracheck)
Easy to use calorie counter with access to the lively Nutracheck community and the chance to take part in weight loss challenges. ORCHA score 79%. In app purchases. Available for Android and iOS.
MyAUTISMteam
This is a social network and support group for parents of kids with autism. Get the emotional support you need from others like you, in a judgement-free space. ORCHA score 81%. Free. Available for iOS.
MEETOO
MeeToo is designed for people aged 11+ and age banding means you chat with people who are a similar age to you. You can ask anonymous questions about literally anything (the app is moderated) and realise you are not the only one struggling with a particular issue. ORCHA score 81%. Free. Available for iOS and Android.
ACTIVELY MOVING FORWARD
Connect to a national network for the support and empowerment you may need after a death loss. Through this app, you’ll be able to connect with others who understand the challenges of grief. ORCHA score 81%. Free. Available for iOS and Android.
Dr Lloyd Humphreys, clinical psychologist and managing director of ORCHA, said:
“We know that lockdown saw levels of loneliness increase*** and we now have an uncertain winter ahead. We have to think creatively about how to reach people in ways which feel good to them.
“It may feel counter-intuitive to use an app to tackle loneliness, especially when it is sometimes suggested they can isolate people. But many apps, often in addition to expert advice on a specific medical condition, offer ways to connect with individuals and communities where there are shared interests or goals.”
“The implications of repeated lockdowns, travel restrictions and social distancing are still emerging and the impact on us all, as individuals, has to be recognised. For example, we now know that areas with a higher concentration of younger people (aged 16-24) tended to have higher rates of loneliness during the key periods of the pandemic.***
“Loneliness can begin with a loss of confidence and then spiral quickly into negative feelings and a withdrawal from contact with others. But the downward spiral can be reversed successfully through psychological approaches including CBT, mindfulness and positive psychology. And even simple steps can make a massive difference. The simplest of all is connecting to people in a similar situation to your own.”
“At ORCHA we work with academics and innovators who are developing world-leading digital health tools. They are increasingly recognising that community support is essential to wellbeing and the apps we’ve featured in this list are all fantastic examples of this.”
Notes to editors:
*www.campaigntoendloneliness.com
**Holt-Lunstad, 2010 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316
***https://www.ons.gov.uk/searchdata?q=loneliness