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Guest blog: Richard Stubbs "Graduation to Self Care"


Guest blog: Richard Stubbs "Graduation to Self Care"

Richard Stubbs, ex Programme Manager of the Newham Whole System Demonstrator Trial, talks about the legacy of the WSD in Newham and how that is being used to transform East London NHS Foundation Trusts community based services.

Graduation to Self Care 

Richard Stubbs"The most important lesson we learned from the WSD is that we can make more efficient use of the clinical expertise of our staff through using telehealth.  Also our patients are just as happy being supported through telehealth as they are face to face.  The business case for us, as a service provider, is that a Community Matron can support around 50 patients as a direct provider of care but when that Community Matron is supported by telehealth and a couple of health care assistants, some 200 patients can be supported. 

One of the frustrations of the WSD Trial was that we couldn’t change our services based on what we learned. It was obvious that our patients had different requirements for support and that we needed a range of telehealth approaches that would allow us to match our service to their need. Happily now the trial is over, and with a little help from Florence, we have now achieved this.

We think it is very important for the NHS to promote the benefits of self care at every opportunity and that telehealth can be seen as a tool to help people require the necessary knowledge, skills and habits. We have three levels of telehealth that we use in a step up/step down manner within the context of a patient “graduating to self care”. These levels we refer to as Coach, Monitor and Review with Coach being the most intensive intervention, however in practice our staff offer coaching and other support when required whatever the service level.

For  “Coach” we use the Philips Motiva system, which uses the patient’s TV and a special set top box to provide a complete educational programme, underpinned by a great deal of interaction along with vital sign monitoring. For example a nurse can set a weight loss target for a diabetic. The system will supply a video about the importance of diet then a week later the patient will receive a questionnaire, their performance in answering this will be ranked by the system and a nurse alerted if the answers are badly wrong so that the patient can be supported in their understanding on a one to one basis. Later on, if the patient’s weight increases, the system will play another video highlighting the risks they face if they fail to manage their weight and again it will provide an automatic questionnaire to test comprehension.

Patients often show friends and family the Motiva videos, helping them to understand the behaviour changes required.  The strength of the Motiva TV based system is its educational capability; the weakness is the fact that after 6-9 months the educational programmes are complete and the continuing cost harder to justify for what is then mainly a vital sign monitoring tool. 

We have recently added “Florence” to contribute to the Monitor role in our telehealth model. It appears to offer an ideal platform for people who understand their condition yet appreciate support and encouragement to maintain their good self care behaviour. As such it is a great “step down” partner to the Motiva TV system.  

There are many things to like about Florence. Its low cost and simplicity are two major factors in its favour,  however I am also a long term advocate for Open Source developments and the incredible diversity of applications that Florence can now support, thanks to clinicians sharing their work and experiences, is a testament to this approach.  I very much look forward to the development of this site in coming months and learning from others’ experiences of this powerful tool as well as sharing ours as we explore the range of applications available.

For the Review level of our model, we use a system called Motiva Guide, which is a structured telephone interview with built in risk assessment.  This is for people who have shown they can look after themselves effectively but who are sufficiently ill to make it wise to have a periodic review to ensure that they are still managing OK. Perhaps this doesn’t fit everyone’s definition of telehealth but it definitely has a role in supporting self care.

If you would like to come along and hear more about our work we have a limited number of places at an event on the 6th December from 11.30am to 4.00pm at West Ham United Football Club where we are intending to launch our redesigned services. Sir John Oldham, National Clinical Lead for Quality and Productivity, is a guest speaker as is Phil O’Connell.   If you want to reserve a space please eMail Sharon O’Callaghan with your name, role, organisation and reason for interest."

email: sharonocallaghan@nhs.net

Richard Stubbs
WSD Legacy and Transformation Manager
East London NHS Foundation Trust


Editor (Phil):  Having recently attended a pre-launch event in Newham, I have to admit that I was taken aback by the level of support Richard and the team have rallied for telehealth.   The event was packed and was literally standing room only.   Attending were Patients, GP's, Nurses & Managers and I found myself at a table during a break sitting with a number of Trustees and discussing how the service might be extended to encompass mental health.
The approach developed by Richard and the Newham team is very much aligned with our own: Empowering patients to help themselves to achieve clear objectives and we are pleased to be part of Richards team.  
Speaking to patients at the event, it was clear that telehealth had made a huge difference to lives through re-ablement.  This illustrates the significant journey that Richard and team have made to muster such enthusiastic support for telehealth across the Trust.  For those Trusts who are just starting their venture into telehealth and I would recommend that they keep a close eye on developments in the East of London. 
Phil O'Connell