Nursing Technology Fund 2013/14 Application Form
Organisation Details
Please complete the table below, providing details for the organisation with lead responsibility for the project. Remember that the applicant must be an eligible organisation as defined in the Prospectus.
Organisation name: / Avon and Wiltshire Mental Health Partnership NHS TrustAddress: / Jenner House, Langley Business Park, Chippenham SN15 1GG
ODS organisation code: / RVN
Key contact name: / Dr Helen Cottee
Key contact role: / Head of Professions and Practice – Specialist Drug and Alcohol Services
Key contact e-mail address: /
Key contact phone number: / 0117 378 4500
Project Key Details
Please complete the table below, providing key details for your proposed project. Remember that the Prospectus sets out a number of criteria for a successful application.
Project title: / CESI and CEST – Using computerised patient assessments to plan and monitor treatmentSolution – devices: / Tablets, Galaxy Tab 3 with protective cover. 60 for prisons without internet connectivity at [section 43(2) ]and 90 with 3G connectivity for Community team s and Bristol Drugs Project at [section 43(2)] each.
Solution – software: / In house built software
Solution – practitioners: / Community Nurses, Prison Substance Misuse Practitioners, Bristol Drug Projects community staff
Financials – funds requested: / [section 43(2)]
Financials – return projected: / [section 43(2)]
Plan – spend date: / By Financial Year End
Plan – go-live date: / March 2014
Project priority: / 1
Other partner organisations: / Bristol Drugs Project
Project Aim and Description
Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) have developed an electronic method for capturing and evaluating patient self- assessment and outcome data. These measures will be incorporated as part of the formal clinical assessment and review process, and will be pivotal in the development of an individualised patient care plan.
The measures, Client Evaluation of Self at Intake (CESI) and Client Evaluation of Self and Treatment (CEST), are widely used in the USA, where they were originally developed and validated(1). They were introduced to the UK by the National Treatment Agency (now Public Health England) as part of a pilot, to assess the feasibility of mind mapping as a therapeutic tool in this country. Although they have proved to be clinically useful and efficacious in combination with mind mapping(2), the implementation of these measures nationally has been hampered by the lack of an efficient and cost-effective method for capturing, evaluating and reporting the data.
The CESI, used at the start of treatment, captures a variety of psychosocial dimensions as well as readiness to change. The CEST, which is administered and repeated throughout the treatment journey, monitors the patient’s progress and degree of engagement in treatment.
CESI and CEST scale scores are calculated based on individual patient self ratings, and these scores are compared against norms for the agency. This measurement framework provides a means of readily identifying patients with unusually high or low scores. By plotting these responses against agency norms, the clinician can match treatment interventions to the specific needs of the patient.
Within AWP we have developed an in-house system that allows the CESI and CEST to be completed electronically. On completion of the questionnaire, the responses are calculated and the data is converted in to a graph format. This provides instant feedback to the patient on specific deficits as well as strengths, and this in itself has been found to be a useful motivational tool. Our software has been further developed to provide an individualised patient feedback sheet which allows for a more in-depth structured discussion about the results, and this forms the basis of the care plan. On-going monitoring and evaluation is facilitated by the ability to view CESI and CEST data simultaneously, again allowing instant and easy monitoring of outcomes.
During the pilot stage of implementing the use of CESI and CEST across teams, it has worked well where teams work from fixed bases and have access to computers. However, there are certain environments where computers are not easily accessible e.g. on the wings in prisons, patient’s homes, and other mobile working sites, where paper versions of the questionnaires have had to be used. This delay in the production of results means that real-time feedback is not possible, which is de-motivating for the patient, and could potentially delay treatment decisions.
As a solution to these problems, we have developed an application for a tablet, specifically developed for a mobile working environment. The tablet has no network or internet connectivity for the Prison environment but it allows completion of the questionnaire electronically and instant feedback of results. For all other environments full network connectivity is available via 3G.
