Self-Care for Multiple Long-Term Conditions


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Multiple Long-Term Conditions (LTCs) are a pressing issue in the NHS with 50% of all GP appointments, 64% of all outpatient appointments and over 70% of inpatient bed days attributable to LTC’s. 

Fueled up with cake, tea and a wrath of business cards and new friends we entered our fifth and final session, diving into the role of Self-Care in the Management of Multiple LTCs.


Tina Woods of Collider Health chaired this session. We first heard from Dr Matt Jameson Evans, Chief Medical Officer and Co-Founder, Health Unlocked - the social network for health.

Health Unlocked has been running for seven years; they have over 750,000 members and Matt can safely say that patients are looking for their own information on over 200 conditions. They recently conducted a survey of 2,054 users and found that 77% of users felt more confident self-managing their condition and 27% visited the doctor less.

As a team they were looking to further validate their self-care information claims, so embarked on a study with the University of Manchester and the Patient Activation Measure (PAM) creators, Insignia. The PAM, being trialled by NHS England, and backed by hundreds of studies, was used as a validation tool in this Activation in Online Peer Support (AOPS) Study. An increase in patient PAM score shows that the patient is more activated than they were at baseline - this means that they are more likely to adopt healthy behaviour, have better clinical outcomes and lower rates of hospitalisation.1 

Over 50% of the 333 users enrolled in the study were 60 years or older, with a blend of education backgrounds. In addition 47% were more than four years post-diagnosis. Within the general population, 40% of people have low PAM levels. In this study group the level was as low as 33% at baseline. After three months use of Health Unlocked they were able to show an average +2.6 (p=0.000) increase is PAM Score.

This improvement in PAM score has spurred Health Unlocked to pursue more avenues in the Self Care context. They are looking into the use of their platform for social prescribing in primary care with six CCGs in London and exploring ways in which Health Unlocked can be used as a background for patient support tools.

Tina then introduced Melissa Ream; Living Lab and 5G lead of Kent, Surry and Sussex AHSN, who introduced the work being done in the Test Bed in the south-east of the country focusing on Dementia. She outlined that with a growing ageing population it was time to focus on citizens receiving care in their own homes.

The KSS AHSN set out on a search to find sustainable solutions to fuel this new models of care. Melissa shared an inspiring vision incorporating growth of the Internet of Things market with the arrival of 5G mobile networks in 2020 and the promise for of Artificial Intelligence to truly enable patients to have access to technologies that will equip patients and their carers to self-care.

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Within the Test Bed they are partnering with a number of companies, including Docobo to help keep people in their own homes, while being safely monitored via GPS tracking solutions and a monitoring centre run by the mental health trust. Melissa showed a video that showed how empowered the technology had made one couple feel. Marion, whose husband John had dementia, is now able to leave John at home while she goes out singing, which helps John to care for Marion. T hey said that they feel safer knowing that they are being monitored.

Melissa explained that co-design has been the heart of what they do. They are trying to create an ecosystem around which a problem is defined and then the solution is sought, rather than the other way around. Something that we subscribe to here at the Health Foundry too!

After two inspiring presentations, Tina introduced us to our final show-case with impressive presentations from a range of products aimed at patient self-care; a platform for adults and young people to improve their emotional wellbeing; diabe tes patient information and extrinsic rewards for the promotion of exercise:

Alex Church, Founder, MYMUP Digital, started by introducing his self-care platform aimed at adults and young people to manage their emotional well-being making use of gamification techniques. The company are making traction with partnerships with the Bradford CCG and University and have 680 registered users already.

Dr Scott Cunningham, CTO, My Diabetes; MyWay; is a diabetes management platform that's been used by NHS Scotland for the last 7 years. They are now part of the DigitalHealth.London accelerator looking to expand their technology down into NHS England and already have a partnership with Somerset underway. Through the platform, patients are able to access their diabetes medical information; 15,500 have already done so and the product is associated with improvements in clinical outcomes as well as patient satisfaction in surveys.

We wrapped the session up with Hannah Bowden, Programme Director, Better Points are a behaviour change focused platform that utilises extrinsic rewards to motivate people to exercise; that is enabling patients to allocate their points for vouchers to buy e.g. new clothes or donate to charity. Better Points ethos is embedded in behavioural science and is utilising machine learning to hone their platform, enabling patients to take positive steps to looking after their health and wellbeing.

This session on patient self-care shed a light onto the host of technologies that are available to help patients to help themselves. The focus of each of these products is not to remove health professionals from the picture but to enable the provision of care in a setting that is more convenient to the patient and their care team and also help to empower patients. The transformation that Mary and her husband have undergone as a result of a "safety net" that the KSS Test Bed have provided is extraordinary. People like to be able to be supported and take charge of their own destiny and many of these self-care technologies help in fulfilling that goal.

Time to set sail on your digital transformation

To finish off the day Martyn Evans, Head of Product, Unboxed, provided a keynote that encouraged us all to learn how to sail! Unpacking the challenge of digital transformation he shared insights on the service redesign work that he has been doing with Guys & St Thomas' NHS Foundation Trust. His analogy explained that like when sailing you need to head into the wind, or resistance, in the healthcare setting. This resistance can be broken IT, limited capacity and pressure to save money. In order make the transformation he recommended creating space to allow people to think differently; a change of scenery (like a trip to the Health Foundry) and explained the concept of utilising design sprints, a 5 day workshop with service team to help map the journey you are trying to transform with feedback captured from service users.

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Martyn, stressed the importance of coming around a shared vision and goal; share bottom-up changes; try different solutions; communicate openly and create a shared space in order to help with trying out interventions like those showcased at the Health Foundry over the summit. Ensuring that a resource commitment is also crucial to help ensure buy-in from the teams trying the new technologies.

That wraps up our Health Summit Series of posts.

We had an excellent day of knowledge sharing looking at the whole journey of challenges presented by multiple LTC's. It's clear that there is a lot of innovation within this space so it will be interesting to take a moment to reflect at out next summit on the progress that has been made with these companies, how patient data sharing is being managed a year on, and to hear the next steps for Test Beds. Ultimately it would be excellent to map outcomes too. What impact have the interventions presented here today made on patient lives? Have we got to the nub of the problem as it was presented, in taming the mundane?

If you'd like to read more one the series refer to the links below: