“It allows us to express ourselves in ways we couldn’t express to our friends – to know its confidential makes me open-up.”
Service user

“Some things are so embarrassing you can’t talk about them. If you message first, the nurse knows what you’re going to talk about when you get there.”
Service user

Overview

EMAHSN_ChatHealth_Image_1LowResChatHealth is a safe and secure text messaging service that helps young people get in touch with healthcare professionals. First developed by school nurses at Leicestershire Partnership NHS Trust (LPT), ChatHealth supports greater efficiencies within adolescent community nursing teams, with individual nurses able to provide for a greater number of service users. It is cost effective and uses technology young people are familiar with, providing confidential and timely access to healthcare. Young people do not need to wait for a nurse visit at school and the service is completely anonymous meaning it reaches out to often seldom heard groups.

Benefits of this include:

  • Increased service reach/access – delivering 100 additional contacts every month
  • Overcomes the stigma of face-to-face (F2F) access for teens
  • Reaches more underserved adolescents – 1/5 male users compared to 1/10 in F2F clinics
  • Reaches more first time users across broader range of enquiries compared with F2F clinics
  • Improved interagency working with police and social care
  • Improved staff efficiency
  • Positive user experiences.

In the first quarter of operations at LPT 20% of school nurse contact was delivered via messaging – 10% higher than expected update.

In just over two years it has grown from 65,000 users in Leicestershire and Rutland and is now available to around a million people across the entire country. EMAHSN has supported ChatHealth since it won an innovation award in 2014, with activities such as intellectual property, marketing and communications and senior commercial guidance.

The ChatHealth platform is predominantly used by adolescent health teams. The majority of enquiries are in relation to emotional and mental health and wellbeing, including self-harming and low mood – some of these kinds of contacts can be significant from the point of view of safeguarding vulnerable young people. The next most regular type of enquiry relates to sexual health. Other types of health teams are now beginning to adopt the platform which is changing the nature of the enquiries received. For example, where it is being adopted by health visiting teams, the enquiries received are about child health and development.

Challenges/ problems identified

ChatHealth is helping to safeguard vulnerable young people. Traditional ways of accessing healthcare for young people can be stigmatised, inhibited by societal barriers to entry and inconsistently available across schools and geographic areas. Meanwhile young people told LPT that they can feel more comfortable/confident if they can talk about difficult and/or sensitive issues by sending a discreet text-message.

As a result, teams that implement messaging enquiries services have fed back to ChatHealth that they get more contact from more new service users across a broader range of issues. This is particularly relevant for certain “hard to reach” demographics, such as adolescent males, who are more likely to ask for health advice and help by sending a message compared with traditional forms of service access.

A well organised messaging enquiries service can also be an efficient way of working for teams that are already stretched, for example one duty nurse can support large populations of people, within existing capacity, delivering up to 100 additional contacts every month. Working in more traditional ways, it would require the appointment of two additional nurses to improve reach to the same level.

Actions taken

EMAHSN_ChatHealth_Image_2LowResThe East Midlands Academic Health Science Network (EMAHSN) took ChatHealth on as a major Industry and Enterprise project in 2015 and has been instrumental is developing the service nationally. ChatHealth was originally pioneered by Leicestershire Partnership NHS Trust (LPT) and has made school nursing accessible to young people. EMAHSN has invested more than £100,000 into ChatHealth to encourage frontline teams across the UK to improve access to healthcare using digital platforms.

EMAHSN has continued to support ChatHealth, providing advice and assistance with areas such as intellectual property, marketing and commercial development. EMAHSN also sit on the ChatHealth Board.

Impacts/ outcomes

With EMAHSN’s support the team at LPT have successfully rolled ChatHealth out to around one million teens (exceeding the project’s uptake target within 6 months).

• LPT generated over £225,000 in revenue in 2015-16 and created 4 full time jobs
• Increased service reach/access – delivering an additional 1200 contacts over the last two years in Leicester, Leicestershire and Rutland alone
• 97% of all enquiries received are wholly dealt with by messaging nurses, only the remaining 3% are triaged onward for more resource intensive targeted care
• Availability spread in 15-16 from a population of 65,000 young people in Leicester, Leicestershire and Rutland to around a million people across 27 locations UK wide including: Sussex, Lancashire, Shropshire, Cumbria, Greater Manchester, Rochdale, Hertfordshire, Suffolk, Norfolk, Walsall, Warwickshire and Nottinghamshire
• Showcased at Testbed events and International School Nursing and Public Health England Conferences
• ChatHealth won a prestigious NHS Innovation Challenge prize in 2014
• Jimmy Endicott won the Leading for Service Improvement and Innovation award at the 2016 NHS Recognition Awards East Midlands.

Pilot Phase 2013/2014 results:1milteens
• Around three hundred episodes of care delivered by messaging
• Service continued to be provided throughout school holidays
• More students accessed the school nurse, particularly young males
• Some students accessed the school nurse for the first time
• Nurses using messaging saved time which was invested back into delivering care.

“Our new messaging system helps to safeguard students. We can even handle anonymous enquiries more safely which is useful because confidentiality is so important to young people.
Dawn Batson, School Nurse, Judgemeadow Community College

“Making the service available to around a million teens is a massive milestone for us and we couldn’t have done it without the support of the Trust and EMAHSN. ChatHealth is improving access to support and for service users who otherwise might not engage with healthcare.
Jimmy Endicott , ChatHealth project lead, LPT

Plans for the future

ChatHealth plans to continue working with school nursing teams as well as health visiting teams, mental health and sexual health services.

Which national clinical or policy priorities does this example address?

Health and wellbeing:
1. Adoption and diffusion of innovation and research
2. Spreading best practice.

Start and end dates

2014 – ongoing.

Contact for help and advice

Jimmy Endicott, Mobile Media Development Manager
E: jimmy.endicott@leicspart.nhs.uk

Lucy Hose, Communications Manager
T: 07972 354 742
E: lucy.hose@nottingham.ac.uk