Leicestershire Partnership NHS Trust (LPT) provides integrated community health, mental health and learning disability services for a population of a million people in Leicester, Leicestershire and Rutland. We have more than 5,000 staff and a passion for quality, integration and excellence. LPT’s division of Families, Young People and Children’s Services (FYPC) provides the School Nursing Service across the area.
ChatHealth is new texting software that safeguards vulnerable teenagers. It keeps messaging conversations safe/secure to provide timely, confidential access to help from qualified clinicians. Our initiative is improving experiences for patients and staff – who co-developed the system uniquely for the NHS.
Our ambition was to transform access to healthcare for young people. They are leading communications change – almost 100% own mobiles, 80% have advanced phones used to administrate every aspect life. If we fail to provide age-appropriate care in this landscape, they will disengage further.
Our ChatHealth school nurse messaging service is now available to 65,000 students aged 11-19 in 90 mainstream schools in Leicester, Leicestershire and Rutland. They no longer have to wait for a clinic appointment or ask a teacher’s permission to attend – they just send a discreet SMS text message at any time and get 1:1 support from a clinician.
Our software proves technology can have large scale, cost-effective impact on improving patient experience – whilst our team is influencing national best practice and actively promoting transfer/dissemination.
Teens are high risk. In the last 10 years depression/self-harming in this demographic has doubled. Texting provides them with timely, age-appropriate, confidential access to help. It’s widespread technology, offering a far-reaching solution for improving patient experience. Yet it’s rarely adopted in the frontline because staff/managers are risk adverse. The risk of messages going unanswered out-of-hours, losing audit trails and holding sensitive info on handsets, seems to outweigh vulnerable young people crying-out for help.
School nurses and young people solved this problem. They co-designed ChatHealth. They imagined pupils in school sending texts from phones as normal, but texts arriving with nurses in a computer-based risk management system that:
- Ensures no message received ever goes un-answered
- Sends automated safety bounce-backs out-of-hours signposting alternative help
- Is fully auditable and reportable
- Notifies staff when action is needed
- Allows nurses to manage messages as a team without giving out numbers for personal handsets
No off-the-shelf product met this specification. So, the Trust employed a software developer to build ChatHealth.
The plan was supported from the outset by senior management, ensuring high quality leadership. This enabled tech development to begin – bringing to life the system patients and nurses had co-designed:
- Chief Executive injected initial funding/created dedicated project lead post
- Director of FYPC chaired project board to ensure robustly governed approach
- Commissioners, impressed with initial achievements, contributed £150K funding to widen impact.
Project lead was appointed from marketing/communications background, to engage patients/staff and communicate objectives. Aims were clear:
- Improve patient access to school nurses
- Enable patients/staff to lead transformation
- Pilot in 3 schools (4,500 students) until at least 10% contact was delivered by text messaging
- Assess impact on patient/staff experience, with a view to rolling-out
IMPROVED TEENS’ EXPERIENCES
Staff capacity’s stretched; sometimes students can’t get to see a school nurse. But, some choose not to see a school nurse. They feel more comfortable talking about sensitive issues without meeting face to face (F2F). Because of emotional/cultural stigma they feel more self-confident speaking remotely/anonymously from “behind the screen” (of their mobile device). ChatHealth gives patients a better experience on both fronts.
- Increased reach/access – 100 additional monthly contacts
- Overcomes stigma of F2F access – half of contacts begin anonymously
- Reaches underserved teens, 1/5 male users compared to 1/10 in F2F clinics
- More 1st time users, broader range of enquiries, earlier intervention compared with F2F clinics
- Improved safety for staff and service users
- Improved interagency working with police/social-care
To better understand the impact we examined/discussed patient/staff experiences in a number of ways:
Focus groups (30 students)
- Student survey (2,000 respondents)
- Staff reference group
- “Mystery shopper” anonymous test by appointed service user
- Patient/staff satisfaction video interviews
- Peer review; 150 conversation transcripts reviewed by school nurses/managers
Reviewers described a thorough, timely, instant, informative, succinct, safe, non-judgmental, sensitive and reassuring service.
See short exert from patient/staff satisfaction interviews: Young People and Staff Feedback
Read more feedback in “Additional Supporting Evidence”.
WHAT MAKES THIS INITIATIVE SPECIAL?
With 1,200 school nurses nationwide looking after 20,000 schools, there aren’t enough staff. ChatHealth is the kind of sustainable solution needed to improve experiences more young people with fewer resources.
School nurses can now provide an industrial-scale messaging enquiries service. We introduced a single point of access triage model, so just one duty nurse handles all enquiries from 65,000 patients across Leicestershire. If all Trusts adopted a similar model, as few as around 30 nurses could handle all messaging enquiries from all UK teens.
We’re delivering 100 additional monthly contacts within existing capacity. Achieving the same in a traditional F2F way would require two additional nurses costing £70K p.a. Low-cost messaging contacts eliminate unnecessary resource-intensive F2F contacts, saving taxpayers’ money. Furthermore, our duty nurse responds to two thirds of enquiries through messaging; only one third is escalated to F2F colleagues. This releases capacity so more F2F care can be delivered where it’s most needed.
The capacity for transferability is infinite – ChatHealth is configurable to multiple services/organizations. We’ve already engaged widely with other Trusts and identified a healthy appetite to adopt the culture/behaviour.
ChatHealth improves the patient experience for teenagers because it’s age-appropriate. Techy young people will become increasingly isolated if healthcare fails to keep up with them – ChatHealth turns that on its head by changing the primary way we interact with patients.
SAFELY IMPROVES ACCESS FOR UNDERSERVED TEENS
This would be impossible without our unique technology and guidance which ensures safety. Nurses say they speak with more new young people than ever before across a broader range of issues. We get more contact from vulnerable/underserved adolescents who might not otherwise engage with healthcare, particularly boys, for whom we are significantly improving outcomes.
ChatHealth is significantly scalable, which we are actively catalysing. This could benefit high numbers of patients.
- Improves access – an open channel, available to patients 24/7
- Innovative – more efficient, but simple and safer
- Age appropriate – empowers patients
- Earlier intervention – discreet and timely, removes barriers for patients
- We learned software development takes much longer than expected, but results are outstanding if patients/staff are involved from the conceptualisation stage.
- We haven’t set out to replace face to face care – but we learned some young people prefer an alternative. They say they feel more self-confident, less judged, less exposed speaking anonymously/remotely.
- We learned young patients are interested in what we mean by “confidential”. We are clear – we won’t tell parents, teachers, etc. if a student makes contact, unless we have concerns about safety. If a message suggests a young person is at significant risk, we ask the police to help ensure they’re safe. Is this a breach of confidentiality? One patient told us they were just pleased someone cared.
- Widening service access has improved our patients’ experiences. We were unsure what would be the impact of this on our already busy nurses, but they say messaging as quick, efficient and manageable. We learned messaging helps them reach more patients within existing capacity.
- Our new single point of access improves timeliness for patients. We thought changing the traditional locality based service model would be challenging. We learned that it flourished. Young people value having direct access and duty nurses say it’s gratifying to support more patients from across the County.
- Patients wanted messaging access and many staff were keen to pioneer it. These confident champions were critical to the success of the project, supporting less confident colleagues to engage. The champions approach was so valuable we made it central to the service roll-out.
CHAMPIONS CREATE CHAMPIONS