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The financial year 2023-24 marked Health Innovation Manchester’s (HInM) seventh formal year of operations. It has been our most significant yet in terms of delivery of demonstrable impact from our innovation activities.
In this year’s impact report, we focus in on our highest priority innovation projects and the key outputs, outcomes and impacts we have delivered to date – particularly in cardiovascular disease, obesity pathway discovery, deployment of virtual wards and optimising the GM Care Record. We have used increasingly detailed methods to define projects robustly and execute them thoroughly, learning from other industries. We have now progressed several projects efficiently to the point of readiness for operational rollout at greater scale.
THE AIM
One key purpose of the GM Care Record (GMCR) is to provide frontline staff with access to vital and up to date information from across GP practices, hospitals and other care providers so they can make better decisions about what care and treatment needs to be provided.
Health Innovation Manchester has been focused on the continued growth and development of the GM Care Record across the system over the last few years, working closely with partners across the system.
The aim of the GMCR project for 23/24 was to increase clinical use of the GMCR by 20%, to support frontline staff to deliver care and reduce the amount of time spent tracking down important information or repeatedly asking patients.
WHAT WE DID
This year we have focused on delivering the following key activities:
Integrated Care Plans
We have developed and launched a new care plan on the GM Care Record to support people with dementia and heart failure. It means professionals involved in a patient’s care will all be able to see their preferences, important medical notes and agreed approaches. This is a big step forward in providing care tailored to people’s personal needs and circumstances across all health and care partners. The care plans are firstly being tested in Tameside and Glossop, and we hope to roll it out to all areas of Greater Manchester over the next year.
My GM Care app
Providing patients with the ability to view their own information and contribute to their care is vital for improving their understanding of their condition and improving their care and treatment according to their specific needs. Therefore, we have this year launched the My Care Plan app on the GM Care Record, which is initially being tested for people with dementia and heart failure. This app allows patients to share information on what matters to them, such as care preferences, home access and pet information. Again, we hope to roll this out further across Greater Manchester over the next year.
Increasing information available through the GMCR
The GMCR becomes more valuable to frontline staff if more information from different sources is included, and more people involved in care delivery can have access to it. This year we have continued to bring in more data from multiple sources including more hospital trust data, as well as preparing the ground for access into community pharmacies to support better medicines management and to some care homes so that practitioners can follow clinical plans for residents more easily.
THE AIM
Cardiovascular disease is evidenced as being as the largest area where the NHS can save significant numbers of lives over the next ten years, as referenced in the NHS Long Term Plan. This is particularly relevant for Greater Manchester, where the prevalence and consequence of cardiovascular disease is particularly significant.
HInM has been working on a complex programme to improve care for people at risk of or who have had a cardiovascular event. A specific project within this programme has been the deployment of a novel medication (called inclisiran) to reduce cholesterol in high-risk groups. Reducing blood cholesterol levels in high risk groups reduces the risk of further events such as heart attacks or stroke. This initiative is part of a broader agreement set by NHS England nationally and has been set as a priority for the Health Innovation Network (previously AHSN).
The aim of this particular project was to optimise cholesterol management across Greater Manchester, including the targeted deployment of cholesterol reducing medicines and novel therapies in high-risk groups – delivered through primary care, taking a population health approach.
WHAT WE DID
HInM worked with GP practices across Greater Manchester in a comprehensive programme of work to identify patients with high cholesterol to lower their cholesterol levels with a range of interventions includingnew medicines. The project has also involved close working with industry partners.
We delivered the following:
Enhanced guidelines and training materials for clinicians
Introducing a novel medication into an established clinical pathway requires significant engagement and collaboration with multi-disciplinary clinicians. Before delivery could get underway, we focused on developing a suite of resources to support clinicians at the point of care, including lipid management guidelines, prescribing toolkit, and a secondary prevention pathway.
Developing digital tools to support cohort finding and tracking delivery
We developed the GM case finding tool to enable GP practices to easily identify patients who required a lipids review and could be eligible for a more novel therapy if existing therapies were not achieving the desired outcome. The tool was integrated with GP practice clinical systems, and searches replicated in the GM Care Record which allowed us to track progress and uptake in real time.
