What to know more about how to support and manage self care? Find out more....

1. Supporting Self-Management & Self-
Care
Tuesday 23 June
#selfmanagement

2. Welcome & Introduction
Deborah Evans
Managing Director
West of England AHSN
#selfmanagement

3. 10:20 - 10:40 Setting the Scene The Health Foundation
10:40 - 11:00 Supporting Patient Independence in North
Somerset
North Somerset
Community Partnership
11:00 - 11:30 Refreshments and Networking/ 1:1 partnering/Exhibition area
11:30 - 12:00 Building programmes for technology enabled
supported self-care
Philips Research
12:00 - 12:25 Company introductions
12:25 -12:45 ‘Diabetes: mHealth – Self-management in a
digital world‘
West of England AHSN
12:45 - 13:45 Lunch & Networking/1:1 partnering/Exhibition area
Programme

4. 13:45 - 14:05 Patient Decision Aid Case Study West of England AHSN & Bayer
14:05 - 14:25 Brain in Hand Case Study Brain in Hand
14:30 - 15:30 Q&A panel debate
15:30 - 15:55 Company Introductions
15:55 - 16:00 Wrap up and close
16:00 - 16:30 Opportunity for Networking/1:1 Partnering/ Exhibitions
Programme

5. Supporting people to manage their
own health and care
Alf Collins
Clinical Associate in Person Centred Care
Health Foundation
Visiting Professor in Person Centred Care,
Coventry University
#selfmanagement

6. We face unprecedented challenges

7. People who live with LTCs face
multiple challenges (and make daily
trade-offs)
See (for instance):
• ‘This does my head in’- an ethnographic study of people who live with diabetes:
http://www.biomedcentral.com/1472-6963/12/83
•‘Treatment burden/minimally disruptive healthcare’ literature:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125457

9. The system also faces multiple
challenges

10. Challenge 1
Multimorbidity

11. Cost rises exponentially with
number of conditions

12. Challenge 2.
Fragmentation

13. 10% of population
25% of population
Challenge 3.
Approx 35% of the population has low
or no confidence to self manage

14. Self management is usual care
Hours with NHS / social care
professional = 3 in a year
Self management
= 8757 in a year

15. Challenge 4
We have a reactive, biomedical, disease-
centric, hospital centric, unaffordable
system

16. The House of Care: proactive and
person-centred
Engaged,
informed
individuals &
carers
Engaged,
informed
individuals &
carers
CommissioningCommissioning
Organisational
& clinical processes
Organisational
& clinical processes
collaborative care
and support
planning
collaborative care
and support
planning
Health & care
professionals
committed to
partnership
working
Health & care
professionals
committed to
partnership
working

17. Care and support plans and care
and support planning

18. Care plans- outputs not outcomes

19. The House of Care in value to people with LTCs:
The House supports National Voices ‘I’ statements
My goals/outcomes e.g.
• All my needs as a person were
assessed and taken into
account.
Communication e.g.
• I always knew who was the
main person in charge of
my care.
Information e.g.
• I could see my health and
care records at any time to
check what was going on
Decision-making e.g.
• I was as involved in
discussions and decisions
about my care and
treatment as I wanted to be.
Care planning e.g.
• I had regular reviews of
my care and treatment,
and of my care plan.
Transitions e.g.
• When I went to a new
service, they knew who I
was, and about my own
views, preferences and
circumstances.
Emergencies e.g.
• I had systems in place so
that I could get help at an
early stage to avoid a
crisis.
Engaged,
informed
individual
s & carers
Engaged,
informed
individual
s & carers
CommissioningCommissioning
Organisational
& clinical processes
Organisational
& clinical processes
collaborative
care and
support
planning
collaborative
care and
support
planning
Health &
care
professional
s committed
to
partnership
working
Health &
care
professional
s committed
to
partnership
working

20. Measuring success
Dorothy

21. 1. How do we make sure that
the system puts Dorothy first? In
everything it does? Always?
2. What is the system trying to
achieve?

22. Primary purpose: the system should
support Dorothy to develop the
knowledge, skills and confidence to
manage her own health
Eg: The Patient Activation Measure
•A 13 item tool that measures knowledge,
skills and confidence
•4 levels of activation

24. 10% of population
25% of population
Approx 35% of the population has low
or no confidence to self manage

25. People at low levels of activation tend
to:
• Feel overwhelmed with the task of managing their
health
• Have low confidence in their ability to have a positive
impact on their health
• Not understand their role in the care process
• Have limited problem solving skills
• Have had a great deal of experience with failure in
trying to manage, and have become passive with
regard to their health
• Say they would rather not think about their health

26. As compared to people at low levels of
activation, people at higher levels tend
to:
• ‘Be engaged’
– Come prepared
– Ask questions
– Make decisions
– Have less unmet needs (nb inequalities)
• Have improved clinical outcomes (including mental
health)
• Enjoy an improved quality of life
• Use less healthcare resource
• Feel satisfied at work
Why Does Patient Activation Matter? An Examination of the Relationships Between
Patient Activation and Health-Related Outcomes. Jessica Greene and Judith H.
Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011

