Eyes and vision
Infection, immunity and inflammation
Patient insight and involvement
Primary care development
Quality and capability
Research and evaluation
The eight fellows joining the NIA in 2016 bring evidence based innovations that address the significant population health challenges of prevention, long term condition management and earlier intervention.
Adrian is a Chartered Engineer by background and co-founder of Docobo, which aims to improve people’s quality of life through efficient implementation of digital health, supporting professional staff to deliver world-class care, and enabling patients to be more aware of their condition and empowered to self-manage.
Half of all GP appointments and 70% of hospital bed days are used by patients living with Long Term Conditions – of which there are 15 million in England. Docobo’s innovation, ArtemusICS, is a data driven population health intelligence platform, which supports community teams to identify and keep patients out of hospital, stopping preventable A&E admissions and in-patient stays through earlier detection and intervention.
It also enables commissioners to assess the needs of their local populations, identify gaps in care, view trends, prioritise care delivery and monitor the impact of early intervention and prevention initiatives, including telehealth supported interventions.
To date, Docobo’s innovations have achieved:
- Reduced hospital admissions by up to 75%
- Reduced 999 calls by 65-70%
- 40-50% reduction in GP and nurse visits
Through the NIA, Adrian would like to engage with policy makers and senior management within Sustainability and Transformation footprints (STPs), Clinical Commissioning Groups (CCG) and providers to articulate the digital health solution ArtemusICS can offer when implemented
properly at scale.
Over 600,000 people in the UK live with epilepsy; people with epilepsy have a 24 times higher risk of sudden death than the general population, although 42% of these deaths are considered potentially avoidable. However, professional discussion with patients living with epilepsy of ways to reduce increased risk of fatality are rare, with regional reported rates of less than 10%.
EpSMon can be used as a prevention tool by providing risk assessments to patients and encouraging early intervention for people with rising risk. It enables patients to monitor their own seizures and well-being between medical appointments and shows patients whether risk factors have improved or worsened to help ensure they seek medical help sooner if required. EpSMon is a digital version of a SUDEP (Sudden Unexpected Death in Epilepsy) and Seizure Safety Checklist developed and available for professionals who register with SUDEP Action for annual updates from a
UK-wide development group of experts.
Epilepsy costs the UK £1.5 billion per year. A preventative tool such as EpSMon can have a significant impact on the personal and financial costs of epilepsy through reduction in deaths and decrease in A&E appointments.
Craig hopes to use the NIA to connect with Academic Health Science Networks and develop expertise in the commissioning environment in order to promote EpSMon and mobile health
as a component of standard clinical practice.
John is the Clinical Director for Adult Critical Care and a consultant in Critical Care and Anaesthesia at Central Manchester University Hospitals Foundation Trust (CMFT).
He is the medical lead for Enhanced Recovery After Surgery + (ERAS+).
Each year, more than 200,000 major elective surgical procedures are performed in England and Wales, which carry a post-operative pulmonary complication (PPC) risk of up to 30%. This can lead to increased length of stay and reduced life expectancy.
ERAS+ works to reduce the PPC risk by better equipping patients and families in their preparation for and recovery from major surgery. It aims to put them at the centre of their own care with the intention that they view themselves as training for their surgery. It provides advice and structure for training on exercise, nutrition, lifestyle and oral healthcare information to help patients play a more active role in preventing PPC, with a focus on the six weeks prior to and the six weeks after surgery.
ERAS+ provides bespoke educational tools including information videos (respiratory training, epidurals, anaesthesia, and peri-operative assessment) and the multi-disciplinary led ‘Surgery School’, where healthcare professionals provide groups of patients with enhanced preparation for major surgery.
ERAS+ has been implemented at CMFT for more than 700 patients and has successfully reduced PPC by over 50% and post-operative hospital length of stay by three days; this has delivered £200,000 in annual savings.
