Four north east London boroughs - Barking and Dagenham, Havering, Redbridge and Waltham Forest - are working with the local NHS and private sector partners to trail a range of different technologies to help people with long-term conditions. These include opportunistic testing in pharmacies for irregular heartbeats.
The London boroughs of Barking and Dagenham, Havering, Redbridge and Waltham Forest cover a population of over one million people. There are approximately 69,000 older people living with multiple longterm conditions and another 10,000 people with dementia. Many of these rely on unpaid carers for their support. In fact, it is estimated that there are over 21,000 people who provide more than 50 hours a week of unpaid care.
Despite this, these groups are heavy users of the health service. One in four patients in hospital beds have dementia and every year there are nearly 3,000 hospital admissions following falls.
The solution
Care City was set up at the beginning of 2016 by the North East London Foundation Trust and Barking and Dagenham Council. The aim of this social enterprise is to explore new ways of keeping people healthy and regenerating the area across the four London boroughs.
A key programme area is innovation in its role as one of NHS England’s five health and care innovation test bed sites. Care City has received funding from NHS England to help run a series of projects to increase independence, enhance self-care and improve carer resilience for the population.
These projects involve testing innovations which have been clustered around three core themes – dementia, long-term conditions and carers.
Perhaps the most advanced has been the pilot using a Kardia Mobile handheld mobile device developed by AliveCor, which can help diagnose irregular heartbeats, clinically referred to as atrial fibrillation (AF). AF is the most common heart rhythm disturbance.
Care City, collaborating with North East London Local Pharmaceutical Committee, Barts Health NHS Trust, Waltham Forest CCG and Sonar Information, is carrying out a pilot of opportunistic screening for AF in 13 community pharmacies across Waltham Forest.
Pulse checks using the Kardia Mobile device are offered to individuals in pharmacy who are over the age of 65 years.
The device can spot AF in 30 seconds and those with an abnormal result receive a rapid referral to a one stop AF clinic at Whipps Cross University Hospital where a patient will undergo tests and, where necessary, receive treatment.
The impact
The whole process from testing for AF to receiving treatment has been reduced from the national average of 12 weeks to two to three weeks.
Nearly 700 patients were screened in the first year of the project and of these approximately 7 per cent were identified as having AF.
An independent analysis by University College London concluded it was costeffective and predicted that if this was rolled out across England an estimated 1,600 to 1,700 strokes would be prevented each year.
Care City Chief Executive John Craig says he is “proud” of what has been achieved.
“We’re showing how we’re collaborating with technology and all levels of the health and care community with a common endeavour to assist patients to pro-actively manage their health and ultimately save lives.”
“The data we collect from this testing will indicate how many people use the service, leave with a diagnosis and start treatment. It will also help us understand whether the service is good value for the NHS and whether adopting this one stop shop approach further across the UK is an effective and viable option.”
Lessons learned
Mr Craig says one of the major focuses of Care City’s work has been to get implementation right.
“What people need to ask when trying out new technologies is ‘how do you translate high-potential digital gadgets into better outcomes and experiences and lower costs?’ While it is tempting for those championing a digital innovation to ask the NHS and local government to ‘just get on and implement’, it is rarely that simple.”
He highlights the detailed work that went into the AF project. Careful groundwork was undertaken to identify the right pharmacists to trial the technology and then to provide on-the-ground support to troubleshoot and a system to follow up patients so their experience could be monitored.
”Health and care services are always messier in practice than in theory,” he says. “To delight patients, change behaviour and make all the right resources and data go to the right place at the right time, innovators must be prepared for surprises and bumps in the road. That’s why our test bed focuses on ‘real world testing’ – putting innovations to work in core health and care services, not simulated or isolated research environments.”
How is the approach being sustained?
The next few years will see a host of new technologies piloted and tested just as the Kardia Mobile project has been. In total, Care City is working with seven technology companies. The projects include:
HealthUnlocked, a social prescribing tool which enables health professionals to signpost or prescribe local support services and other beneficial resources that relate to holistic needs.
Kinesis and Gaitsmart, two devices which assess falls risk and mobility using sensors attached to various parts of the body.
Canary Care, a monitoring and notification system which aims to provide round-theclock reassurance to family members while allowing older, vulnerable people to stay at home.
Join Dementia Research, supporting local people to register their interested in participating in dementia research and enabling them to be matched to suitable studies in their area.
St Bernard’s GPS Emergency Location Service reassures both the individual and their carer/s and family. As each project progresses, Care City will be looking at how new technologies can be used in combination with the current system.
This approach is about combining the innovations with existing tools, services and technologies to understand how they can have the most impact and be integrated in a sustainable way.
Mr Craig says: “You cannot see these things in isolation. To sustainably improve the wellbeing and resilience of older people, you must take a holistic approach and work with existing services, tools and technologies to understand how the innovations might be integrated most effectively. We strive for this combinatorial approach to maximise impact on our populations.”