Adoption Fund award winners 2021

Lead NHS organisation

• North East London Health and Care Partnership

In partnership with

• Kings College Hospital NHS Foundation Trust
• Barking Havering and Redbridge University Hospitals NHS Hospitals Trust
• Healthcare Communications LTD

Details

North East London Health and Care Partnership will work with partners to procure and implement an automated text messaging system, which will provide reminders to patients as to when to commence dietary changes and take bowel preparation medication. Patients will receive up to five messages starting 14 days prior to their agreed appointment to improve the rate of good or excellent bowel prep leading to a reduction in repeat procedures or missed diagnosis.

Lead NHS organisation

• NHS Derby and Derbyshire Clinical Commissioning Group (CCG)

In partnership with

• University Hospitals of Derby and Burton
• Chesterfield Royal Hospital Foundation Trust

Details

NHS Derby and Derbyshire CCG will be delivering a project to pilot at home monitoring of IBD patients through the use of IBDoc, a diagnostic device to determine faecal calprotectin levels in stool samples. Both patients and clinicians will be able to access results through a web based portal to determine the best health plan for the patient. This aims to reduce the amount of outpatient appointments, colonoscopies and overheads and promote self-management and increase medication compliance.

Lead NHS organisation

• Cheshire and Merseyside Health & Care Partnership

In partnership with

• Liverpool University Hospitals NHS Foundation trust (LUFT)
• DrDoctor

Details

LUFT plans to pilot the use of home faecal calprotectin (FC), in conjunction with DrDoctor tool, within three different groups of IBD patients. The first being those identified as low risk for annual check ups, second for longitudinal management of biologics and thiopurine high risk patients with a four monthly test and the third being those that have a non Liverpool postcode or have to travel more than 30 mins to an appointment. Results will be compared against current practices with the aim to increase return rate of FC results, decrease the amount of journeys patients have to make and improve follow up times for patients with active diseases.

Lead NHS organisation

• Staffordshire and Stoke on Trent STP

In partnership with

• Stoke on Trent CCG
• University Hospitals of North Midlands NHS Trust
• Remcare

Details

Staffordshire and Stoke on Trent STP plan to trial the use of the Remcare app to provide on demand access to bowel prep instructions and education. Currently every endoscopy patient is required to attend a 30 minute face to face appointment for a pre-endoscopy assessment process. By implementing this app it would enable crucial clinical capacity to be released to support other activities. The Remcare app can also be used to collect key information remotely from patients such as risk factors, digital poverty and other health inequalities.

Lead NHS organisation

• Our Health South East London

In partnership with

• South East London CCG
• Kings College Hospital NHS Foundation Trust
• The Royal London Hospital, Barts Health NHS Trust
• South-East England (SEE), IBD Network
• Calpro AS: CalproSmart
• Ampersand: My IBD Care
• Thriva

Details

Our Health South East London, in conjunction with its partners, plan to implement a three pronged project to enable at home monitoring for IBD patients in remission. Patients will be offered a virtual review via the My IBD Care app, with 3 monthly calprotectin testing using the CalproSmart home test kits. A smaller group will also trial the feasibility of the Thriva at home blood testing. The aim of this project is to reduce face to face appointments within this cohort, provide safe self monitoring for disease activity, ensure patients can trigger follow up interactions with the direct care team and to reduce the use of endoscopy resources.

Lead NHS organisation

• Herefordshire and Worcestershire CCG

In partnership with (partner type and lead organisations)

• Wye Valley
• Calpro AS: CalproSmart
• Ampersand: MyIBDCare

Details

Herefordshire and Worcestershire CCG plan to implement the use of the My IBD Care app alongside the CalproSmart at home faecal calprotectin to enable at home monitoring for IBD patients in Wye Valley. Patients will be given four tests, two to be used in a 12 month period and the other two for when they are experiencing a flare up. Results from these will determine what clinical action needs to be taken and help prioritise those experiencing significant flare ups. The aim of this project is to increase patient empowerment and experience, reduce unnecessary appointments, increase clinical capacity and effective prioritisation of patients.