Strategic Alignment
[Describe the fit of the project with the organisation’s clinical transformation, information and IT strategies, and the current level of infrastructure and capability - 400 words maximum statement]The Trust’s previous IM&T strategy ( published on 2nd August 2011) aimed to have the majority of clinical and business information held electronically by 2014 and for the Trust to be actively utilising technology to support service change. Investment was made to provide a common IT infrastructure, providing an integrated working environment supported by appropriate IT systems, services and skills.
The Trust requires accurate, timely and relevant information to enable it to deliver the highest quality care and to operate effectively as a modern and effective public sector organisation responsible for health and social care of individuals. Having accurate relevant information available at the time and place where it is needed is critical in all areas of the Trust’s business and plays a key part in corporate and clinical governance, strategic risk, service and workforce planning and quality management.
NHS Information Strategy
The NHS Information Strategy published in May 2012, “The Power of Information”, sets a ten-year framework for transforming information for the NHS, public health and social care. This new strategy has changed direction on the provision of information systems from one of centrally purchased and controlled, to one of locally procured and owned systems with the capability to interoperate with other NHS systems.NHS England now sets the direction for NHS information technology and informatics so that commissioners, providers and suppliers can make informed investment decisions, identifying, amongst the alternative approaches, those that deliver the highest quality care for patients. Frontline clinicians leading this agenda will ensure that systems are designed around optimal clinical workflows, enabling health and care professionals to do their jobs more effectively.
This vision will be delivered by the following Trust strategic objectives for IM&T:
Deliver the best care: Combining and integrating our data and information making it accessible anywhere to those that need it, in an appropriate form, through the use of cloud, virtual and interoperability technologies.
Future focussed: Being courageous and innovative in our use of Information systems and technologies to deliver better healthcare.
Continually improve what we do: Building powerful healthcare knowledge and research bases that can inform the development of care, increase competitor knowledge, enhance reputation management and fully support the future running of the business.
Use our resources wisely: Providing a supporting IM&T infrastructure where staffing and service delivery are flexible, nimble, cost effective and fit for purpose ensuring that the rapid development and use of new technologies are not inhibited.
Support and develop our staff: Ensuring our whole workforce is comfortable with the use of technology both in the workplace and beyond.
Digital Paperless Roadmap
[Provide the organisation’s roadmap to move from paper to paper light to paperless. This should include an indication of the progression that an award of funding would make in terms of scope, scale or speed - 400 words maximum statement]The Trust runs community based services that cover a wide geographic area. These services need to be able to operate flexibly with individuals not tied to Trust bases in order to access information. Following a successful pilot and roll-out the Trust will continue to provide real-time mobile access through utilising 3G, 4G and Wi-Fi technologies for offsite use.
The Trust’s policy for desktop infrastructure replacement to ensure end user equipment is kept up-to-date is currently five years. This will include the flexibility to change these devices to meet the changing needs of the service e.g. through replacing PCs with mobile devices. This will support the Trust’s service redesign programme enabling different working patterns such as mobile and home working. A range of mobile solutions will be developed to enable access to the Trust network from anywhere with internet connectivity from a variety of devices e.g. smart phones and tablets. The more services that adopt mobile working the greater the opportunity for realising the benefits around patient care and quicker the move to paperless systems.
Nursing Leadership
[Provide a description of how you have ensured Nursing leadership of this project, at Board, project and frontline levels respectively - 400 words maximum statement]The Executive lead for this project at Board level is Alan Metherall, Interim Director of Nursing. He is fully cited and supportive of this bid.
The project lead within the Specialist Drug and Alcohol part of the Trust is Paul Townsend, Service Director (RMN, RGN). Along with Dr Tim Williams, Clinical Director, and Dr Helen Cottee, Head of Practice and Professions – this Triumvirate manage and lead the Specialist Drug and Alcohol Services within the Trust.
Responsibility for the operational delivery of the project rests with the Nursing Team and Service Managers.
