For a recent HTN Now virtual discussion, we were joined by panellists including self-management specialist Steph Lowen; Dee McMullan, senior district nurse at Leicestershire Partnership, and Charlotte Furness, partnerships lead at Isla Health, to talk about the implementation of supported self-care.
Beginning with some introductions, Steph shared that she has nine years’ worth of experience working on self-management projects across the UK, leading to her setting up her own team in Leeds solely working on self-management to promote independence. She raised the point that “when we talk about self-management, what we’re really talking about is personalised care,” noting that this is something important for people to understand. “We need to be able to switch the ethos.”
Charlotte offered an introduction to her role at Isla, where she works with organisations to adopt and scale Isla’s technology, and explained that Isla’s solutions are specialty-agnostic and can be used right across the care pathway. “We offer a web-based platform that provides a tool for enhancing patient monitoring and facilitating the exchange of high quality visual data and forms between patients, clinicians, and their wider care unit. We believe that technology can be used to adopt the supported self-care model, as well as to enable that scalability and sustainability of that model. We’re looking to bringing that tech to as many patients as possible, and developing support for a wide range of conditions.”
The way Isla works for clinicians, Charlotte continued, is by “making sure that supported self-management pathways are really low friction; so it’s easy for clinicians to onboard, we can streamline the clinical flow, and we’re preventing clinicians from having to make phone calls to patients.” The technology covers everything from patient enrolment to monitoring.
Dee shared her own insight from Leicestershire Partnership and from working in district and community nursing for over 20 years, emphasising the importance of nurses being able to the focus on “those patients who need us the most. A lot of the time, it’s just a case of providing reassurance that they’re doing the right thing, that everything’s fine, and that they’re not going to deteriorate. Maybe sometimes all they need is to send us a picture that we can look at and call them to say that everything looks fine and they’re doing a good job.”
Whilst the “ideal option” would be to hire more nurses to meet demand, Dee acknowledged that “the answer isn’t going to be more nurses, because there aren’t more nurses. So let’s use technology to empower patients to seek advice where necessary. Send us a picture, we’ll assess it and give you a treatment plan. I’ve even got an 85-year-old patient who has been using it to send us pictures – we have been able to reduce his hospital visits, which has given him a bit of his independence back.”
Enabling self-care and addressing health disparities
Considering the sort of support structures necessary for successful self-care implementation, Steph said that education is first and foremost required across different NHS roles.
“As we move towards using digital platforms, it’s important that we have a very clear, sustainable approach – not only for clinicians, but for the individual, too,” she reflected. “We need to ensure that we are keeping that person-centred approach from the beginning of that journey.”
When it comes to ensuring that self-care does not have a negative impact on existing health disparities, Steph stressed the importance of understanding the individual, talking about her experience meeting an individual with diabetes who had been discharged from hospital, and who was having a very difficult time with a perceived poor quality of life.
“He said that due to his visits three times a day for insulin, he wasn’t able to go to the day centre anymore to play games with his friends, and that he had been discharged with an information sheet, which was no use because he couldn’t read. By delivering that information to him in a way he could understand, and by changing some aspects of his care plan including through digital means, we made sure that we were delivering personalised care – using symbols instead of words, for example, to ensure that information could be understood. Ultimately, you can’t deliver self-care without personalised care.”
Charlotte talked about Isla’s research on health disparities, and how her team has worked “to ensure that our technology is easy for both patients and clinicians; as if it’s not easy for patients to use and engage with then the pathway isn’t going to work”. So far, she continued, this research has shown that in order to achieve high levels of patient engagement across broad patient caseloads “we need to make the digital flow as low friction and as simple as possible”.
To make sure that Isla is moving in the right direction on this, Charlotte explained that access has been enabled for patients through a web-based app so there is no need to own a specific type of phone. Additionally, the team have simplified the login process using only a date of birth, rather than requiring users to remember login credentials and passwords, which demonstrates another effort to offer “a simple flow” for patients.
“That’s why we have market-leading patient engagement rates; because we’ve made it very simple for patients. We’ve also taken steps to address challenges around digital literacy, so that a patient’s carers, family or neighbours can be approved to have responsibility for sending that information back.”
