However, I came across an interesting example of an NHS Trust this week that is looking to reinvent some of how it operates, using online tools, to generate more resources and get more feet on the ground.
West Sussex County Council working with Western Sussex Hospitals NHS Foundation Trust is using an Oracle cloud system - which it has adapted, and is called Family Assist - to link up local organisations that provide parental support throughout the life of a child, from conception to 19 years old.
The system also considers how it can incorporate providing information to the entire family unit, in the hope that this will nudge and promote positive behaviour amongst the parents.
The aim is to give parents and families the information and guidance they need, when they need it, online, stripping out stacks of paper-work and bureaucracy. Kelly Pierce, senior midwifery manager and public health lead at West Sussex County Council working with Western Sussex Hospitals NHS Foundation Trust, was speaking at the Oracle Modern Business Experience event in London this week.
Pierce explained the challenges that currently face midwives and parents in local areas, where limited time and too much information to distribute leaves parents confused. She said:
As far as information, I did a count up, we give over 280 leaflets just in pregnancy alone. That’s without all of the other information that’s out there on the internet. So, we need to find a solution.
And we have a challenge - which is that we work in silos in the NHS and local authorities. We try to join things up. They’ve got a lot better recently, but we still generally have information that’s conflicting. We find time is a pressure. And we also don’t necessarily know what our service users think.
I don’t know whether the information is any good and I’ve got no feedback and no way of knowing. So we’ve got this real big challenge to try and make things easier on our service users.
Beyond the confusion that parents may experience when being bombarded with too much information at an already overwhelming time in their lives, Pierce is also all too aware that local organisations are struggling to support positive behaviour amongst parents. She said:
The other issue we have got is around behaviour change. We can also spend a lot of time trying to right people’s behaviour, when we know that doesn’t work. So how can we try to work together to deliver more sustainable ways of trying to change behaviours?
We know that still 1 in 5 people are smoking. We know rates of obesity are going up. We know that suicide is one of the leading causes of maternal death. We are making some impact, but just not enough. And that obviously has huge ramifications on resources, the personnel, and the finances spent.
Joined up thinking
Approximately four years ago Oracle approached West Sussex NHS Trust with a system called ‘Maternal Assist’, which was already being used by one other NHS Trust. The system allows women to sign up when they become pregnant and provides them with a searchable local knowledge base.
However, West Sussex wanted to take this further. Whilst Maternity Assist was good for just maternity, it wanted to link up with other local organisations such as those that provide health visits, or school nursing, or social care. It wanted to join forces with the third sector, with children and family centres.
West Sussex was lucky in that it already had very good multi-agency meetings and networks. It already had an early years programmes board, with those key people feeding into that. Its business processes for integrated working were quite good, according to Pierce. However, the Trust had never addressed joining up the information that it gives to the public.
So what we’ve done is create a new product called Family Assist, which will stem from minus 9 months to 19 years. So when that woman first signs up at the beginning of pregnancy, she’s signing up for a long time. What that means is that she can get information sent at certain points throughout pregnancy.
So we can say, okay at 12 weeks she’s going to seek information on nutrition, what’s going to happen at your next scan, where the local midwife is, where the local children centre is. That information will get sent out on a Saturday morning into their inbox, when they’re more receptive to reading it.
In addition to providing this information to the parents, West Sussex also enabled the system to incorporate the wider family network, in the hope that this will include all members of the family in the child’s upbringing and reinforce some more positive behaviours where necessary. Pierce said:
The other great thing is that they can sign up their friends and family. What we do know about behaviour change is that they don’t listen to us. They hopefully don’t listen to Google too much (there’s a lot of dross on the internet that we want to steer people away from).
But what we do know more than anything is that they listen to their nearest and dearest, and that’s most likely to create that behaviour change.
So looking at the 14 year old girl that’s pregnant, and her mum is a smoker and she’s also smoking. We’re not going to expect that that pregnant young person is going to give up smoking, without also supporting her mum. So let’s send the information about smoking cessation, about smoke free homes, about sudden infant death to the whole family, because we know that’s more likely to have an effect.
Further supportIn addition to the weekly mail out and the searchable knowledge base for parents and their support network, West Sussex is now looking to add additional support features - such as live chat. Pierce explained that often when parents are struggling, they just need someone to talk to, or at least know someone is there. She said:
We are setting up live chat at the moment, hoping it will be live in April. We know that at 7 o’clock in the evening, mum’s breastfeeding can really be struggling at that moment in time. They feed and feed and feed. And it can be really stressful.
Actually if we can make a midwife or maternity support worker available for live chat, so that they know that someone is there if they need it. Sometimes that’s enough, just to know that there’s support.
And how does Pierce anticipate that this will impact West Sussex’s pressure on resources? Will the system make a tangible difference? Pierce admitted that it’s quite hard to know at this moment in time, because what West Sussex is doing is quite unique. However, it has taken note of what was achieved in the other Trust using the system for just maternity assistance. But she hopes that West Sussex can achieve more. Pierce said:
The difficult thing first off is that nowhere else has done this. We can’t find anywhere else in the world that’s done a whole children’s workforce approach. What we can do, is we can draw parallels from Maternity Assist - when they looked at this at Liverpool, relating it to just maternity, the saving in year one was £118,000. That would give me quite a few midwives to get put out there and work clinically.
That’s just talking about maternity, that’s not talking about health visiting, school nurses, all the tangible benefits that are likely to come from the whole children’s workforce.
I think it’s really important to make sure that we evidence this and get some really good papers out of it. We need to really look at the public health outcomes. Also, really importantly, what is the customer experience? Is this helping them? Is this genuinely going to make life better for them?