Lead NHS organisation

• Humber, Coast and Vale Health and Care Partnership

In partnership with

• Hull University Teaching Hospitals NHS Trust
• Ampersand: My IBD Care

Details

Humber, Coast and Vale Health and Care Partnership plans to pilot the use of the My IBD Care app and at home faecal calprotectin (FC) within two different IBD patient cohorts in Hull University Teaching Hospitals. The first cohort would be patients experiencing a flare up. Results from an at home FC will be available to clinical staff via a dashboard to trigger follow up actions. The second cohort are patients in long-term remission. The aim with this cohort is to replace scheduled reviews with a virtual monitoring dashboard, which will provide monitoring and surveillance with results being available to both the patients and clinical staff. The project aims to:

• reduce the number of routine outpatient appointments
• reduce emergency hospitalisations and admissions
• reduce excess steroid use
• improve patient engagement and satisfaction scores

Lead NHS organisation

• Greater Manchester Health and Social Care Partnership

In partnership with

• Manchester University Foundation Trust
• Ampersand: My IBD Care

Details

Greater Manchester are planning to implement a patient pathway for IBD patients. This pathway will introduce a patient initiated follow up (PIFU) navigator to provide support and guidance for patients on this pathway. The pathways will use the My IBD Care app and home calprotectin tests to allow for patient self management and symptom based follow ups.

Lead NHS organisation

• Cambridgeshire and Peterborough ICS

In partnership with

• Local maternity and neonatal system digital midwives

Details

Cambridgeshire and Peterborough ICS, plan to identify what the main barriers and blockers are to accessing digital services within the maternity pathway. Results from this will be used to inform suitable localised action required to help improve and address these blockers. The project will also look at how accessing digital services is influenced by deprivation and by patient ethnicity.

Lead NHS organisation

• Suffolk and North East Essex ICS

In partnership with

• Healthwatch Essex and Suffolk

Details

Suffolk and North East Essex with their partners plan to identify the digital needs of patients identified as being suitable for at-home monitoring or other digital care devices. For example the BP at home project where patients wear a monitoring device for a short period of time. Outcomes of the analysis will be used to directly tailor the at-home health care to increase participation in the most deprived communities and mitigate digital exclusion.

Lead NHS organisation

• North West London ICS

In partnership with

• North West London CCG

Details

North West London CCG are undertaking a comprehensive review on patients receiving or needing community or mental health treatment to understand the scale of digital exclusion across North West London. This will involve mapping exercises, literature reviews of existing best practice, focus groups with those who are currently digitally excluded and research exercises to produce a strategy, and action plan to address the gaps, and ensure equitability.

Lead NHS organisation

• Central North West London

In partnership with

• VCSE Mental health alliance

Details

Central North West London will be commissioning an external supplier to undertake a comprehensive independent review of digital inequalities within their community for patients with severe mental illness. The outcome will be a research report detailing local understanding, a gap analysis and recommendations on how to mitigate digital exclusion. The requirements of that report will be agreed across all partners and will ensure co creation.

Lead NHS organisation

• South West London Health and Care Partnership (SWL ICS)

Details

South West London (SWL) has implemented a digital solution for self management within MSK patients in the form of an app. Since release there has been a cohort of MSK patients who have not taken up the use of the app and SWL are undertaking a project to understand the reasons behind this. They want to undertake research to understand the barriers and co-design solutions to help identify and close digital divide gaps. Alongside this SWL will also develop a digital exclusion assessment to use for any new patient facing digital solutions.

Lead NHS organisation

• NHS Derby and Derbyshire Clinical Commissioning Group (CCG)

In partnership with

• Florence Nightingale Community Hospital

Details

Derby and Derbyshire CCG are implementing a local photography service to support their current Dermatology pathway. Patients who do not have access to digital means to provide initial images or would benefit from a dermatoscope image are able to access this service within a community setting. The pilot may also extend to a mobile service for those who are unable to or find it hard to leave their homes.