Sign-Off Process
[Provide details of the Board / senior management / financial sign-off processes this application has undergone (or is undergoing); within this, please confirm you have Director of Finance approval and that the affordability of both the initial trust investment and the future costs associated with the project are understood - 400 words maximum statement]The implementation of this strategy will be delivered through the annual IS&T work plans that are aligned to the Trusts Integrated Business Plan and annual operating plan. The constituent IS&T projects will be managed using the PRINCE2 project management methodology.
Business cases are produced for projects requiring capital funding for consideration by the Investment Planning Group, agreement by SMT and approval by the Trust Board.A project proposal and project brief were presented to the Investment Planning Group to gain approval to invest time, capacity and resources to the project. The Director of Finance is the chair of this group so that affordability of both the initial trust and the future costs are associated with the project are understood and therefore approval is granted to proceed with the project.
Technology Diagram
Applicants are asked to submit a technology diagram that clearly shows the following;
1. The technology for which funding is requested
2. How the technology will integrate with existing systems and technology
3. Any changes, upgrades or additions to existing infrastructure that are required for the new technology
The diagram must be submitted as a separate file as detailed in the “Application Instructions for Bidders” document.
Realising Benefits
[Highlight in brief the benefits you anticipate securing via this project N.B. A VFM Analysis template is also included in the application pack - 200 words maximum statement]1. Patient information is available in real-time; allowing feedback and discussion of results at the same time that the measures are completed.
2. Treatment plans and decisions about treatment can be agreed more quickly.
3. A paperless system means that less clinician time is spent travelling to office bases to input data; allowing more time to be spent in direct patient care.
4. Reduced bureaucracy.
5. Improved information sharing between teams, specifically between the Bristol ROADS treatment providers. To date BDP and the AWP specialist drug and alcohol service have operated different case record systems, but with both agencies being able to access CESI and CEST, patients will benefit from better sharing of clinical information, and therefore a more co-ordinated and managed journey through the treatment system.
6. Ability for services to offer more choice to patients in relation to where they are seen.
7. Adapted tablets, with no network or internet connectivity, are likely to be acceptable to the prison service.
8. The tablet version of the questionnaires are in an easy to complete, touch screen format; making them an efficient and effective means of collecting data.
Project Context
[Describe the context for your proposed project – for example, whether it is an extension of a previous pilot or deployment, whether it is one project within a broader programme, whether it is one phase of a wider roll-out, how it fits with any applications for Safer Hospitals Safer Wards funding, etc.; also highlight any relevant previous experience in developing, deploying and supporting the proposed technical solution - 400 words maximum statement]The approach for this project has been phased. Initially the community team in Bristol piloted the measures, following training, to assess the usability of the software and acceptability to patients. This was then rolled out to teams in Bath and South Gloucester.
The next phase was to look at Prisons and how we could implement the measures within this environment where we could have no connectivity to the internet. Currently, prisoners are completing the CESI and CEST on paper, administrators are then inputting into the system, with clinicians feeding the results back to the service user several days later. The disadvantages of this approach led to the Trust looking at other options. We have since built an app that can be accessed on the tablet. It does not need any wifi or internet signal to work on. The assessment can be completed on the tablet, it will produce the results and also the feedback sheet. The tablet can then be taken to an office and synchronised with the server.
An additional driver for developing the app related to the increasing need for more effective joint working with non-NHS providers as a result of new commissioning. In November 2013, for example, a new Recovery Orientated Alcohol and Drugs Service (ROADS) was commissioned in Bristol. The successful providers include NHS and non-NHS organisations working seamlessly to deliver drug and alcohol treatment. To ensure that information flows between all the organisations the plan is for all providers to use the CESI and CEST as part of the assessment and monitoring measures. The original plan was to enable the non-NHS providers to access via Citrix on their desktops, having completed the assessments on paper; however if these teams have tablets, they will be able to carry out assessments at any location suitable to the patient, and the clinician will be able to plan and direct the patient to the most appropriate treatment there and then.
Project Delivery Approach