Wessex NHS Insights Prioritisation Programme Project (NIPP)

National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex and Wessex Academic Health Science Network (AHSN)

Digital innovations for people living with frailty

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Project team

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

Background to the project

NIPP was funded by NHS England’s Accelerated Access Collaborative  to enable ARCs and AHSNs to work together to accelerate the evaluation and implementation of innovations that support post-pandemic ways of working, build service resilience and deliver benefits to patients. The Wessex NIPP project focused on the use of digital interventions to support the care of people with frailty. We worked collaboratively with stakeholders from across the Integrated Care Systems in Dorset and Hampshire and Isle of Wight to identify system priorities in this area. The project had several components:

1 – Evaluation of uptake and use of the myCOPD app by older people

We undertook a mixed methods evaluation of the myCOPD app, a digital monitoring and self-management tool, in relation to its use by older people.  The findings showed a higher prevalence of COPD in the myCOPD eligible population than the general population, highlighting the importance of understanding the impact of frailty on uptake and use of the app. Those aged 75 and over, or living with moderate or severe frailty, were less likely to register with and more likely to decline the app.  There was also evidence that follow-up support to promote use of the app could increase activation and help overcome technical barriers.

2 – Development of a Theory of Change on use of data to enhance care of people with frailty

Theory of Change is a method to develop understanding of how an initiative can achieve impact. This is displayed in a Theory of Change map.  The development and refinement of the Theory of Change map drew on a review of the evidence and individual discussions with a wide range of stakeholders.  Participants were from primary care, community services and acute care working in digital health or care, frailty, commissioning and population health management. Stakeholders identified that a lack of availability of routinely collected data from across organisations to inform decision-making impacted the care provided to people with frailty. 

3 - Investigation of the use, applicability and acceptability of digital remote monitoring for older people

a) Listening activities with older people’s community groups to understand perceptions of digital remote monitoring

We held face-to-face events at six older people’s community group meetings, including a carers’ group, an exercise class and a community group serving a majority black ethnic population.  At these events we discussed benefits, concerns and barriers to the use of digital remote monitoring (the ability to monitor aspects of an individual’s health remotely using technology). We also asked group members how they thought their views might change as their health or abilities declined.

b) Research study investigating use and acceptability of digital remote monitoring for older people with frailty in the community

This mixed methods research study investigated digital monitoring at home approaches among older people with frailty, using Artificial Intelligence (AI)-facilitated sensors to monitor daily activities and routines. 

c) Evaluation of digitally enabled care within frailty virtual wards

The evaluation used qualitative data from two frailty virtual wards (NHS England » Virtual wards) to explore the use, decision-making and impact of digital remote monitoring.

We combined the qualitative data from the above three work packages (a, b and c) for thematic analysis.  We found that a personalised approach is important, with a need to consider practicalities (such as cost and sensor positioning) and design of the technology. Face-to-face care is highly valued and should not be replaced by digital remote monitoring. Users and carers need to know what to expect, how the technology works, who is monitoring and when; this would aid trust.

4 - Co-production, piloting and evaluation of an online Implementation Toolkit

Implementation is a complex process. For those tasked with introducing an innovation or a change to practice, service provision or delivery, there are a range of models, frameworks and tools to choose from to support the implementation journey. However, these can be inaccessible, specific to particular user groups, or fail to take implementation considerations into account at the outset.

The Web-based Implementation Toolkit (WIT) was co-produced with a range of stakeholders by NIHR ARC Wessex.  It is a user-friendly and accessible guide on what needs to be considered when implementing and how to achieve this. WIT can be accessed at: Helpful resources | NIHR ARC Wessex

More details can be found at: Implementation | NIHR ARC Wessex

Rapid Insights Guide for 2022/23 work

A Rapid Insights Guide (with project highlights) was produced for NHS England at the end of the 2022/23 projects (work packages 3 and 4 above).