27. Activation as a mediator of other
indicators

28. Tailored interventions can support
people on their journey of activation
Thus tailored interventions improve all other ‘downstream’ indicators

29. People with Lower Activation Associated with Higher
Costs; Delivery Systems Should Know Their Patients’
‘Scores’

30. Build the House
Engaged,
informed
individuals &
carers
Engaged,
informed
individuals &
carers
CommissioningCommissioning
Organisational
& clinical processes
Organisational
& clinical processes
collaborative care
and support
planning
collaborative care
and support
planning
Health & care
professionals
committed to
partnership
working
Health & care
professionals
committed to
partnership
working

31. For Dorothy

32. www.personcentredcare.health.org.uk
Alf Collins WEAHSN, June 2015. Twitter: @alfcollins

33. Supporting Patient Independence in
North Somerset
Jane Impey and Caroline Sawyer
North Somerset Community Partnership
#selfmanagement
Wi-Fi
Network - Public Wi-Fi
No code required

46. Key Note Address
Cees Van Berkel
Director of Innovation
Philips Research
#selfmanagement
Wi-Fi
Network - Public Wi-Fi
No code required

47. Slides have been emailed to you
separately as a PDF

48. Company Introductions
#selfmanagement
Wi-Fi
Network - Public Wi-Fi
No code required

49. Steve TreadwellPhD Computer Communications

50. Who we are
 Specialise in websites and online services
for Primary Care organisations
 In business for over 10 years
 Have processed over 2 million online
patient requests for GP Practices and Health
Centres

51. The problem
 Reducing demand on Primary Care
while:
– Improving patient satisfaction
– Improving practice efficiency

52. Our approach
 Give more ownership to the patient
 Essential to be topic specific
3 Tier Filter
1.Guide patients to solving their problem
themselves
2.Then, use online requests where possible
3.Finally, direct them to the most appropriate
clinician

53. Decision Tree
 A series of simple questions, topic specific
Results in:
– The patient dealing with the issue themselves
– or, completing an online form
– or, advising that they need to see a
professional.

54. An example: Renewing contraception
 Patient self-assesses their risk online
 Enters their own blood pressure readings
 Decision tree decides whether:
• Appointment required with a practice nurse
• or their prescription can be renewed without
visiting the practice

55. Wide range of decision tree topics
 Asthma reviews
 Hay fever
 Back pain
 BP monitoring
 Referral requests
 Sick notes
 And many more..

57. Presented by
Janet Jadavji, CEO and Founder, YECCO
Mobile Solutions for Supporting
Self-Management & Self-Care

58. Digital Inclusion- in Leeds
Participant YY, 58, said: “It’s great
because you can have conversations
with people who have had the same
experiences as you and most
importantly it’s fun.”
Participant XX, 73, said “I think it’s
wonderful and has made a real difference
in helping us connect with each other. I’d
never used an iPad before, some of us are
better with technology than others but
we all support each other, come in for a
cup of tea and learn together.

59. Contact
janet@yecco.com
+44 203 176 6840
www.yecco.co.uk
@teamyecco
www.facebook.com/yecco
www.linkedin.com/company/yecco

60. PainSense
Two Digital Assets for an Integrated Digital Pathway
for Persistent Pain
(Pain Toolkit App and Pain Management Plan App)
Commissioned by NHS England with SBRI Funding

61. Supported self-care – linking
smartphone based
self-care apps to GP systems
• Proven interventions- delivered digitally, Integrated clinically,
Integrated technically = Digitally enabled service improvement
5M people with persistent pain present to health care every year in the
UK. Most are managed with analgesics including opioids , or referred
to medical specialists … now viewed as mainly ineffective high cost,
low value interventions, cause dependence and fail to improve health .
IASP stresses pain is a disease of the person, requires effective
interdisciplinary care, graded fitness programmes, medicines
management and CBT focused self management skills. This is neither
generally delivered nor available. Our proposal, Pathways through
Chronic Pain will use integrated digital resources to make the
recommended treatment available to all those who need it

62. Pain Toolkit App
Assessment Tools:
Health Need Assessment, Body Chart,
DoloTest and Self Efficacy PSEQ
Reports.
With the Pain Toolkit app patients
learn more about:
•Accepting pain so you can begin to
move on the pain cycle’ – and how
to reverse it.
•Pacing and relaxation skills.
•Learning to go easy on yourself.
•Setting goals and overcoming
setbacks.
•Get involved - building a support
team.
•Learn to prioritise and plan out
your days.
•Be patient with yourself.
•Learn relaxation skills.
•Stretching & Exercise.

