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.
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.
A partnership of health and social care organisations working together, Our Dorset holds the ambition for its 750,000 residents to lead healthier, fulfilling lives supported by sustainable health and care services. But the organisation faces real challenges. Dorset’s population is ageing, bringing more long-term conditions, which places a growing demand on services. Its funding cannot keep pace with this growth in demand and without changing its services, in five years it would face an annual shortage of £229 million a year(1).
To address its ambitions and challenges, the Integrated Care System has identified a clear plan, in which digital plays an enabling role. It established a ‘digitally-enabled Dorset programme’ to increase the use of technology in the health and care system, to support new approaches to service delivery.
The programme first researched and established the building blocks needed to establish public facing digital health. Alongside videos and the NHS choices website, apps were identified as a key building block to enable patients to better manage their own health.
To understand more about if and how health professionals could recommend the use health apps and what would be needed to support them, a pilot was run with 20 nurses. This revealed the team didn’t know where to find good health apps, how to know if they could trust them, if they met policy or who to ask for advice.
Without the expertise to establish a closed-loop quality assured programme, or capacity to be able to test health apps, let alone test them again when they are updated, the team recommended partnering with ORCHA. They selected ORCHA as they had seen how it had delivered testing at a national level and for other regional providers. With ORCHA, Our Dorset could build a programme to mitigate risk and assure clinical teams they are recommending safe apps.
ORCHA tested apps against 350 standards and measures and worked with Our Dorset to identify the best health apps across each priority health area. A dedicated app library was built to house the apps and enable patients and staff to search. It was also agreed that if an app doesn’t appear in the library it will not be recommended by any member of staff. If an app is ever nominated that isn’t in the library it will first be reviewed by ORCHA before being used by Our Dorset.
Our Dorset also opted to include a feature to enable staff to recommend apps via email or text message from the app library directly to residents and patients. This eliminated human error and enabled recommendations to be monitored.
Once ready, the team ran a series of 30 onboarding sessions across all ICS providers and governance leads, including all non-clinical teams, including link workers, health coaching and social prescribers. Over one or two sessions, teams were briefed on the value proposition of health apps, walked through the system and key apps were demonstrated. The health app programme also saw the emergence of a local Community of Practice which became a regular fixture on team meetings, prompting people to share learnings, tips and good practice including hearing about cohorts that are responding well to health apps.
Alongside training staff, the app library was launched to the public, forming part of its #HereForYou campaign which reassures Dorset residents that their health services are still available should they need them and that they should seek help and advice despite the Covid-19 pandemic. This included PR, social and paid digital activities.
Since introduction, the teams have actively embedded the app library and the practice of recommending health apps into their service offer. The teams drive home the concept of self-management and pick out effective tools that are available.
There have been almost 25,000 pages viewed on the site (up to the end of November 2020), and in one month alone, the app library achieved nearly 5,500 page views. Social prescribers are actively recommending apps to service users and vitally, this advice is being acted upon, with almost 1,500 apps recommended to date and 56% of recommended apps downloaded, which is a very good engagement rate, especially compared with other services.
The most popular search terms include Mental Health MSK, Dementia, Diabetes and Cancer. Some of the most popular apps to be viewed are Wysa: Stress, Depression & Anxiety Therapy, Sleepio, NHS Weight Loss Plan and Musculoskeletal (MSK) Self Care, providing a range of health interventions and show that apps are being selected to improve the physical and mental health of the population.
One of the most active recommenders of health apps is George Mitchell, Social Prescriber, Live Well Dorset. One app from the library he finds useful is Quit Now, as he shares that “it gives people support 24×7.” He regularly shares app tips with other prescribers, as he says “Don’t assume that just because you know about an app, everyone else does.”
Commenting on the programme Crystal Dennis, Interim Lead for Public Facing Digital Health Services, Our Dorset Digital said:
“ORCHA power our health app library. They help us to break down the barriers and mitigate issues around digital health. Previously our clinical leads didn’t recommend digital health technologies as they had no idea where to look, were concerned about implied liability and couldn’t tell if a technology was of a good standard. Thanks to ORCHA we are building the trust with clinical teams and have put in place the tools and governance they need.”
Source: (1) https://ourdorset.nhs.uk/wp-content/uploads/2018/07/Our_Dorset_STP.pdf
Home to 870,000 people, life expectancy across Staffordshire has risen year on year, but its ageing population still face an average 17.5 years of poor health. To further extend lives, but crucially increase the number of healthy years, Staffordshire County Council runs a range of public health support services.
With around 40% of ill health preventable, and obesity, smoking and diabetes the major factors, the Council’s support services aim to help people make better lifestyle choices. This includes one-to-one support sessions; providing advice, medication and information to help people make long term behaviour changes.
Although effective, the team identified that face to face appointments don’t work for everyone, and even during COVID-19, when appointments were moved online, the format still stops many people from engaging. Some people can’t make the time of day, others, prior to COVID-19,couldn’t get to the clinic, and a significant number don’t want to face a person with their lifestyle choices.
