Wessex NHS Insights Prioritisation Programme Project (NIPP)

Investigation of the use, applicability and acceptability of digital remote monitoring for people living with frailty in the community, to inform development of frailty virtual wards.

Wessex NHS Insights Prioritisation Programme Project (NIPP) Applied Research Collaboration (ARC) Wessex and Wessex Academic Health Science Network (AHSN)

Project title

Investigation of the use, applicability and acceptability of digital remote monitoring for people living with frailty in the community, to inform development of frailty virtual wards.

Project team

Nicola Andrews (ARC), Cindy Brooks (ARC), Cheryl Davies (AHSN), Linda Du Preez (AHSN), Richard Finley (AHSN), David Kryl (ARC and AHSN), Susi Lund (ARC), Michelle Myall (ARC), Rebecca Player (AHSN) and Phoebe Woodhead (AHSN).

Background to the project

NHS England and NHS Improvement is funding ARCs and AHSNs to work together to evaluate the potential for innovations introduced during the pandemic to be adopted and/or sustained as part of an NHS Insights Prioritisation Programme (NIPP).  The purpose of NIPP is to evaluate and assist implementation of innovation whilst addressing health inequalities.  The Wessex NIPP project focuses on the use of digital remote monitoring to identify deterioration among older people with frailty.  We worked with stakeholders from across Dorset and Hampshire and Isle of Wight to identify their priorities in this area, as part of joint ARC and AHSN work funded during 2021 – 2022.  The project described here to run from January 2022 until March 2023 reflects these priorities.

The objectives of the project are:

• To understand the advantages and disadvantages of digital remote monitoring for older people with frailty, in terms of uptake, ease of use, acceptability and cost effectiveness.
• To provide evidence to inform development of services for older people with frailty.
• To develop guidance to support implementation of digital remote monitoring in frailty virtual wards.
• To produce a web-based Implementation Toolkit for use by researchers and practitioners.

The project is made up of four parts: 1) Listening activities; 2) A study of use and acceptability of digital remote monitoring for older people with frailty; 3) An evaluation of digitally enabled care in a frailty virtual ward; and 4) Development and piloting of an Implementation Toolkit.

1 - Listening activities (April – September 2022)

We will hold face-to-face events at older people’s community group meetings. We will discuss benefits, concerns and barriers to use of digital remote monitoring at these events.  We will also ask group members how they think their views might change as their health or abilities decline.  We will link with a range of forums including those in under-represented communities. We will analyse the feedback shared by these groups to identify key themes.

See further recommendations from listening activities

See themes from listening activities

2 - Investigation of the use and acceptability of digital remote monitoring for older people in the community (June 2022– March 2023)

This research will investigate digital monitoring at home among older people with frailty.  It will examine two digital approaches in use in Wessex.  We are working with Dorset Council, the Isle of Wight NHS Trust and the Portsmouth Primary Care Alliance oximetry@home service.  One digital approach consists of the remote monitoring of signs and symptoms.  What is monitored varies by service but include signs and symptoms such as oxygen levels, blood pressure and breathlessness.  The other digital approach is the use of Artificial Intelligence-powered sensors to monitor daily activities and routines.  Both of these approaches seek to identify deterioration.

We will analyse data sets to understand uptake and differences in usage between older people with and without frailty.  We will also analyse differences between older people with frailty at different stages of the frailty trajectory, in different age brackets and from different ethnic backgrounds.  We will ask older people who have used one of the services about their experience of using it and how acceptable it is.  We will also ask informal caregivers, community nurses and domiciliary care workers about their experiences.  This will involve an interview or, if this is not possible, completing a questionnaire.  Analysis will search for themes within the data.

3 - Evaluation of digitally-enabled care in a frailty virtual ward (August 2022 – March 2023)

We will work with Hampshire and Isle of Wight ICS (HIOW ICS) to evaluate the use of digital remote monitoring in frailty virtual wards (VWs) within Southern Health NHS Foundation Trust and Solent NHS Trust. HIOW ICS distributed the Whzan blue box to support the VW launch across the VW services, two within Solent and three within Southern Health. The Whzan blue box is an all-in-one telehealth case that measures vital signs, records photos, and performs multiple assessments including NEWS2 score.

We will be looking to investigate the benefits and challenges of using digital remote monitoring as part of this model of care.  We will explore when and how digital remote monitoring is used, the implementation process and decision-making and its impact.  We will also assess the impact on workforce, the operational barriers and enablers, alongside cost effectiveness, workforce implications and attitudes to the use of digital remote monitoring. Evaluating impact on workforce will involve interviews with frontline staff and evaluating attitudes of the workforce will involve two Rapid Insight events. Anonymised data will also be extracted from the local Trusts to gain valuable insight and assist in service development, system and operational resilience.

4 – Co-production, piloting and evaluation of an online Implementation Toolkit (April 2022 – March 2023)

For those tasked with implementing a new innovation or change to practice there are many models, frameworks and theories to manage the complexities of implementation.  However, these are often complex, use inaccessible language, are specific to particular user groups and do not take into account implementation considerations at early stages of the research process.  This can make them difficult to apply, especially for those with little or no experience of implementation.

Building on a review of existing frameworks and a survey, already completed, we will develop a toolkit that is easy to use and access to help successful take up of research outputs and innovations in practice.  We will co-produce the toolkit with academics, health and social care professionals, third sector organisation representatives and public contributors, through a series of interactive workshops.  The toolkit will assist anyone involved with implementation across the health and social care system.  The toolkit will provide guidance on what needs to be considered when implementing and how to achieve this and include focus on implementation at an early stage of research.  It will consider specific requirements for implementation of digital interventions.  We will pilot and evaluate the prototype Toolkit in health and social care settings, including frailty settings.

For further information about the ARC –AHSN NIPP project please email Rebecca.Player@wessexahsn.org.uk or N.M.Andrews@soton.ac.uk