63. Pain Management Plan
App
The Pain Management Plan App
takes this further, with a set of
practical tools for self management
that include:
•Target setting tools and ways to
stay on track.
•Pacing, prioritising and goal setting
including lots of tips on helping you
deal with anger, frustration, moods
and anxiety along with much more
besides.
•The Pain Management Plan app
also allows clinicians to access
patient information through the
InHealthcare platform to generate
reports on patient progress, and
utilise the insights gained to work
more effectively with patients
PMP Reports Goal Setting, Targets
etc.

64. N3, Integration & Heath
Economics
N3 Secure NHS Commissionable
Service
•Integrated technology enabled
pathway
•Supported by e-Learning
•Clinical Pathway Focussed
•Significantly improves outcome
for patients
•Data collection
at source
Health Economics
•Cash releasing savings from
reduced prescribing (up to 20%)
•Reduced hospital costs (27%
reduction in onward referrals to
secondary care)
•Reducing primary care activity
(50% reduction in hospital
consults)
•80% more patients saying
personal goals in managing pain
were met
Source: North Kirklees

65. Enabling self care
ADI-Health training partners
Patrick Hill (Clinical Health Psychologist) and Eve Jenner (Specialist
Physiotherapist) have extensive pain management experience
and have worked together for 7 years
• One full day Pain Management Plan workshops are
provided for a wide range of clinicians experienced at
working with patients with persistent pain.
• Two day training introduces health & social care
professionals to the techniques they need to engage
and support people to self-manage persistent pain and
other long term conditions
• Bespoke training programmes can be arranged for
whole services or teams
• For further details and dates of forthcoming programmes, please
email info@enablingselfcare.com

66. 02/16-1142365-0000 Date of Prep Feb 2015

67. Why MSD
67
In the UK, MSD places great importance on the
development of service solutions which add value to the
NHS. We currently provide a diverse portfolio of service
offerings that are adding value to the NHS while
transforming MSD into a true healthcare company
MSD is a global healthcare leader working to address
unmet health needs. We provide innovative medicines,
vaccines and animal health products to help improve health
and well-being. We work with customers in 140 countries to
deliver broad-based healthcare solutions.
Why MSD

68. 68
Our Healthcare Services offer Solutions Beyond the Pill
1998-present
We have developed an LTC
clinical change management
programme proven to support
Primary Care to implement
NICE guidelines and improve
confidence of care across their
multidisciplinary teams
We support the patient
directly through our self-
care service that activates
patients through Health
Coaching while keeping
them out of hospital
through Remote Monitoring
2008 -present
2013 -present
MSD provide informatics solutions that impacts 33% of the UK practice population
enabling Health professionals turn information into insight
Insight through Analytics
Enabling
Patient
self-care
Changing Clinical
Behaviours

69. more about……
Our Remote Patient
Monitoring service
has helped change the
lives of acutely unwell
patients with long-term
conditions. Closercare
uses the latest
monitoring technology
combined with patient
coaching techniques to
embed patient self-
care. We assess
impact on the patient
by using the PAM
algorithm.
www.closercare.co.uk

70. more about……
www.closercare.co.uk

71. Remote
Monitoring
Care
Integration
Patient
Optimisation
Professional
Engagement
Our approach: whole system

72. Closercare Case Study
Harrow CCG,
Heart Failure and COPD
12/16-1139624-0000 Date of Preparation December 2014

73. Overview
• Patient monitoring began in February 2014
with the objectives:
– Establish an active care plan for patients with COPD or HF monitored from 1st
February 2014
– Reduce COPD/HF related avoidable admissions
– Support patient confidence in self management, independence and quality
of life
– Support community service productivity by reducing travel time of nurses
and frequency of visits
• 134 patients monitored
- 64% COPD
- 36% HF

74. Closercare-Harrow Outcomes (cost benefit)
• Calculation of net savings and Return on Investment
– Where recruitment is targeted to patients with >1 cardiorespiratory admission in the previous
12 months (n=61)
– Monthly cost of service monitoring £181 (monitoring one patient for one month)
Mean monthly non-elective
cardiorespiratory admission costs, based
only on patients with ≥1 cardiorespiratory
admissions in the 12 months before
intervention (n=61)
Criteria Gross Monthly Cost
Saving
Net Monthly Saving Return on Investment
Patients with at least 1
cardiorespiratory
admission in the year
before closercare (n=61)
£468 £287 159%
Results

75. For more information:
• www.closercare.co.uk
• 01992 455400
• Email: msdhealthcareservcies@merck.com
Reference: Telehealth in Harrow, Early Findings & Cost Benefits; David Barrett, University of Hull, September 2014