Lead NHS organisation

• Surrey Heartlands ICS

In partnership with

• Surrey Heartlands CCG
• External Contractor: TBD

Details

Surrey Heartlands will be commissioning an external contractor to undertake an extensive digital inclusion gap analysis to understand how prospective parents in their most deprived and digitally excluded areas could have better access to services and information. This will include user research primarily aimed at asylum seekers and their families.

Lead NHS organisation

• Surrey Heartlands ICS

In partnership with

• Mental Health Partnership Board

Details

Surrey Heartlands plan to develop and implement a digital inclusion plan for patients who are accessing the Early Intervention in Psychosis (EIIP) service in East Surrey who may be at risk of digital exclusion and not benefitting from digital tools. They will work with a number of stakeholders already working on the inclusion and diversity agenda and will share learnings to support in all projects across the ICS having a digital inclusion plan.

Lead NHS organisation

• Bristol, North Somerset, South Gloucestershire (BNSSG) CCG, Healthier Together

Details

BNSSG plans to research, review and address digital inclusion across two of their pathways: cancer and MSK. The MSK pathway already has digital tools embedded and BNSSG wants to understand what the barriers are to those not utilising these tools and create an action plan to address these. The cancer pathway is due to have digital tools embedded and BNSSG wants to look upfront at which cohorts might experience digital exclusion and create an action plan to address this.

Lead NHS organisation

• Devon ICS

In partnership with

• Devon CCG

Details

Devon ICS plans to undertake user research and a gap analysis to understand the digital barriers faced by patients who live in rural communities. This approach will use virtual consultations and research to understand how patients feel, what support there is and what good looks like to produce a digital exclusion strategy.

Lead NHS organisation

• Harrogate and District NHS Foundation Trust

Details

Harrogate and District NHS Foundation Trust is developing their advice and education website Harrogate Health Hub, which has been instrumental in treating high volume, low complexity patients through educating and encouraging self management of common MSK conditions. Funding will be used to further develop education resources, including videos to support the consenting process, educational content for patients attending accident and emergency departments and post-operative orthopaedic education and rehabilitation for the most common high volume, low complexity conditions. The platform will also be used to direct patients to appropriate resources following virtual consultations which are accessible through the Health Hub.

Lead NHS organisation

• Guy’s and St Thomas’ NHS Foundation Trust

In partnership with

• Kings College Hospital NHS Foundation Trust
• Lewisham and Greenwich NHS Trust

Details

Our Healthier South East London will be embedding and further scaling digital remote monitoring and patient reported outcome measures (PROM) collection in rheumatology departments across the South East London Integrated Care System (ICS). Through analysis of PROM data and SMS communication, the in-house platform will expand its support to those who are well in low disease activity or remission through greater shared decision making around appointment need. The overall aim is to reduce low clinical value follow-up and enhancing capacity for those in flare who may need to be seen. Plans also include identifying variation and opportunities for shared learning and improvement across the ICS.

Lead NHS organisation

• Northamptonshire CCG

In partnership with

• Northamptonshire Healthcare NHS Foundation Trust

Details

Northamptonshire CCG are embedding ‘Physitrack’ to deliver virtual physiotherapy rehabilitation and to enhance the remote consultation offer. Exercise videos and customised information will be sent to the patient. An interactive platform will record progress through the remote capture of patient reported outcome measures and facilitate active participation by the patient and their family, carers in their rehabilitation. Video assessments can also be facilitated through the platform.

