Claire Stidston: Lessons from the Care City Test Bed

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Claire Stidston, Programme Lead, Care City Test Bed, discusses how real world testing can create solutions that spread across health and social care.

This presentation was recorded at our Digital Health and Care Congress 2017 on 11 July 2017.


What I’m going to start off talking about is something that we found really interesting in our test bed which is actually how real world testing can create solutions that spread across health and social care.  So I’ll talk a bit about that and then I’ll get into some of the solutions that we’re actually testing.

So from our perspective the real exam question of the test bed is how we can realise the full potential of a set of innovations, but most of the innovations that are involved in the test bed we already know are good, quite a few of them you can buy on Amazon if you want to right now, I think the real question is about how we get the best out of them in health and social care in our systems in the complexity in the provision that we have out there.  This is about closing the gap between innovation and invention on the one hand and how we actually spread and scale on the other hand.

So the reason in our experience that we feel that this gap still exists is that many … despite the many pilots that we have around innovation in the NHS is that there’s often a lack of very senior leadership in these pilots and the innovation that’s going on in the ground.  There’s also a habit of academics, leaders and even clinicians in some situations to innovate and pilot innovation in parallel to ongoing service provision.  So it’s not actually testing whether that’s going to be applicable and be able to work in a real world setting.  Particularly in the private sector there’s a trend and a focus on innovating and developing innovation and getting somewhere really far along the journey without actually taking into consideration that alongside developing that technology you also need clinicians and people who are providing that service to be innovating on the front line and the innovation itself is about bringing those two things together.  

So at Care City we’re focusing on ensuring that we’re addressing the priority issues in our area.  So we’re testing innovations that are focused on three key clusters, we’re looking at long term conditions, dementia and carers because those were the areas that were identified as the biggest level of need and something that we’ve identified is quite often innovation comes into provision without actually matched to the need in the first place.  So it’s about establishing what that need is and then identifying what can address that need.  We’re also testing innovations through existing services because we believe that’s the most meaningful way to assess their viability, their desirability and their feasibility and also by testing in existing services it means that the people that are delivering them are constantly focused on ensuring the best outcomes for their patients because it’s an existing service in a real world setting.  

So now I’ll talk you through a few examples of what we’ve experienced and what their journey has been.  So one of the innovations that we’re testing is called Cardio Mobile by Live Car and it’s a single lead ECG monitor that you can put on the back of your phone and it detects whether you have any heart abnormalities or specifically around detecting atrial fibrillation.

So we’ve been testing that in community, pharmacy and primary care with the aim of doing that very much up front opportunistic testing where nobody’s experienced symptoms because the current pathway is that you experience symptoms you go in for a twelve lead ECG and then hopefully you’re put on anticoagulation that will prevent stroke in the long run.

So what we’ve found is that that’s a very viable solution.  The issues around it actually what happens after that?  So you’ve detected that someone has got an issue but then where do they go next?  In the current system is then you then go back to your GP or they’ve been referred to … hopefully you can have a twelve lead ECG at your GP but if not you’re referred on further than that.  So what we’re actually looking at is developing a one stop shop which means someone can be detected before they’ve even experienced symptoms in community and pharmacy and then they’re anticoagulated within one to two weeks.  

So it’s kind of that process of we didn’t know that was the answer at the beginning but it’s that testing and that iterating through different cycles that has led to identifying that.

I’ll just give one other example, I’m not sure how I’m doing on time, but another thing that we’ve been testing is Kinesis which is a falls risk assessment tool and we’ve also been looking at using that in community, pharmacy and primary care and the interesting thing that we’ve found about testing that is that what we weren’t aware of at the beginning was that actually although you can identify … you use this innovation to identify risk of fall actually in some areas the provision … falls support provision has been cut so radically that there's not really any point because you identify someone has a high risk of a fall and there’s nothing to refer them on to.  So we’re currently looking at gait analysis and remote physio so that we can identify also what their specific needs are and then actually a physio remotely can prescribe them exercises via video or through print outs.  So it cuts out that whole need for that whole falls service to be established.

So those are the kind of things that we’re learning and evolving as we go on.