76. Technology for independence
© Inclusive Media Solutions
LTD 2015

77. Who we are?
• Founded in late 2013 by William Britton
• PGCE – SEN post 16 lecturer teaching ICT, Media and graphics
• Assistive Technology specialist
• BA (hons) – Video Production
• Accolades Start up of the year 2014 finalist, North Somerset 2015
‘making a difference’ business award, BBC Radio 4 the Doctors
Dementia
• Our current clients include Brandon Trust, South Gloucestershire
Council, North Somerset ‘Think Autism’ Project, Weston College,
SGSC College, Knightstone Housing Association and Macintyre
Charity.
About us!
“Inclusive Media Solutions LTD believe mobile
technology can provide solutions to independence for people with
cognitive disabilities”
© Inclusive Media Solutions
LTD 2015

78. Who we are?
• Cognitive difficulties such as Learning Disabilities, Dementia
and associated difficulties
• Daily struggle to achieve tasks independently
• This support is currently provided by people
• This comes at a great cost to the Government, Educational providers, NHS,
Local authorities and many other organisations and costs billions
• Autism costs ‘32bn a year’ in the UK – BBC News (http://www.bbc.co.uk/news/health-
27742716)
• Dementia care costs the UK £26.3bn a year – Alzheimer's Society
(http://www.alzheimers.org.uk/dementiauk)
• These will continue to rise!
• Why the rising costs of social care cannot be ignored – BBC News
(http://www.bbc.co.uk/news/health-31001151)
The barriers to independence people
with cognitive difficulties face
© Inclusive Media Solutions
LTD 2015

79. Who we are?
Our Solution
The worlds largest
library of
instructional videos
for people with
cognitive
disabilities
Our unique QR
code system
enables users to
scan ANY item with
a smart device and
it plays a video of
how to use it
Q-View“I think Q-View is brilliant, I
was really encouraged and
thrilled to see such things
existed because I am very
computer literate myself…
as I progress, not
deteriorate, they will be
very valuable and important
to me to help remind me
how to do things because
we forget simple things”
Dr Jennifer Bute
Diagnosed with Dementia
“Q-View has been amazing!
My 19-year-old son has used
a number of the videos; he
follows them with ease and
is able to operate the iPad
without support. The pride
he feels in completing the
task is evident for all to see
in the huge smile when he
presents his drink/snack”
Penny Cutbill – Parent Carer
Son with Down syndrome
“Q-View has been a valuable tool for both
in class for my independent living sessions
and for the students to use independently
during their time staying residentially.
Using Q-View frees up staff that would
normally spend time overseeing students
whilst giving students a sense of ownership
of their independence. The visual impact is
hugely important to our students who find
following written instructions difficult”
Leigh Murray
Autism Specialist Tutor – Weston College
© Inclusive Media Solutions
LTD 2015

80. New subscribers
receive a staff
training session
Ensure all staff
have the skills and
confidence to
support their
patients
Staff Training
Who we are?
Supporting our products
0117 205 0654
Available during the
working week to
answer any
questions and
support our
products and
services
Over the phone
YouTube videos
We also provide
free online ‘How to’
videos, many
clients and staff
use these to refresh
their memory
and/or show new
patients – cost
effective
Online
© Inclusive Media Solutions
LTD 2015
Reports
Monthly tracking
data provided to
clients, if required
these can be put
into presentations
and/or graphs
showing outcomes
Data tracking

81. Technology for independence
Thank you for listening
© Inclusive Media Solutions
LTD 2015

82. Challenge Launch Diabetes:
mHealth: Self-Management in a digital
world
Elizabeth Dymond
Deputy Director of Enterprise and Translation
West of England AHSN
#selfmanagement

83. AHSN’s Mission
• Building a culture of collaboration and partnerships
• Speeding up adoption of innovation into practice
• Creating wealth through co-development testing and
early evaluation and spread of new products and
services
Driving Innovation by making the NHS a Lead Customer

84. Challenge led approach
AHSN Challenges R4H

85. National scene
“We want to see patients and carers involved in decisions about their care,
receiving appropriate structured education to support self-management,
having more control and managing their own health, care and treatment.”
Act for Diabetes 2014 NHS England
Provide staff and patients with access to high-quality tools for structuring
and recording care-planning and shared decision-making.
Kings Fund 2014
The NHS Five Year Forward View committed to developing a National
Diabetes Prevention Programme. A delivery group from NHS England,
Public Health England and Diabetes UK is currently leading the design of
the programme.

86. Challenge Process
Soft Start Innovation

87. Content slide heading

90. Our Members

91. • “By working with the AHSNH we would be able to access
technologies and providers that otherwise we would not be aware
of but neither would we have the internal resource to procure.”
(South Gloucestershire CCG)
• “Together we are leading on redesigning the clinical pathway for
our patients with Diabetes and are consequently very interested in
this project.” (BANES CCG)
• “I was interested to read about the diabetes mobile and web based
work in the West of England AHSN newsletter. We would be keen
to be involved in testing and evaluation of products if you are
looking for this.” (North Somerset CCG)

92. Opportunities for company applicants
Your innovative product will be used & evaluated in a real world setting.
You will submit a quotation rather than a tender as we are looking to evaluate a
number of innovative solutions with the costs of each one less than £50,000
You will receive a report on the evaluation which will also be shared with West
of England AHSN members who commission and provide healthcare services
across our region with a population of 2.4 million people.
You have the opportunity to develop your products in line with commissioner
and provider requirements.
Increased potential for sales in West of England healthcare providers.
Increased potential for national sales as the 15 AHSNs across England share
case studies.
Registration on national portals to receive alerts on further relevant public
sector procurement opportunities.

