By 10:30am the pitches were filled with talks, yet the opening slot in the main room remained blank. As a fellow volunteer to help the day run smoothly I decided to step in and take it. I had not planned to talk at all and had nothing prepared, I did however have some posters. I decided to open a discussion on how we can use some of the design principles from GDS in healthcare and used a service I have helped work on for Integrated Care Partnerships as an example of how it can potentially be done.
Developing a pre-diabetes case finding service.
Diabetes is becoming more prevalent with currently no known cure. We are however learning more on how its impact can be reduced. It does depend on (a) what type of diabetes you have and (b) your own ability to manage it should you be able to do so. Before one can develop certain types of diabetes, its most likely pre-diabetes has been. Luckily it can also be tested for.
So the service looked at risk stratifying practices (a case finding service) for GPs to firstly find pre-diabetics and then manage them. The intended outcome would be for those offered an intervention to become more aware of their condition and consider managing their lifestyle which in turn will stop the onset of them developing type 2 diabetes.
The area to which I work within the system is trying to help alleviate the increasing demand of an ever aging population. Its doing this by offering alternative services and more integrated pathways for managing people so they depend less on acute care. Its known as shift left and a report was written a few years back in NI about how we should try and do it.
The diagram below is how I see it…
So we invited GPs to run a query on their clinical system (risk stratification). We were given anonymised data back from the practice and that data was used to help us identify how many possible pre-diabetics there were along with helping us ask for funding for the second part of the service to provide an intervention. We also asked service users and workers about how it should be delivered (co-design) and we reviewed some feedback from other similar projects within the system, using the NHS evidence repository and by looking at the fab stuff academy as a resource. Designing a service using data is important it provides evidence and stops guesswork.
At all times we reminded ourselves that this service was for the need of the user not the system. By allowing the practice staff themselves to design what interventions they would carry out made perfect sense. Practice staff know their patients better than anyone else and what will work best for them hopefully giving us better outcomes.
For a person to be told they potentially will develop a chronic condition that will change their life before it happens can be very unsettling. The need to explain what pre-diabetes is and to show what help is available helps the patient – the user. Now imagine that user is living alone (7.7 million people in UK households lived alone). They need more help. This is where health needs to be more ‘social’. In tackling its issues, companionship is needed. Health is not just a problem for the NHS / HSCNI it needs the community voluntary sectors helping it along and it needs input from all sectors from housing to education.
Social prescribing (SP) can show its benefit in giving these companioned options to help promote self care. Anything from joining a befriending service to finding a men’s shed is a social prescription*
From our service allowing more options would be beneficial – linking it to social prescribing could offer even more interventions for other resources.
As we have now run the service twice (in 2016 and again earlier this year) we have some data. We also have some user feedback. Good numbers to prove the worth and need and more importantly the views of the users and enablers on how we can further design the service making it better for the user. Iteration is very important. Always testing and always trying to improve the users experience will be key for us going forward.
Hopefully that snippet stayed true to the talk on the day and gives a little insight into how its possible to use GDS design principles in health transformation as well as in digital transformation.