Blueprint delivery model in primary care
This population health approach was delivered in primary care, and we deployed three different approaches across Greater Manchester to support practices. This included a standard delivery model at practice level, working with a third party supplier to support with cohort finding and patient onboarding, and a third approach working with primary care providers at scale.
Tracking patient outcomes, with an inequalities focus
By using the GM Care Record, we have been able to undertake an analysis of patients who have benefited from a lipids review and had their treatment plan modified according to the guidelines. We have then been able to understand what impact the medication has had on their cholesterol levels pre and post administration. Through the cohort finding approach, we can also segment cohorts according to demographics, and have put in place additional work packages to focus on underserved communities, including Pakistani community in Rochdale, the Black Caribbean community in Manchester and diverse communities in North Manchester. This work is ongoing and will report later in 2024. This will help to ensure that we do not deepen inequalities through this new intervention.
THE AIM
Set by NHS England as a national priority, virtual wards are a new transformational model of care intended to provide acute care and support to patients in their own homes enabled by technology, as an alternative to a hospital stay. They allow patients to access care at home safely and conveniently, with providers using remote monitoring technology to monitor their health indicators.
The aim of the project was to design a model for virtual wards across Greater Manchester and support providers to deploy it across the system to deliver 1095 virtual ward beds by March 2024
WHAT WE DID
Working on behalf of the GM Integrated Care Board and the Trust Provider Collaborative, Health Innovation Manchester led the virtual wards programme to codesign the model of care and pathways, and then operate a PMO function overseeing delivery across the NHS trust providers.
We delivered the following key outputs:
GM virtual ward blueprint
The blueprint codesigned model of care based on a network model across all GM localities, including what should be delivered at system level, network level and local level to achieve common standards and optimise economies of scale from use of technology.
Standard pathways, definitions and data sets
We codesigned standard pathways for virtual wards with clinicians for acute respiratory, frailty, general medicines and heart failure, which are now being implemented by all providers. To ensure we could report and analyse virtual ward activity from across providers consistently, we agreed standard definitions and data sets, clarifying the classification and coding of virtual ward cohorts and enabling providers to flow data into a single GM virtual wards dashboard.
Communications campaign
An insights-based communications campaign was launched in Summer 2023 which has helped raise awareness, understanding and usage of the service across Greater Manchester.
Building an evidence base and deepening understanding
Given this is a new transformational model of care, we worked with providers and academic partners to deepen shared understanding of virtual wards and what evidence supported the approach. This included the NIHR ARC undertaking a rapid evidence synthesis, resulting in a published academic paper1. HInM has completed a programme evaluation, and researchers from the NIHR ARC-GM are undertaking an independent evaluation of the GM virtual ward programme which will complete in late 2024.
THE AIM
Obesity is a complex, chronic condition that increases risk for over 200 diseases and for the world’s leading causes of poor health and early death, including cardiovascular disease, several common cancers, diabetes and osteoarthritis. The UK has among the highest rates of obesity in Western countries. It is clear, that there are significant benefits to be gained from bringing down levels of obesity in GM.
The aim of the project was to deepen understanding of the cost of obesity to the GM system (both in terms of direct health costs and wider productivity impacts), and the current status of weight management and obesity services provision, as well as the potential impact of introducing alternative models of care and novel medicines.
This project was delivered by HInM in partnership with Lilly UK and select industry partners to undertake specific work packages.
WHAT WE DID
Service mapping
Through engagement with the NHS GM ICB and weight management service providers, we mapped weight management services across GM, covering from tier 1 to 4 services, via stakeholder workshops, interviews and data analysis.
Health economic analysis
We worked with a partner to develop a health economic report detailing the full range of costs incurred in GM due to obesity, including health and social care costs, economic inactivity and the non-financial costs of informal care and reduced quality of life.
Pathway redesign
We undertook further work with Tier 3 (weight management support service for people living with obesity) providers to understand the anticipated impact of introducing new obesity medications into the pathway, supported with modelling the potential capacity, demand and costs.
Innovation products horizon scan
We undertook a market review to identify potential industry innovations, including digital and MedTech products, that could help to solve some of the pain points in a future designed pathway. This included consideration of the NICE early value assessment of digital weight management service providers.
Public engagement
Given this is a complex area of care, we needed to understand the patient perspective and undertook a series of focus groups to gain insight into their lived experience and barriers to accessing care and treatment.