For a number of years the Council has explored using digital technologies to improve support for residents, and so in-line with this thinking, the Public Health team looked at how technology could be best used to reach and engage with people to change behaviours and extend the services offered.
The team conducted research, looking at the market and what services are available on G-Cloud. They’d been aware of ORCHA and saw that it was the only organisation who could effectively enable the Council to connect people with reviewed and trusted health and care apps, and so the team engaged ORCHA to work with them to integrate these into its lifestyle services.
ORCHA’s implementation team worked with the Public Health team to identify the most important health challenges its residents face, then identified and mapped the most effective apps to each of these. ORCHA ensured that each app had been robustly reviewed against 300 measures and, where appropriate, additional COVID-19 criteria.
An App Library was then built tailored to the Council’s branding and health priorities. A carousel of pre-prepared searches for each of the priority health areas was included. This was embedded via an iframe within the Council’s website, so that it could be easily found: https://www.staffordshire.gov.uk/appfinder. ORCHA Pro Accounts were also added to the library, which would enable staff to logon to their own account, keep a favourites list of their preferred apps, recommend apps via email or text to residents, and keep a track of who has been recommended an app and if they have downloaded it.
After two months of development, the programme was ready, a training programme was rolled out across Adult Social Care teams, social prescribing teams, the local NHS Trusts, and the information services within libraries. This enabled teams to start recommending apps to service users.
Engaged with the programme, teams made favourite app lists and when they spotted a new app that wasn’t on the library, they asked ORCHA to review it, to make sure it was safe. Ifit made the grade it was added to the library, but if it didn’t (as 85% apps don’t), the team knew to warn service users about it.
To make residents aware of the programme, the team created a three-month paid-for social media campaign. It focused on the positive difference apps can make, encouraging people to visit the library and choose an app. The campaign targeted certain groups of people, by geography, demographic and interests. Initially the focus was placed on those over 50 years old, tailoring the images and messages to maximise engagement.
The programme has been successful, with good engagement levels by the public through the social media campaign, and strong levels of recommendations by service teams.
Feedback from staff has been extremely positive. They have been comfortable with the library, finding it very easy to use and have been reassured by the review process behind every app selected to be featured. It has made them more comfortable recommending an app to supplement their care delivery.
In its first five months of launching, the library has seen around 4,000 sessions, with approximately 10,000 pages viewed. People have searched for help with everything from Fitness and Nutrition, to Mental Health, Dementia and Diabetes and already downloaded hundreds of apps.
Steve Tranter, Stop Smoking Practitioner, Everyone Health, describes his experience:
“I’ve used the ORCHA tools to identify and send apps which I feel will benefit service users. I have been able to identify apps to help clients not only stop smoking, but also with a wide range of additional challenges, including apps to help improve overall health and wellbeing; nutrition and food apps for those seeking to lose weight; mental health apps for clients who are suffering with anxiety, depression, stress and OCD; sleep apps to help clients sleep better; and MSK apps to help a client to relieve a persistent shoulder pain.
“Its design and ease of use is one of ORCHA’s particular highlights. Each specific app is categorised and can be accessed just by using the scroll bar. In addition, you can also just type into the keywords box your specific search and then it gives you a breakdown of all the apps available to assist. There is a huge selection of apps available once have performed your search, it is then just a case of scrolling the huge quantity on offer and using the filters (budget, platform, etc) to help you find the App which you feel will assist the client with the particular issue they need help and support with.
“To recommend or send an app it is just a case of typing in the client’s email or mobile number and then clicking to send the recommendation. This will then be sent directly to the client’s phone via text or email for them to download. The app that has been sent can then provide them with some additional support right at their fingertips.”
The Public Health team see the library as an effective tool it can use to tackle challenges including obesity and smoking. But they don’t see the library as a product that after they’ve purchased the work is done. To keep achieving results, they believe they need to keep it alive. With this view, they continue to educate the workforce on health and care apps to maintain enthusiasm and education. They have also identified champions within each service delivery team, who will continue to find apps for testing and support other members.
Communications have been central to the success of the programme. Following the dedicated social media campaign, the team have embedded the apps library into their wider heath campaigns. Apps have been at the heart of its recent STOPtober campaign, for example, offering a practical, measurable, call to action.
Commenting on the programme, Lucy Gratton, Commissioning Officer, Public Health and Prevention, Health and Care Directorate, Staffordshire Council, summarises:
“Apps offer a real, practical solution that people can engage with to make a difference to their health. Carried with them all day, they can offer regular motivation and feedback that other formats of intervention can’t. They also appeal to people who, for whatever reason, do not want to engage with traditional services.
“But lots of apps aren’t safe and so it was essential for us to connect our residents with apps we know are assured and will make a difference to their life changes. The ORCHA reviewing and library have been essential for us to achieve and deliver this.
“The programme has been a success. We see the number of recommendations and downloads growing and know that for many, it is helping to change their lives and become healthier.”