The challenge
People with severe mental illnesses (SMI) in England die on average 15 to 20 years earlier than the general population. It is estimated that 2 in 3 deaths are from physical illnesses that can be prevented, such as cardiovascular disease, respiratory disease, diabetes and hypertension.
Emily wanted to develop a digital risk stratification tool that could calculate and assess key physical health indicators for developing cardiovascular disease and diabetes for patients prescribed certain drugs, for example antipsychotics. This would link via an electronic interface into the clinical electronic patient record (EPR) system to inform clinical prescribing decisions, or potentially combining antipsychotics with health promotion activities or other interventions.
However, Emily soon discovered that if you didn’t address the digital skills staff need then digital tools would languish unused on the EPR system. To address this, her Topol project pivoted to working with NHS England and Health Education England (HEE) to develop staff digital competency frameworks and review any gaps in the training or resources that would be needed specifically for staff working in mental health.
This assessment process included a HEE commissioned a ‘user needs’ analysis report produced from a review of key discovery documents and other reports. It also incorporated feedback from mental health staffs’ user experience from roundtable discussion sessions to validate the key findings, consider gaps and gather targeted intelligence on mental health digital literacy.
This demonstrated a need to understand how mental health may differ from other areas in the NHS, from the way data is used and how a much more narrative approach is taken to recording SMI patient history, behaviours, actions and reactions. This narrative is used by mental health professionals to manage risk but makes extracting structured data from the EPR system a challenge (unlike a field like renal or phlebotomy where you are just entering numbers or data, which can then be used to monitor and improve services).
The benefits
Working with HEE, Emily created a framework for digital competency specifically for the mental health workforce. This framework is now being created within a new HEE digital portal, alongside the other frameworks for Associate Health Professionals and Pharmacy. The continued aim is to develop the portal with links to relevant training resources to help staff increase their digital skills and knowledge, so team managers and staff groups can self-assess their digital capability as being validated at the right levels.
“My background is in prison nursing,” says Emily. “When you think about digital solutions you must also think about the percentage of the population with no access to technology, like prisoners or even forensic patients. If you’re thinking of managing a long term condition through an app, you must remember that there will be a section of people who can’t access it. When you’re creating a digital framework, you need to make sure that it covers both digital and non-digital solutions so that it doesn’t widen inequalities. The framework also empowers staff to think about when to use digital and when not. That patient choice is really important. Sometimes digital isn’t always the right answer. Staff need to be equipped to do an assessment that understands the challenges that digital brings.”
Emily continues: “NHS England is now looking at how digital competency fits with its digital readiness strategy for the workforce. I’m currently doing a Florence Nightingale Fellowship, working on this as part of the Ives Nursing and Midwifery Review to inform that strategy, looking at the gaps in mental health research and learning, and my work on extracting data from mental health patient stories fits into that.”
How has the Topol Digital Fellowship helped you?
“I was the one nurse from a mental health background to be awarded a Topol Digital Fellowship and the only one of four to have been awarded a Florence Nightingale Leadership and Digital Fellowship,” says Emily.
Whilst she was undertaking her Topol Digital Fellowship, she was given the role of operationalising her Trust’s Covid-19 vaccination programme.
“I was developing the programme from start to finish and I’d never done anything like that before,” she says. “But using the tools from Topol and visualising what we needed to do, to look at what works and what doesn’t, and thinking through ‘how can I iterate quickly to develop a working model?’ Although it wasn’t completely a digital project, it had digital elements, and I was able to take the learning I had and apply it. I’ve also been able to use those skills in other clinical work, encouraging colleagues to adopt the approaches I learnt – testing hypotheses and understanding user groups instead of jumping to the first solution you think of.”
Emily has now moved into a strategic role as an associate director for physical health. “My role now is more blue-sky thinking. The Topol Digital Fellowship has certainly helped with that and it’s an opportunity to take forward the leadership skills I’ve gained and take people with me.”
What would you say to other NHS or Social Care staff thinking about doing the Topol Digital Fellowship?
Emily said, “The Topol Digital Fellowship kept me sane when I was thrust into one of the most challenging roles in my career in the middle of a pandemic. It gave me time and space, kept my passion for nursing and for digital going, and allowed me to create a network, friends and support.
“Fellowships aren’t just for medical doctors. If you have a passion and can see how to make improvements, the Topol Fellowship can get you to the place where you can do it yourself.”
Dr Laurine Hanna, Consultant Liaison Psychiatrist, University College London Hospitals NHS Foundation Trust and Chief Clinical Information Officer, Camden & Islington NHS Foundation Trust
“The skills, knowledge and networks acquired during Emily’s Topol fellowship shine through long after the fellowship has ended. Emily’s leadership and input to subsequent digital project has been invaluable, as well as her mentoring of the next generation of Topol fellows across our organisation.”
Follow on social media
Emily Burch
Twitter @elmorose84
Barnet, Enfield and Haringey Mental Health NHS Trust
Twitter @BEHMHTNHS