Online platform for virtual working with patients and carers supports self-management and more personalised care

South London and Maudsley (SLaM) NHS Foundation Trust provides care and specialist services for around 1.3 million people across Southwark, Lambeth, Lewisham and Croydon. The Trust has over 800 beds across more than 50 inpatient wards and provides services in 4 main hospitals and 88 sites.

The Trust provides the widest range of NHS mental health services in the UK working in partnership with the Institute of Psychiatry, Psychology and Neuroscience, King’s College London and the Maudsley Charity. SLaM is part of King’s Health Partners Academic Health Sciences Centre.

Situation

Clinical care is traditionally based on a model of intermittent face-to-face appointment contact supported by posted letters, telephone calls, texts and email between individual members of staff and a patient. The flow of communication and its boundaries can be problematic, and guided self-management and progress monitoring in-between appointments can be limited.

If in-person appointment contact remains the primary means through care is provided, the digital opportunity to improve both communication between patients and their care teams, and to facilitate a more self-directed approach to support and management that promotes autonomy and resilience is lost.

Communication with carers can be sub-optimal, with carers sometimes feeling unsupported and frustrated by the process of trying to get hold of the right person to speak to within a team and have their concerns or questions addressed. Flow of information to carers in turn can sometimes be sub-optimal even when those carers are integral to someone’s care and safety planning.

Patients have limited access to, or oversight of, information held about them and records can be incomplete or inaccurate, for example, with regards to ethnicity and other demographic data, up to date contact and carers information. All data entry meanwhile relies on staff. This increases the administrative burden and reduces therapeutic time within appointments. While access to health records remains entirely behind Trust ‘walls’, there is no opportunity for patients to directly contribute comprehensive and accurate information to the record (including their own patient rated outcome measures to identify problems and track progress). Patients are also unable to access useful clinical information to support more self-directed, personalised and effective care.

Printed care and safety plans are easily lost and usually not to hand when patients need help in a crisis or are attending for support from other agencies such as their GP or third-sector organisations.

Mental health care support and recovery do not, and cannot, rely on the input of secondary mental health care alone, but it can be problematic integrating clinical care within the wider landscape of local community and national organisation support. Across Trust services there has not been a way to consistently connect people to appropriate sources of information or potential support locally or nationally, leaving both patients and carers to rely on internet search engine curation of information, which can vary in quality and relevance.

Aspiration

The aspirations of the Trust were to:

• improve both patient experience and outcomes, and carer experience, through improved communication, information sharing and engagement with staff online
• improve ‘anytime, anywhere’ online access to care and safety plans for patients to use themselves and share with others as they chose
• increase the uptake of virtual (video) appointments and calls within a model of blended working, reducing reliance on clinical consultation by telephone or in-person contact (with its associated travel costs and environmental impact)
• support more self-management through online tools within the platform and signposting to appropriate information, resources and external organisations
• support more self-directed and personalised care through patient direct data entry for information to flow into their electronic health record

Solution and impact

SLaM NHS Foundation Trust has been working in recent years with the Maudsley Charity and King's Health Partners Mind and Body programme, NHS Digital through the Digital Global Exemplar programme and the Biomedical Research Centre to design to develop a personal health record for patients using SLaM services.

This work has previously gone through 2 iterations, called ‘myhealthlocker’ and ‘Healthlocker’, involving extensive engagement, testing and piloting throughout with patients, carers and staff, through which the Trust has evolved its thinking about the platform’s purpose and functions.

‘Beth’, named after the Bethlem Royal Hospital, and to sit alongside ‘Maud’ (as in Maudsley) the staff intranet platform, was launched in July 2020. Beth is a mobile, web-based application which enhances interaction and information sharing between SLaM staff, patients and carers, providing patients with access to parts of the electronic clinical record, alongside self-management tools and signposting to external resources.

The new system:

• supports new ways of virtual care and treatment provision and blended working (incorporating both in-person and virtual engagement)
• supports self-management for patients in between appointments with their mental health care teams and links them into wider sources of support locally and nationally, beyond secondary mental health care
• saves time as useful resources are brought together in one place
• supports coordination of care between team members
• improves access to care and safety plans, so patients have them to hand whenever needed, for example, when seeking crisis support or engaging with other health and care or support organisations
• improves secure and consistent communication, information sharing and collaboration between staff and patients and staff and carers, supporting therapeutic relationships and engagement to improve patient safety, experience and outcomes
• facilitates virtual appointments (through Microsoft Teams video calls) rather than over-reliance on either in-person reviews or telephone calls for clinical assessments and reviews (virtual appointments made in the electronic health record system are shared in the Beth calendar with an embedded video link)

Functionality

Beth is an online web-based application, accessible through any device with access to the internet, that integrates with the Trust’s core local electronic clinical record, providing patients and carers with a digital front door through which they can receive virtual care and support. Beth is also integrated with Microsoft Teams, including a link for all video calls.