Lead NHS organisation

• Midlands Partnership NHS Foundation Trust

In partnership with

• Keele University
• Royal Wolverhampton NHS Trust
• University Hospital of Derby and Burton
• Dudley Group NHS Foundation Trust
• University of Glasgow
• University Hospital North Midlands

Details

Midlands Partnership NHS Foundation Trust are supporting digital self management of lower back pain, for low to medium risk patients, through the use of a dedicated platform ‘SelfBack’ and ‘STarTBack’ to provide information about physical activity, strength and flexibility and daily educational messages in an attempt to reduce pain and promote mobility for patients.

Lead NHS organisation

• Shropshire, Telford and Wrekin CCG

In partnership with (partner type and lead organisations)

• The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
• Shropshire Community Health NHS Trust
• Shrewsbury and Telford Hospital NHS Trust

Details

Shropshire, Telford and Wrekin CCG will utilise ‘MyRecovery’ to support delivery of consistent, high quality services to their patients with MSK conditions. By going ‘paperless’ and collecting and collating electronic patient reported outcome measures (PROMs) such as the MSK-Health Questionnaire into remote patient monitoring, the technology aims to support patients to self-manage their condition, access better information to inform treatment decisions, support those on waiting lists and provide robust data to support patient initiated follow up.

Lead NHS organisation

• Brighton and Hove CCG

In partnership with

• East Sussex Healthcare Trust
• Horder Healthcare
• Sussex MSK Partnership East
• Sussex MSK Partnership Central
• Sussex Community Foundation Trust
• University Hospitals Sussex NHS Foundation Trust

Details

Brighton and Hove CCG are implementing ‘Cemplicity’ to remotely track MSK patients’ healthcare status throughout and beyond an episode of care. Alerts will enable clinical teams to understand if a patient is showing signs of deterioration and facilitate proactive recall of the patient for more rapid review. This will support a reduction in patients presenting elsewhere in the system, such as A&E.

Lead NHS organisation

• North East Hampshire and Farnham CCG

In partnership with

• Surrey Physio Group Limited including Rehab Me Limited

Details

North East Hampshire and Farnham CCG are rolling out the ‘Rehab Me’ app providing video-based rehabilitation and physiotherapy led group exercises online that can share rehabilitation programmes between multidisciplinary teams through integration with clinical systems. Benefits of the app have already been acknowledged across the Integrated Care System and this project will look to scale the benefits demonstrated.

Lead NHS organisation

• Dorset CCG

In partnership with

• Dorset Integrated Care System with Bournemouth
• Christchurch and Poole Council
• Dorset Council
• Public Health Dorset
• Dorset County Hospital NHS Foundation Trust
• Dorset HealthCare University NHS Foundation Trust
• South Western Ambulance Service NHS Foundation Trust
• Primary care (86 practices, involving 18 primary care networks)
• University Hospitals Dorset NHS Foundation Trust
• Active Dorset

Details

Dorset CCG will be implementing a population health management approach to supporting the majority of people with MSK conditions who do not require hospital care to live well within the community adopting a personalised care approach via their MSK Matters website. Focussing on lifestyle optimisation, early intervention with programmes such as Escape-pain and through further development and implementation of shared decision tools on an existing platform, Dorset Medical Decisions.

Lead NHS organisation

• Gloucestershire CCG

In partnership with

• Gloucestershire Hospitals NHS Foundation Trust
• Gloucestershire Health and Care NHS Foundation Trust

Details

Gloucestershire CCG are implementing the GetUBetter platform to provide end to end support through prevention and self management of common MSK conditions via dedicated resources mapped to local population needs. Gloucestershire CCG will work with the voluntary, community and social enterprise sector, to ensure that community offers including social prescribing are incorporated within local MSK pathways on the app.