John is looking forward to working with the NIA to support the scaling-up, implementation and sustainability of ERAS+, as well as taking advantage of mentorship opportunities
to further develop diffusion strategies at regional and
Julia is a consultant in Palliative Medicine at the Royal Marsden and Royal Brompton NHS Trusts and a Visiting Professor at Imperial College London. She founded Coordinate My Care with the aim of providing a step change in ensuring patients receive the care in the place they would prefer, particularly at the end of life.
Coordinate My Care (CMC) is a web-based IT platform enabling digital, multidisciplinary urgent care planning for end of life care. Frequently, a lack of continuity and coordination can lead to fragmented delivery of urgent care. Consequently, a patient’s wishes are often not delivered. CMC empowers patients to make decisions with their GP about the interventions they receive, and allows caregivers to better understand patient preferences and clinical needs.
Patients using CMC have seen 78% compliance with their stated preferred place of death, equating to 17% dying in hospital compared to 47% nationally and is on average saving the NHS £2,100 per patient equating to an annual saving of over £16.8 million in London where it is currently deployed. If implemented throughout England, projections for annual savings would be over £556 million.
During the NIA, Julia would like to engage with national health leaders to ensure urgent care planning stays on the national agenda, and work with mentors and peers to enable Coordinate My Care to become a national service.
Malcolm, a registered pharmacist, is Senior Manager in Projects & Contract Development at Boots UK. For him, the most expensive medicines are: “those that are either not taken, or are taken when they are not needed”, and he believes pharmacy can play a significant role in this issue.
Each year, around 1.2 million people will visit the GP with a sore throat and recent studies show that 62% of these visits result in the prescribing of antibiotics. Tests have shown that less than 10% of people who present with a sore throat actually have a bacterial infection.
In response to concerns of unnecessary GP visits for sore throats and the unnecessary prescribing of antibiotics for viral infections, the Sore Throat Test & Treat service was developed. This is a walk-in service at community pharmacies where patients can receive screening and point of care testing for group A streptococci, which causes bacterial infections in the throat. If tested positive, patients can receive antibiotics from a pharmacist without the need to visit the GP.
Of the 367 patients that have received the service so far, two-thirds of those who would have seen their GP did not need to do so as their sore throat was viral. If this service was rolled out nationally, 800,000 GP consultations would be saved, equating to £34 million a year.
Patients using the service reported a highly positive experience, noting the convenience of having a local walk-in screening service compared to taking time off work to attend a GP consultation.
Malcolm is interested in the NIA’s support to improve the Sore Throat Test & Treat innovation to allow greater accessibility for patients and integration within existing primary care pathways to bring the most benefit to the NHS. In addition, he hopes the NIA can provide him with the information and access to key local decision makers in order to enable conversations about how the service could be commissioned.
Paul is a specialist mental health sergeant with Hampshire Constabulary. In 2012, he led ‘Operation Serenity’, the UK’s first joint mental health and police ‘Street Triage’ response car. Since then, Paul has focussed on another problem: the small number of service users in every community struggling with complex mental health disorders. They will encounter emergency teams on a regular basis and often make limited clinical progress with mental health teams.
Paul developed SIM based on his theory that if a police officer was trained to understand and help manage high intensity behaviour, then a combination of clinical expertise, compassion and appropriate boundaries would help service users gather new momentum towards healthier and safer outcomes. Developed over the last three years, this new model of care has:
- Reduced frontline emergency costs by 90%
- Eliminated the use of mental health wards
- Helped service users rebuild relationships with loved ones
- Helped service users re-engage with their community and employment
- Helped service users to achieve medical discharge
It is estimated that the basic cost of a single highly intensive service user of police and ambulance response, emergency department attendances and mental health beds is at least £19,800 per year (if there is no specialist intervention) and that there could be as many as 3,400 service users needing this model of care across the UK at any one time; that’s a £67 million problem.
Paul intends to use his NIA Fellowship to develop a professional network across the UK so that more SIM teams are created, enabling this highly specialist area of work to be further professionalised.