Capabilities

The system links with parts of patients’ health records and promotes communication and collaboration with patients and their care teams. It allows patients to:

• view agreed care plans, including safety/crisis plan, mental health, physical health, social care and where indicated, specialist perinatal and addiction care plans
• view appointments in the Beth calendar - each appointment will have details of the date and time, duration, attendees, venue and type of contact, for example, in person, telephone, or video call (including the link to the digital platform)
• download SLaM appointments into their own calendar to help plan their diary. (This feature is active in Android smartphones and tablets, and in laptops and computers. SLaM is working to include this feature in Apple devices)
• fill in assessments and patient outcomes - patients can fill in patient rated outcome measures like DIALOG scale, CORE-OM and PHQ-9 in their own time before their consultation
• message the care team and see contact details - secure communication between patients and their care team members. (Clear safety information is provided regarding not using this platform to send any urgent clinical messages with signposting to the Trust 24/7 crisis line)
• access their physical health information as recorded in their mental health records, to better integrate their physical and mental health care, including signposting to approved information and resources

The system promotes patient self-directed care, by enabling patients to:

• record personal goals and coping strategies - these aim to help a care team understand a patient’s priorities and what works for them in real time
• track their own progress - patients can track their mood, a target problem of their choice and monitor their sleep
• access a secure diary - a private place for patients to reflect on their health and recovery. The care team will not see this unless a patient chooses to share it

It supports patient self-management:

• giving access to free, trusted online resources with information and support groups for mental health conditions and crisis resources
• offering inspiration and ideas from patient stories and NHS wellbeing tips

The system also supports carer engagement and wellbeing. A close family member, friend or carer can't see the patient's Beth record but can set up their own Beth account. They can use it to message the care team for the person they care for and have access to the self-management and self-directed resources to look after their own mental health.

People not currently using SLaM services can also benefit. People with lived experience, staff and people in the community can use the self-management and self-monitoring features in Beth to look after their own mental health.

Scope

Beth is designed to be usable from the first point of contact with the service in advance of someone’s first appointment, then across their care journey, including independent use at home or in clinical settings (community, inpatient) with staff. Beth therefore aims to improve the collaboration and communication between patients, carers and care teams both in between and within appointments and then potentially to support an individual's sustained recovery after discharge.

Key learning points

The Trust needs to clearly articulate at the start of the work what it needs from a clinical standpoint and what problems and opportunities it wants the platform to address. All developments need to be informed by frontline staff, patients and carers input to make sure functionality and usability meets clinical needs. This entails clear oversight of who is included in those conversations, so the input is representative of different patient, carer and staff population needs.

It is important to undertake regular evaluation to understand how Beth works, for whom and in what settings.

Take up of the platform is challenging given limited staff capacity to engage with anything new. Ultimately staff are unlikely to use the platform if it does not save them time, and if staff are not using it, patients and carers will not be pulled to their platform as part of their care. The first iteration of the platform had insufficient functionality to support the more transactional aspects of care such as appointment management, which would appeal to staff as a time saving feature.

It is important not to underestimate problems with digital literacy and capability, not only in patients and carers but also in staff. The Trust was late to systematically think about digital inclusion alongside work with Beth but it is now very much aligned to the project. There are now plans to gather information on which patients are digitally excluded in a systematic way, due to lack of devices, lack of connection or motivational barriers such as thinking is too difficult, not for them, too expensive or due to a lack of support.

As uptake has also proved challenging due to lack of digital confidence among staff, patients and carers, to increase people’s digital capability to use Beth (awareness, knowledge and skills) the Trust has designed and delivered:

• frequent, co-produced and tailored coaching sessions for staff, and SLaM Recovery College webinars for patients and carers
• a flexible approach to disseminating the information using different channels of communication in the Trust, such as the Live Broadcast, weekly e-news and easy access to resources on the intranet and external Trust website
• bespoke demonstrations in a variety of services and levels of the organisation
• proactive outreach and involvement of all members of the multidisciplinary team, including occupational therapists and vocational workers

The Trust worked to promote motivation to try and to adopt among different users, through:

• key messages delivered concisely, with language free of jargon, for example:
  • Beth is a new way to communicate, is free and user friendly
  • Beth resources are all in one place that can be accessed from any device when you want
  • Beth is a secure online platform
  • Use of Beth saves both patient and staff time
• key functionality highlighted and adapted to each audience, for example:
  • Beth empowers patients to have access to their information and support their goals
  • Beth supports carers involvement and promotes their own wellbeing
  • Beth simplifies staff needs for documentation by sharing appointments and care plans and facilitating secure communication
• key visual representations and videos, with images of people using Beth in day-to-day life (also, technical videos offering a wide range of functionality for people to choose what works for them)

COVID has proven to be an opportunity to promote this platform in the context of virtual and remote working during the pandemic. The Trust will now be promoting use of Beth in future as part of this ‘bigger picture’.

Key figures/quotes

Beth’s launch has coincided with the pandemic-driven shift to remote working. With Microsoft Teams video calls now embedded, it already has 734 active users (204 patients and carers, 530 staff). (21 March 2021)

Find out more

Online health record and patient portal case study (requires login)

Key contact

Beth team

Beth@slam.nhs.uk