The NHS Atlas of Variation tells an important story of the level of variation found in health outcomes across England, providing data in accessible and comparable ways so that local areas can explore further and test whether the variation is justified or unwarranted, and where the latter, do something about it.
Invented in 2011 by Professor Sir Muir Gray, it was a terrific idea and one of the things we can uniquely do in the largest semi-integrated health system in the world; we are particularly well placed to compare and learn from each other.
Inspired by this first Atlas, we have worked together as the AHSN Network, to compile another Atlas; this one describing Solutions. These are those schemes, devices and technologies that have achieved really significant, measurable benefits and are strong candidates for further scale.
Each of the 15 AHSNs, covering the 55m population of England, has put forward their strongest schemes. Unlike many case studies, Atlas Solution entries are written in a compelling and readable style, they contain video, images, data, infographics, quotes from patients and clinicians involved and importantly contact details, so that those interested in taking on that Solution locally are given every helpful tool and plenty of support.
When the AHSN Atlas of Solutions launched in September 2016 at NHS Expo we were delighted to demonstrate it to Simon Stevens, and at this point it had at least one case study per AHSN. 12 months on, by this year’s Expo, this had increased to 74 entries.
We are also delighted to now be carrying the hallowed blue lozenge as “NHS Supported“ as a perfect one-stop shop for those change agents in the NHS looking to learn from one another and to avoid expensive, time consuming wheel reinvention.
We are proud too that our Atlas has a firm quality bar. We only accept Solutions that are ready for spread, which means significant demonstrable results and being supported by teams who are genuinely committed to helping interested others implement, and this quality control is maintained by an Editorial Board.
There are many great examples of digital tools making a real difference to patients and services, so it is really fitting that NHS England and NHS Digital are now partnering with us so we can build a great resource to convey the strongest digital Solutions.
A few highlights of the Digital Solutions on Atlas include –
- myCOPD – a terrific, comprehensive digital platform for people with COPD (chronic obstructive pulmonary disease), a relatively common lung condition which sadly worsens over time but benefits hugely from regular exercises called pulmonary rehabilitation and really good inhaler technique. The platform provides on-going support for people at home and in trials was shown to correct 98% of inhaler techniques, without a clinician intervening. It’s also the first – and currently the only – App in the NHS App Library with the coveted “NHS Approved” rating. There’s a great short film showing how it works from the viewpoint of Paul living with COPD. There are now over 45,000 citizens benefiting from this solution, with many clinicians now accessing it for their patients with moderate to severe COPD free under the new innovation & technology tariff. (For more on the tariff see a previous blog A Tariff for Innovation.)
- Much simpler is Flo telehealth – which helps support patients in a range of ways including adherence to treatment plans and medication therapy. It does this through simple SMS text reminders and requests for readings, which the remote clinical team can review and adjust treatment accordingly. There’s another great film, this one made by the Health Foundation, that shows how simple technology can make a huge difference to people with a range of long term conditions, and help them better look after themselves and out of hospital such as Josh’s story about succeeding in getting his hard to control T1 diabetes in line, and Lauren who found that Flo (with some terrific midwives behind her) helped her succeed in breastfeeding her baby. Over 30,000 people are now supported by Flo.
- A final example is GDm-Health – a really helpful digital tool for pregnant women with gestational diabetes developed by Oxford Trusts, the University and Oxford AHSN. It enables women to better track their condition, and thereby help them minimise the impact on their baby and get on with their lives. Feedback from testing with almost 2,000 women demonstrated the system to be safe, robust and user-friendly, bringing many benefits for patients and services alike. There were improvements in reliability, convenience and efficiency. It showed better glucose control and a reduction in clinic visits by eligible women of approximately 25%, freeing up hospital capacity and improving efficiency. It has been extremely popular with mothers with Maternity units estimating the time saving for them being up to an hour every day. As Vanessa, a lady with gestational diabetes puts it “It was handy to know that I was in constant touch with somebody and that I would get a message if there was something to worry about. We live about an hour away so having fewer appointments as a result of using this kit helped a lot.”
What’s important is that the Atlas doesn’t simply hold a database of great digital, service and other tools, the “seed” if you like, it describes how colleagues have implemented them, or “done the gardening” which is the really critical part of spread and adoption.
Change agents wanting to do so locally will naturally need to give thought to how best to bring in the idea, using their local knowledge and connections to give the best conditions for success, tending the ground if you like so that the seed can best flourish. Do take a moment to have a browse, and if you see a Solution to a problem you’re grappling with, do get in touch with the Solution author who would be glad to help.