Rupert, a former GP, is the CEO and Founder of Outcomes Based Healthcare. OBH has developed a population health analytics platform that measures ‘true’ health outcomes that matter to people and populations, in near real time. OBH supports commissioners, providers, and health and care systems to organise care around these priorities, measuring the resulting health outcomes. The key focus for OBH is to shift measurement and reimbursement away from solely treating illness, towards improving people’s health.
OBH’s Outcomes Platform enables commissioners and providers to identify baselines for their selected outcomes, set improvement trajectories and monitor outcomes specific to their local populations on an on-going monthly basis. Outcome sets, designed by OBH, typically measure both the presence of health and the avoidance of illness. By encouraging commissioners to pay providers based on improvements in patient outcomes, health systems are incentivised to combine new and existing care activities to keep patients well.
After working closely with several CCGs in North London, the West Midlands and the North West on a range of outcomes based projects for people with diabetes, serious mental illness and older people with frailty, OBH Outcomes Platform now features extensive outcomes sets for a range of different conditions, as well as population-based outcomes metrics. The service is used by commissioners across the country, and Rupert aims to have it implemented in health systems covering at least 10% of England’s population over the next year.
As a NIA Fellow, Rupert hopes to further scale OBH within the NHS by finding more feedback and testing opportunities, particularly in vanguard and STP communities. In addition, Rupert is looking forward to joining a community of innovators through the NIA, and supporting the entrepreneurship of other Fellows.
Trained as an engineer and a former management consultant, Tom identified an opportunity to improve the way hospital appointments are booked and managed, and reduce appointment non-attendance, and developed DrDoctor to enable just that. It has already been successfully introduced to six acute trusts serving four million patients.
DrDoctor is an online and text based service that allows patients to confirm, cancel, and change bookings digitally. For hospitals, this means they can maximise and manage patient volume to best fit their capacity. The technology can target long waiting lists and automatically book patients into empty slots in clinics. In addition, it provides digital assessments before and after appointments, saving time for both patients and caregivers.
Where it is currently used, DrDoctor has made a positive impact on acute care efficiency. It has:
- Reduced time to first contact by eight days
- Increased utilisation by 10%
- Reduced DNAs by 40%
- Cut waiting lists by 10-15%
This equates to an average saving of £1.8 million per year for each acute trust. 96% of patients recommended DrDoctor, which has also earned press coverage and been named in the top 100 global social innovations by the Nominet Trust.
Tom is looking forward to working with the NIA to understand the core problems that face trusts across the UK and to develop DrDoctor into a national and international service. Tom would also like to take advantage of networking opportunities provided by the NIA to develop an advisory board.
Maryanne Mariyaselvam is a 2015 NIA Fellow and successfully applied to add a second innovation to her NIA portfolio – the WireSafe.
The WireSafe is an engineered solution to prevent the never event of retained central line guidewires. When a central line catheter is placed, a guidewire is used to correctly position the catheter in the vein, and then it should be removed. The error occurs when the clinician forgets to remove the guidewire. If this occurs, the guidewire can travel to the patient’s heart causing significant harm and requiring a further procedure to remove the guidewire at a tertiary centre. Retained guidewires have a reported mortality of up to 20%.
The Never Events database report this error occurring once a month in the UK, however this is under-reported and has a true incidence of 1:3000. The WireSafe is a novel procedure pack which prevents the clinician completing the procedure without first removing the guidewire. The WireSafe has a locking mechansim and contains the equipment required to complete a central line insertion after the guidewire is removed: suture, suture holder, dressings and flush syringes. The only way to access the equipment is by unlocking the WireSafe with the guidewire. This forcing function ensures that clinicians always remove the guidewire.
This innovation benefits patients by preventing harm, helps clinicians to perform their job safely and is cost saving for the NHS by removing the unnecessary costs incurred to remove the error.
Over the next year Maryanne hopes to make patients, junior doctors, consultants, medical and nursing directors and hospital managers know that retained central line guidewires is now a preventable never event and hospitals should actively adopt safety measures in order to prevent this error.