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Flo Focus On: Strategic Leads

Janet Davies NHS Test Bed Programme Manager 

Janet Davies was the Test Bed Programme Manager for the LCIA Test Bed during wave 1 in 2016-18, and wave 1.5 in 2018-19. Janet has kindly taken some time to share with us her experiences of working with Flo for our new “Focus on Evaluation Project”.

What is your background and role within your organisation?

I have over 12 years’ experience in a senior management role, and 26 years of operational management.  During the past 16 years this experience has been within the NHS, however I have undertaken management roles in Private, Voluntary and Statutory sectors.  As Test Bed Programme Manager, I have responsibility for the delivery of the Testbed programme. I report to the Programme Board and the Programme SRO.

What did you set out to achieve with Flo and how did you go about it?

Flo was one of 7 technology partners chosen to work with the Test Bed to implement and evaluate a combination of technologies and practices aimed at supporting older people (aged 55 +) with long term conditions (LTC) to remain well in the community, avoiding unnecessary hospital admissions.  The combinatorial health technologies were designed to better enable older people with LTC to self-care at home and to improve patient activation.  The LTC included COPD, heart failure and dementia.

The LCIA Test Bed was delivered through two neighbouring Vanguard sites – the Fylde Coast Local Health Economy and Morecambe Bay Health Community (Better Care Together), located in Lancashire and South Cumbria.

Both our Vanguards were focused on population-based new models of care that were central to delivering the vision of the NHS Five Year Forward View: integrated primary and acute care systems (PACSs) and multi-specialty community providers (MCPs) whose focus was on integration.  The MCP model was designed to dissolve the historical divide between health and social care.  It involves redesigning care around the health of the population, irrespective of existing institutional arrangements. Blackpool Fylde and Wyre (Your care, Our priority) was a MCP Vanguard.  Better Care Together was a PACS Vanguard. PACS were based on GP registered lists with the aim of improving the physical, mental and social health and wellbeing of the local population and reducing inequalities.  PACS were designed to bring together health and care providers with shared goals and incentives, so they could focus on what is best for the local population.  Critically, the general practice was at its core.

Patients with LTCs were recruited to one of three cohorts depending on their level of risk of hospital admission (Cohort 1 being the highest risk category); individuals with mild to moderate dementia were recruited to an additional Cohort 4.  The combination of technologies each patient received was dependent on their level of risk and their primary LTC. 

Flo was used within Cohort 2 in which patients had a risk score of 10% – 25%. Protocols were developed with clinicians for Falls, COPD, Heart Failure and carers.

Patients were recruited to the Test Bed through the clinical teams within the Vanguard, which for Better Care Together was GP led, and were taken from the patients lists using risk stratification through Aristotle.  In Fylde Coast, patients were identified by teams e.g. Pulmonary Rehab and Falls Team. 

Were there any surprises?

Engagement with staff was sometimes challenging and we experienced some resistance from teams to using technologies including Flo, with capacity being the most frequently cited barrier.  Due to the nature of testbeds being proof of concept rather than an introduction of new working practices, teams were required to continue with their traditional pathways alongside the new technologies we were asking them to try.  This sometimes meant that information was available in both existing pathways and new technologies, and so using new technologies for monitoring was often not a priority in an already busy workload.

Self-management as a concept is also relatively new and demands a real shift in thinking for teams in respect of delivery of care, which has historically been clinician led. As a team we were able to meet each concern as we went along, working closely with teams to break down barriers whether this be related to capacity or something more practical in nature such as the supply of handsets for patients who didn’t own a mobile phone. However as with any change in practice, there were of course some teams who were unable to overcome their local challenges to be able to fully engage with the testbed. 

How does Flo fit with your organisational vision/current strategies?

Flo was an integral Partner in the LCIA Test Bed.  While that programme has now concluded, the knowledge and understanding of Flo will however remain with the Test Bed leadership Team, who are now working with Healthier Lancashire and South Cumbria Integrated Care System to take forward the Technology Enabled Care agenda, starting with a Digital Discharge Bag.

What do you consider your biggest success with Flo?

Most patients interviewed in Cohort 2 experienced an increase in confidence in relation to their health as a result of taking part in the Test Bed.  This was linked to an increase in knowledge and skills, resulting in people being better able to self-manage their health.

  • 83% of Cohort 2 indicated an increased confidence about their health.
  • 94% with a risk score 10% – 25% indicated increased knowledge and skills enabling self-management of LTC.

The majority of Phase 2 patients in Cohort 2 had COPD.  Most found participation in the Test Bed programme helped them to learn about their condition and how to better manage it.  Participation in the Test Bed programme also had a positive influence on daily activities for some participants, with the biggest impact occurring in Cohort 2.

In addition, there was an overall total cost saving for Cohort 2 participants using Flo of approximately £133 per patient. 

How do you engage your clinicians and wider organisation with Flo?

To help us to engage with clinicians, we set up ‘Use of Clinical Operation Groups’ for each area (Better Care Together, Fylde Coast and Dementia), as well as providing a number of updates to encourage use of Flo and other TEC in the Test Bed, including: Innovator monthly updates, reporting as part of Board updates, as well as weekly updates for those using Flo and other TEC within the test bed. 

What are the future plans with Flo?

Despite the Test Bed ending, we have learnt a great deal and improved our understanding of Flo and how her unique persona can support patients with LTC improve their self-management and in turn their long-term outcomes.  The Test Bed leadership Team‘s experience and learning with Flo will support our work as we take forward the Technology Enabled Care agenda with Healthier Lancashire and South Cumbria Integrated Care System, beginning with the Digital Discharge Bag as I previously mentioned.

#LCIA #Test Bed #COPD #Falls #Heart Failure #Dementia #Better Care Together #Fylde Coast Local Health Economy  #Morecambe Bay Health Community #TotallyUnique

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