93. What if ……healthcare
records were shared
between the person with
diabetes and other people
and services that the
person wishes to share
that record with? Viewing,
inputting and editing rights
are controlled by the
person with diabetes and
records are available in
real time.
What if ……healthcare
records were shared
between the person with
diabetes and other people
and services that the
person wishes to share
that record with? Viewing,
inputting and editing rights
are controlled by the
person with diabetes and
records are available in
real time.
What if….. services
were set up so that
healthcare
professionals and
patients can email,
text and phone each
other?
What if….. services
were set up so that
healthcare
professionals and
patients can email,
text and phone each
other?
What if ……services
were truly joined up
to be person-centric
and personalized to
account for many
people with
diabetes having
another long term
condition?
What if ……services
were truly joined up
to be person-centric
and personalized to
account for many
people with
diabetes having
another long term
condition?

94. What if ….we can
enable every citizen
to self-care in their
own way to the
benefit of their health,
both physical &
mental?
What if ….we can
enable every citizen
to self-care in their
own way to the
benefit of their health,
both physical &
mental?

96. Diabetes
• 139 per cent more likely to be admitted to hospital with angina
• 94 per cent more likely to be admitted to hospital with
myocardial infarction
• 126 per cent more likely to be admitted to hospital with heart
failure
• 63 per cent more likely to be admitted to hospital with a stroke
• 400 per cent more likely to be admitted to hospital for a major
amputation and 817 per cent more likely to be admitted with a
minor amputation
• 272 per cent more likely to be admitted to hospital for renal
replacement therapy (ESKD)
http://www.hscic.gov.uk/nda

97. mHealth
• ….also known as mobile health, covers
medical and public health practice supported
by mobile devices
• Mobile phones
• Patient monitoring devices
• Apps
• Wearables
• Health information
• Medication reminders

98. Self-Management
99% of diabetes care falls to self-management.
Shared decision making: clinicians and patients
working together to
– clarify treatment, management or self-
management support goals,
– share information about options and preferred
outcomes
to reach mutual agreement on the best course
of action

99. Key Dates 2015
• 23rd
June – Launch
• 22nd
July – Deadline for submissions
• 27th
July – Prepare shortlist – in scope?
• 31st
July – Review panel & interviews
• August – Due diligence
• September – Project set-up
• October onwards – Projects & evaluation go
live

100. Application Process
Our Application Process is in two stages:
If you are not already registered on the MultiQuote portal, please
contact our procurement partner, Royal United Hospitals Bath
Foundation Trust to register on the portal and receive further
documents and guidance.
ruh-tr.procurementteam@nhs.net
You will submit a quotation and complete a short application
form as we are looking to evaluate a number of innovative
solutions and their cost implications; indicative pricing will aid the
evaluation process. Responses are to be submitted via the
MultiQuote RFQ by 17:00 hrs 22nd July 2015.

101. Patient Decision Aid
Case Study
Sarah White
Karen Cooper
Date of Preparation June 2015.
L.GB.NPM.06.2015.11613

103. Project Development
NICE CG180
Quality Improvement Team develop the project in 3 phases
In conjunction with key stakeholders we develop a range of products
Patient Decision Aid is created using NICE PDA
Working with Industry is a key objective
Joint Working Agreement is developed

104. The Rationale for Joint Working
Initial MEGS approach
Why is there a need for Joint Working?
Evolved (and evolving) project support
Supporting resourcing of Don't Wait to Anticoagulate in order to drive the
project forward

105. The Patient Decision Aid
Prototype
Booklet with AF information and FAQs
Risk Score Sheets
Used by Healthcare professionals and patients
Tested by 11 Innovator Practices

109. PDA Testing in Phase 1
Tested in 11 Innovator practices over 3 months
Task and Finish Group

110. Task and Finish – Learning from
Feedback
Patient Feedback and Healthcare Professional Feedback
Relative Risk sheets
Numbers Needed to Treat (NNT)
Risk over time
Adding new OAC

111. Medical Communications
Expertise Required
Further development needed to review and redefine the DWAC products
Support and expertise is required
Initial meeting with Medical Communications Experts
Now in tendering process to create the web portal for patients

112. Next Steps
Joint Working has been extended to cover Phase 2 facilitating the roll
out of DWAC over 83 practices in Gloucestershire CCG
PDA will be available online for all AF patients to benefit from
By working together we aim to prevent 200 strokes in AF patients
across the WEAHSN area, through empowering patients to make
informed decisions about their anticoagulation by using this
Patient Decision Aid

