Yorkshire Smokefree using digital health products to support service delivery

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.

Solution

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.

Results

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.