Lead NHS organisations

• Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System

In partnership with

• Royal Berkshire NHS Foundation Trust
• Buckinghamshire Healthcare NHS Trust
• Oxford University Hospitals NHS Foundation Trust
• Oxford Academic Health Science Network (Oxford AHSN)

Details

The participants are collectively working on implementing and scaling up digital innovations within the perioperative care pathway. This consortium is led by the ICS Director for System Performance working together with place-based leads from the three NHS trusts, the Oxford AHSN and 4 evidence-based technology providers, to implement and evaluate digital solutions that have shown potential in transforming the perioperative care pathway. The 4 providers are:

• Ufonia: autonomous clinical assistant Dora
• Concentric: digital consent
• PRO-MAPP: patient reported outcomes measures for initial triage of patients listed for surgery
• DaytoDay: a digital patient pathway management tool

Oxford AHSN will evaluate the implementation in the lead NHS trusts to support sustainable pathway redesign across the ICS. Based on the evaluation outcomes, implementation will be spread across ICS providers and our medium-term plan is to extend the transformation into other HVLC pathways.

Lead NHS organisations

• Cheshire and Merseyside Health and Care Partnership

In partnership with

• Liverpool CCG

Details

Optimise the clinical care pathways and participation in managed self-care for patients awaiting surgery both before, during and after their operations. This takes place through individualised risk stratification, individualised prehabilitation and prevention or reduction in avoidable clinical harm. In other words – "Helping optimise and educate the right patient, in the right environment, with the right team, at the right time for their procedure and perioperative care."

C2-Ai is a risk stratification tool that uses machine learning algorithms. It will enable identification of patients at risk of deterioration on NHS waiting lists and identify those patients in need of individualised prehabilitation. Sapien Health, a digital prehabilitation service for elective surgery will deliver remote health coaching to patients following their risk stratification.

Lead NHS organisations

• Humber Coast and Vale ICS

In partnership with

• York and Scarborough Teaching Hospital NHS Foundation trust
• North Lincolnshire and Goole
• Hull University Teaching Hospital

Details

Digital prehabilitation, preoperative assessment, shared decision making and consent using existing Patient Knows Best platform. The approach outlined will ensure surgical capacity is used appropriately through the improved shared decision making and consent processes, utilise clinician time more effectively through the use of remote consultation, pre-op assessment and patient recovery monitoring, and transform the patient journey with applications delivering person-centred, intuitive, accessible experiences.

Lead NHS organisations

• Gloucestershire CCG

In partnership with

• Gloucestershire Hospitals NHS FT

Details

Digitise pre-assessment pathway giving clinical staff the ability to document the pre-assessment journey electronically and patients the ability to electronically communicate with the trust. This electronic communication would include receiving questionnaires, documentary information, universal prehabilitation guidance as well as two way communication should circumstances change. The technology will be developed in our existing patient record, currently used by all clinical staff and accessible across the ICS through shared systems.

Allscripts EPR will provide the clinician facing functionality and surface clinical and patient information for those on the pre-assessment pathway. InterSystems Healthshare will provide the link between Allscripts and Notify to allow clinicians to communicate directly with patients from Allscripts EPR. Notify will then be used to receive and deliver patient communication which will be passed to Allscripts EPR via InterSystems Healthshare.

This transformation will support improvement in two key bottlenecks for elective surgery, namely pre-assessment capacity and on the day cancellations.

Lead NHS organisations

• South West London Clinical Commissioning Group on behalf of the ICS

In partnership with

• Kingston Hospital NHS Foundation Trust
• Croydon University Hospital
• St George's Hospital NHS Foundation Trust
• Epsom and St Helier University Hospital

Details

Focusing on the six High Volume, Low Complexity (HVLC) specialities, using technology to support the development of a pre-op pathway to identify low risk patients that could be managed using an alternative approach. The Cerner patient portal, shared across 3 acute sites in the ICS, expanding to 4 in 2022, will allow patients to access and interact with their local hospital and complete preoperative assessments remotely. Digital consenting and digital preoperative assessment self-assessment questionnaires will be completed by patients. Three digital consenting solutions have been shortlisted for procurement, patient self-assessment questionnaires and a review of current clinical and administrative processes will be facilitated by the SWL Clinical Networks to ensure a consistent approach to preoperative assessment across the ICS footprint.