113. Brain in Hand Case Study
Andrew Stamp and Tom Pittwood
Brain in Hand
#selfmanagement

114. 114
An Information System

115. 115
• Description
• History
• Opportunity
• Enterprise Model

116. Guided independence in day-to-day living
Where decision-making and response is compromised
• Smart technology: phone & cloud
• Patient-Centre:
User driven + help on demand
• Grounded in Clinical practice
Supports established approaches
• Enables:
• Users; and
• The people who help them; and
• The funding organisations116
Description

117. How does Brain in Hand help?
117
Personalise activities and &
coping strategies
On your
phone in your
pocket
Instant help “on
the go”
Data for continual
improvement
Mood
monitoring
Description

118. 16© Brain in Hand 2013
Online diary syncs with the smartphone or tablet
118
Description

119. 18© Brain in Hand 2013
Mentor support
- help when you need it most
• Alert when reds pushed
or 3 ambers in a row
• Alert is by text and dashboard
• Mentor - call, text or meet
119
Description

120. 120
Timeline
• Alexander Project 1997-2009
• Home Intervention Programme (Alexander Stamp)
• Clinically Supervised, ISO9001 quality standard
• Southampton Childhood Autism programme (SCAmP) 2000-2006
• Peer-reviewed Research
• Autism Diagnostic Research Centre (2007)
• Spinout from Southampton University
• Advanced Interdisciplinary Clinic
• Funded by Roger Brooke Charitable Trust
• Registered Charity
• Brain in Hand Ltd (2009)
• Seed Funding from Roger Brooke Charitable Trust
• Commercial Company
• £1.2 million raised up to end 2014
History

121. Mental Health
Anxiety
BPD
Ageing
MCI
Alzheimer
(early stage)
Brain Injury
ABI
Stroke
Epilepsy
Autism
Asperger/HFA
………a much bigger opportunity
Opportunity

122. 122
Kings Fund:
Existing approaches no longer sustainable…….
….but there is a technology opportunity
• By 2018 3 million people with three or more long term conditions
• 1 million extra care workers needed over the next 10-12 years;
• Requires step changes in productivity.
But
• New medical and information technologies:
• enable different ways of working, including
• enhanced roles for patients
• Most have mobile access to the web
Source: The Kings Fund:
NHS and social care workforce: meeting our needs now and in the future?
Opportunity

123. 123
Source: Ernst & Young
http://www.ictliteracy.info/rf.pdf/mHealth%20Report_Final.pdf
Can Technology Help?
Opportunity

124. 3© Brain in Hand 2013
SAP Specification
• Create a patient-centered model of care
• Equip patients and caregivers with tools to use on the go
• Connect patients and caregivers
to the medical community in the cloud
124
(http://www.forbes.com/sites/sap/2013/04/09/3-ways-technology-can-make-a-dent-in-autism-research/)
Louis Bridgman, Media Relations & Strategic Industries, SAP June 2013
Opportunity

125. Enterprise Model
• Licensed Implementation (Annual Charge)
• “Enterprise Solution” not “an App”
• Clinical benefits
• Social benefits
• Productivity and financial benefits
• Technical Compatibility
• Existing Information Systems
• All major mobile platforms
• IG Compliant
• Demonstrate “Real-World” Efficacy
• Collaborative Trials
• BiH Mentoring Service
• Effective Implementation
• People System
• Proven Path
• Operating Standards
• Review and Accreditation
• Target organisations where change is imperative: Not just NHS
• Social care
• Education
• Employment
• Rehabilitation
125
27
Enterprise Model

126. 27
Implementing People Systems:
The critical factor
126
Enterprise Model

127. 27
Implementing People Systems:
The critical factor
127
Enterprise Model

128. Current Deployment
• Tavistock and Portman NHS Trust
• Leeds and Yorks NHS Trust
• MenCap (6 sites)
• National Autistic Society
• Dame Hannah Rogers Trust
• 3 x Autism Alliance (Wirral, Burgess, Norsaca)
• FE Colleges
Totton College, Fareham College, Sussex Coast College, Petroc College
• 5 x Secondary Schools
• Hampshire County Council
• Doncaster (mental Health)
• Warwick
• Solihull
• 3 Universities
128
27
Enterprise Model