Dee talked about the importance of maintaining patient safety and quality of care whilst promoting self-management. She described how the pathway her team have been using with Isla ensures that all photos submitted by patients are reviewed by senior clinicians “to make sure the patient is on the right pathway for them”, and to pick up on instances where a patient may be deteriorating, or might need to be escalated.
“It’s actually highlighting risk earlier than if we were just seeing them once a week, because we have the ability to capture an image at any time, rather than waiting for their next visit,” she noted. “If a patient or their family members are worried, then an image can be sent through immediately. That might lead to a change of treatment, we might talk to the GP, we might collect a swab, and that’s happening sooner through this pathway.”
Adopting and scaling self-care pathways
On how tech can enable the adoption and scaling of self-care pathways, Charlotte stated that use of digital, specifically remote engagement and monitoring, can offer a “really safe and secure way for communication to be happening between clinicians and patients”.
She said: “The technology facilitates that communication piece, so patients feel like they’re being monitored and cared for even if they’re not having a face-to-face intervention at that time. To have a piece of technology in place which is sharing what is actually happening across self-care pathways – like healing rates improving or capacity being released – can help us understand local needs. We can then pick up quickly where changes might need to be made to ensure that self-care is successful at scale.”
Steph said that from her experience in the NHS, there can be a lot of fear about the risks involved in self-management. However, she said, once people have received their training and developed an understanding of what self-management entails and how it works, and once they can start to see the difference it makes for patients, “they realise it’s not a scary term”.
Steph added that she has been motivated both by NHS England’s push to encourage self-management and by the benefits she has seen first-hand. “On average in Leeds, we were discharging around 200 people every month, saving 3,000 plus community nursing visits, and reducing bed stay by four days on average from acute and community,” she said. “It has a massive impact, and the people we are delivering care to are getting the care that they want. I appreciate the risk element is scary, and that’s because we care about people. But we are not taking safety away, we’re just delivering care in a different way.”
Isla’s technology in self-managed care
Moving on to discuss how Isla’s technology can be integrated within existing healthcare systems to support areas such as data sharing and patient care coordination, Charlotte highlighted the importance of making sure that “we’re not asking clinicians to take on another job or another piece of reporting that they need to do”.
Reducing duplication and making the platform as easy as possible for clinicians to engage with and use as part of their everyday toolkit depends on “really solid integrations with EPR”, she continued, “so the EPR is always going to be the baseline”.
Isla already has integrations with most EPRs, Charlotte continued, meaning “patient demographics and information that sits in the EPR would then be available in Isla. Anything that you’re then collecting within Isla – patient reported or clinician reported – will then be pushed back into that EPR.”
Dee agreed with Charlotte’s points around duplication, pointing out that at Leicestershire, use of Isla has “actually taken steps out of our process – because up to now, when we wanted to submit a photo or something virtually in the patient’s record, it’s traditionally been a long-winded process. With Isla it’s a one-stop-shop: you take the photo, it’s already on Systm One, it’s already downloaded, and it’s all there to be reviewed instantly, which has saved time rather than increasing problems.”
Key messages about self-management
To close the discussion, we asked our panellists to share a key message about self-management with our audience.
Steph said that she hoped the audience would walk away with a slightly different view on self-management and “not see it as a scary thing, because it’s really important to the people we care for, and it’s enhancing the care we can deliver”.
Charlotte shared her belief that self-management can help “make a real positive impact across community services and on the care delivered for patients, especially if we bring together change leaders, providers, and our incredible clinical and operational teams”.
Dee said: “Let’s give our staff the permission to empower their patients. Let’s promote across the country that it is OK to self-care; and let’s support them to have the best pathway and best treatment they can have. This can be used in absolutely any service – podiatry, district nursing, catheter clinics, and more.”
We’d like to thank Steph, Dee, and Charlotte for their time, and for sharing their insights with us on support self-care and self-management with Isla.
To learn more about Isla and how it can help to support self-managed care, please click here.