Lead NHS organisations

• Leicester, Leicestershire and Rutland STP

In partnership with

• Leicester CCG
• NHS East Leicestershire and Rutland CCG
• NHS West Leicestershire CCG
• Leicestershire Partnership Trust

Details

Redesigning preoperative processes to reduce administration time, improve process, traceability, data accuracy and increase patient engagement. Consent and preoperative assessment digital technology shortlisted and final selection in progress - A key criterion of this selection is the ability of the packages to co-exist and integrate with the trust’s existing digital architecture.

The eConsent package will enable a shared decision making process, with patients able to access appropriate information leaflets to make better-informed decisions. Once patients have decided to proceed with surgery, the ePOA will be able to quickly identify patients who need further pre-operative investigations, treatment or consultations reducing the time between booking and operation. Robust integration will ensure information on decision and assessment is effectively shared across the pathway in an accurate and timely manner.

In partnership with

• East London Health and Care Partnership
• North London Partners in Health and Care ICS
• North West London Health and Care Partnership ICS
• Our Healthier South East London ICS
• South West London Health and Care Partnership ICS

Details

This bid seeks funding for remote monitoring technology and change management resources to implement remote monitoring pathways in elective cardiac surgery and cardiac lists (TAVI, PCI, ablation) in eight London sites.

Procured digital solutions will enhance pre and postoperative pathways through digital investigation and virtual clinical tools. Once deemed successful, these will be rolled out across other national Cardiac Pathway Improvement Programme (CPIP) priority pathways.

Charged with delivering on CPIP, the North and South London ODNs will use this funding to procure and implement remote monitoring technology across both networks, with the Strategic Clinical Network (SCN) collating and disseminating best practice.

The SCN will oversee the procurement process, which will use the NHSX Spark Dynamic Purchasing System for remote monitoring. Clinical consensus will be sought through the existing clinical reference group for the most appropriate solutions for the eight London cardiac centres.

Digital requirements

The clinical network will seek solutions that work seamlessly within current systems and can be embedded. A single digital platform will be procured to deliver the cardiac surgery solution, which will be prioritised as the first pathway for implementation.

Lead NHS organisation

• Cheshire and Merseyside Cardiac Network

In partnership with

Working in partnership with the 9 CCGs of Cheshire and Merseyside place-based care, Population Health Board, the Cardiovascular Disease Board, Cardiology Network and supporting programs and networks.

Details

Cheshire and Merseyside has a long track record in delivering enhanced clinical pathways through scaled up adoption of telehealth. This programme will build on their existing and well tested infrastructure, both in cardiac service pathway collaboration, and digital collaboration across providers and partners.

The funding will address healthcare inequalities by supporting access to specialist care for all patients; relying not on hospital footfall, but delivering to the patients’ own homes. They propose scaling active one-to-one patient-staff interactions, with supplementary passive and active one-to-many interactions to enhance patients’ journeys.

The format of this remote “prehabilitation” and remote enhanced recovery will be using existing telehealth infrastructure for monitoring, support, education and alerting to Mersey Care NHS Foundation Trust. Escalation will be from hub to LHCH via protocol driven pathways.

The intention is to expand the use of Docobo. This is the platform already identified by the ICS with a telehealth hub and infrastructure already in place and operated by Merseycare NHS Foundation Trust. Using Docobo within this pilot therefore offers significant advantages. As a result, the expanded use of Docobo is the preferred option because of the benefits this will bring.

• The underlying platform is already operational (5,000 concurrent users).
• Significant expertise with this platform already exists within the region which will be drawn upon to support the proposed pilot.
• It aligns with the Cheshire and Merseyside ICS digital strategy hence avoiding fragmentation across the footprint.
• The procurement process will be significantly more straightforward - this is important during a time limited trial.

Docobo’s effectiveness as a telehealth solution within this geographical area has already been established hence the pilot can focus on the benefits its use brings to the pathway and patients rather than also having to prove the credibility of the platform.