129. 27
129
June 2015 News

130. Q&A Panel Debate
#selfmanagement

131. Questions from the Panel
What conflicts or
difficulties come up
with working so
closely with
Pharma Industry
What conflicts or
difficulties come up
with working so
closely with
Pharma Industry
How have
patients been
involved in
developing and
shaping the
Patient Decision
Aid
How have
patients been
involved in
developing and
shaping the
Patient Decision
Aid
How easily do
patients & staff
move to shared
decision making?
How easily do
patients & staff
move to shared
decision making?
What are the
issues?
How do we
make it easier
for everyone?
What are the
issues?
How do we
make it easier
for everyone?
Development of new
technology based
approaches to care carries
risk
If the public sector is too
risk averse to support
development, should we be
bringing in the private
sector?
Development of new
technology based
approaches to care carries
risk
If the public sector is too
risk averse to support
development, should we be
bringing in the private
sector?
Research by the Kings fund suggests
that with current approaches to care
a million more carers will be needed
in the next 10 years. This is
unaffordable, so would you:
- raise the bar so that fewer
people qualify for care
- adopt new approaches?
What do you think is happening at
the moment?
Research by the Kings fund suggests
that with current approaches to care
a million more carers will be needed
in the next 10 years. This is
unaffordable, so would you:
- raise the bar so that fewer
people qualify for care
- adopt new approaches?
What do you think is happening at
the moment?

132. Company Introductions
#selfmanagement

133. Patient INR self-testing using the Roche CoaguChek XS
Matt Marshall – Inhealthcare
Phil King - Roche

134. Who are NHS Health Call?
• Joint venture between Inhealthcare Limited and County Durham and
Darlington NHS Foundation Trust.
• Joined forces in 2013 following the successful roll out of a number of
digital health services.
• The vision is to help redesign care pathways across the UK, whether that
is providing warfarin patients greater freedom to self-test from the
convenience of their own home or helping health professionals manage
undernutrition at scale.

135. What is Health Call INR monitoring?

136. An automated phone call system is used to
collect the INR reading
Thank you. The INR reading you
entered is 2.0. If this is correct,
please press 1. If this is not
correct, please press 3.
Please enter both digits of the
INR result using the star key on
your keypad as the decimal point.
When finished, press the hash
key. For example, if your INR
result is 2.5, please press 2 star 5,
followed by hash.

137. NHS Health Call provide warfarin
services across County Durham
• 2,648 registered warfarin patients
– Any Qualified Provider (AQP) funded
• Service locations
– Outpatient clinics
– Satellite clinics
– Home visits for the house-bound
– Telehealth (self-testing)
• Serviced by
– Anti-Coagulation Nurses (Band 6)
– District Nurses (Band 5)
– Healthcare Assistants (Band 3)
– Pathology Assistants (Band 3)
– Administration (Band 2)

138. Existing warfarin patients were
recruited onto an INR self-testing study
• Number of Patients
• Referred: 200
• Patients withdrawn: 17
• 2 moved area
• 4 died (non-related
reasons)
• 5 had difficulty due to
frailty
• 5 stopped warfarin
• 1 returned to clinic

139. Patient feedback was almost
universally positive
• Some patient responses on the
perceived benefits of the service:
• Reduced time attending clinics
• Less impact on work disruption
and money lost from taking
holiday or no pay to attend
clinic
• Money saved from travel costs
and parking
• Able to test whilst working
away from home or on holiday
• Flexible around me

140. Clinic staff were also very supportive
of the service

141. Patients across both cohorts saw
significant improvements in their TTR
compared with pre-study TTR
INR Self-Testing
Cohort 1
INR Self-Testing
Cohort 2
Number of patients 100 100
Recruitment Selection Criteria
Narrow
Most were hand-picked by
staff
Broad
Most were recruited from
ads
TTR - 6 months before study 60.4% 59.0%
TTR - 3 months before study 58.9% 59.0%
TTR - 3 months after study 72.8% (+13.9%) 71.0% (+12%)
TTR - 6 months after study 74.4%(+15.5%) 75.0% (+16%)

142. Summary
• Patient-centred: It is a simple and efficient solution that has taken
away the need for patients to travel to clinic.
• Safe: Clinicians were involved in designing the system and
processes.
• Increased patient satisfaction: Fewer trips to clinic mean less travel
expenses and less disruption to daily life.
• Increased clinic capacity: Fewer patients unnecessarily attending
clinics should create capacity for those more complex cases who
require face-to-face care. At scale, this will help address the
problem of INR clinics that are currently bursting at the seams.
• Improved outcomes: Improved INR control means patients have a
reduced chance of stroke or haemorrhage thus reducing demand
on acute services.

143. Thank you
Visit our website
www.nhshealthcall.co.uk
Follow us on Twitter
@NHShealthcall

144. Oviva: remote provision of dietetic patient care
June, 2015
COPYRIGHT OVIVA AG 2013-2015
West of England AHSN: supporting self-management and self-
care

145. 147
Obesity and its comorbidities are a massive burden to
society
Obesity 3rd
largest burden to
society
2.8% of global GDP (direct and
indirect costs)
Drives major comorbidities
including diabetes and
cardiovascular disease
SOURES: McKinsey Global Institute, 2014; Risk factors for Diabetes and Coronary Heart disease; BMJ; 2006

146. 148
Our approach builds on extensive clinical evidence for
remote care in the treatment of obesity
Approach
Westenhoefer et
al.
Findings
▪ People adopting “lean habits” have significantly higher chances of
loosing and keeping off weight long-term; adopting multiple lean
habits is significantly stronger than individual ones
▪ Examples are regular mealtimes, taking time eating, conscious
eating and healthy food choices, no “forbidden” foods, regular
physical activity
Outcomes
Appel et al.
▪ Remote coaching supported by digital tools was as effective as
traditional, face-to-face counseling (6 months counseling, 24
months observance period) in a comparative clinical trial
Source: LJ Appel et al., New England Journal of Medicine (2011) 365 (21); N Scheuing, Ernährungsumschau 21.10.2014; J Westenhoefer et al.,
International Journal of Obesity (2004) 28, 334-335; TA Radcliff et al. J Acad Nutr Diet. Sep 2012; 112(9): 1363–1373.
Cost-
effectiveness
Radcliff et al.
▪ Telephone based-program had a lower cost, but similar outcomes
compared to the face-to-face format
Photo-Food-Log
Scheuing et al.
▪ Study participants prefer photo-food-log over a food weighing log
(86% agree / fully agree)
▪ Photos are accepted over a longer period of time and can be more
accurate than food weighing log

147. 149
Face to face dietetic counseling, the gold-standard medical
approach for dietary lifestyle change, has shortcomings
The problem
Low availability of dietitian for day-to-
day challenges
Lack of accountability
Time consuming physical meetings
Limited, and low quality, data
collection on behavioral change
Traditional approach
Prescribed by physician
Infrequent face-to-face meetings
Hand-written food and activity diary
Lots of scientific facts and tips

148. 150
Oviva’s remote care model drives improved effectiveness
through frequent interactions, whilst increasing efficiency
Value proposition
▪ Daily tips, motivation and accountability
▪ Simple and effective data logging: food with
photos, weight and activity with wireless trackers
▪ Efficient for patient and dietitian

149. 151
Value proposition
▪ Daily tips, motivation and accountability
▪ Simple and effective data logging: food with
photos, weight and activity with wireless trackers
▪ Efficient for patient and dietitian
Communication & CRM System – not an app!
Oviva’s remote care model drives improved effectiveness
through frequent interactions, whilst increasing efficiency

150. 152
Results for self-paying clients with weight-loss goals
Days between first and last weight log; average weight loss in lbs
SOURCE: Oviva, April 2015, N=62, average starting weight 170 lbs
14-30 31-60 61-120 121-360
▪High patient
engagement,
sending on
average 2.9
messages per day
▪Good retention
rates, with clients
spending an
average of 16
weeks with Oviva
Our initial outcomes in simple obesity are very encouraging
Other key
metrics
On average, Oviva patients lose ~7% of total body weight by 4
months of treatment, and maintain this up to 1 year

151. 153
Superior patient
experience
Cost efficiencies
Improved
patient access
 Substantially reduced waiting times
 Rapid responses to patients’ questions and issues
 Enhanced patient engagement through daily tailored advice
 A multi-cultural and multi-language offering
 Flexible coverage for any subspecialty dietetic skills gaps
 No travel or transport requirements, and out of hours service
availability
 A ~15% saving on face-to-face care; ~35% saving on locum provided
care
 Lower DNA rates and reduced demand on outpatient clinic space
 Oviva can help in implementing the latest, cost efficient care
pathways
 Robust outcome assessments, detailing patient engagement and
knowledge
 Assessment of patient activation, a key metric for chronic disease
mgmt.
 Flexible symptom monitoring to allow for early intervention if required
Effective outcome
measurement
Source: Oviva expert dietitians and KOLs
Overall, Oviva drives quality, is well established, and integrates
seamlessly into standard care pathways
Oviva’s remote model offers four key benefits to the NHS

152. Overview of DiabetesCareFinder
Jens Birkenheim
Founder
Xperio Health Ltd
Copyright 2015. Xperio Health Ltd

153. 4 locations
35+ total hours£50+ travel expenses
7 of 9 NICE care processes received
16 diabetes ‘touchpoints’
12 years without an annual care plan
18 month wait for structured education
0 digital ‘interactions’
Copyright 2015. Xperio Health Ltd
Inconvenience of Care

154. Copyright 2015. Xperio Health Ltd

155. Value to CCGs
SERVICE
NAVIGATION
USER
ENGAGEMENT
SERVICE
INSIGHTS
Copyright 2015. Xperio Health Ltd

156. Copyright 2015. Xperio Health Ltd
Patient trial
Apr 2015
Public launch
Q4 2015
XH

157. “This could be a fantastically
useful tool to enable people with
diabetes to find the best care
near them and ultimately to raise
standards of care”
“Love the site! Great
interface and think the
concept is brilliant!”
Copyright 2015. Xperio Health Ltd
jens@xperiohealth.com | @dcarefinder | diabetescarefinder.org

158. THANK YOU