Healthier Together App pilot
The Healthier Together app has been co-designed with parents. Semi-structured interviews were conducted in 2020 to obtain invaluable feedback on usability and feasibility of the prototype app. 10 parents participated in the interviews and their responses were analysed.
This feedback on usability and barriers to use allowed the app to be refined before being formally piloted within the Sovereign Primary Care Network in Fareham.
The pilot showed that 64% of parents planning to seek a review in 1° care reached a self-care disposition and manual review of “amber” patients that contacted primary care online (conducted by PCN) were all appropriate.
Based on this pilot, the Healthier Together app has been rolled our across Hampshire and IoW (started January 2022). The impact of the app is being formally evaluated by the Wessex Academic Health Sciences Network (AHSN) and may be implemented in other parts of the country.
Thanks to Joanna Vale (Medical Student, Southampton Medical School), Sophie Perrio – (Sovereign Project Officer), Dr Tom Bertram – Sovereign Clinical Director and Dr Jill Choudhury – Sovereign Quality Improvement Lead
To access the app, click here.
For full project report, click here.
In November 2022 Hampshire and IOW (HIOW) launched the Healthier Together App alongside a centralised Maternity Triage Line (MTL). The app allows women with antenatal or early labour concerns to self-triage. They are then linked to the correct health care professional for their concern or given advice to support staying at home. The MTL is staffed 24hours a day 7 days a week by midwives to triage concerns, offer advice, or make an appointment with their local maternity unit. Since this was launched, we have seen a 30% reduction in the number of calls going through to the MTL and 92% of calls answered within 20 seconds. The app is consistently accessed of 13,000 times a month and over 60% of women have their query answered without needing to speak to a health care professional which has reduced attendance figures across HIOW by 21%. Almost all pregnant women across Hampshire and the Isle of Wight have downloaded the app.
The Healthier Together App won the Royal College of Midwives award for digital innovation in 2023 and many other areas are looking to adopt this triage service. This service improvement is currently being independently evaluated by Wessex AHSN.
Background: Despite the incidence of life-threatening illness in children reducing, health-seeking behaviour and demand on secondary care services, such as Paediatric Assessment Units (PAU’s) has increased. Re-presentations via temporary open access represent a significant proportion of the workload and may be avoidable with improved safety netting processes.
Methods: Scoping work across Hampshire, IoW and Dorset assessing facilities, procedures, re-presentation rates and length of stay was performed. Views on safety netting from health care professionals and parents and carers were acquired via purpose-designed questionnaires. Using quality improvement methodology and a series of Plan-Do-Study-Act (PDSA) cycles, a document of all safety netting resources was introduced at Southampton Children’s Hospital. The primary outcome measured was proportion of children seen on PAU returning via temporary open access.
Results: there was a significant reduction in the proportion of children seen returning via temporary open access from 11.5% to 4.2% following introduction and promoting of the safety netting resource.
Conclusion: Reducing the number of children re-presenting via open access released time for staff to concentrate on the children who did need to be there. By augmenting the safety netting process, parents were more empowered to manage their children at home.
For more information, click here
The aim of Connecting Care Children's Hubs (CCCHs) is to improve the delivery of care to children and young people by increasing the connections between GPs, health visitors and paediatricians. The core elements of the hubs are that they are centered in primary care and built around a monthly multi-disciplinary team (MDT) meeting followed by a clinic in which a paediatrician and a GP see children together. The project, which was funded by NHS England, began in April 2018 and was led by the Hampshire Isle of Wight (HIOW) Sustainability, Transformation and Partnership (STP) children's programme team:
12 CCCHs were initially piloted across Hampshire and the Isle of Wight:
Impact of the CCCHs:
In addition, the introduction of the hubs was associated with reduced rates of urgent GP appointment, A&E attendances and admissions to hospital:
The NHS has rolled out CCCHs across much of Hampshire, IOW and Dorset so that many children can benefit from them.
To hear more about the hubs from the people involved about them, click here.
For final project report, click here.
Parents commonly call NHS 111 when they are concerned about their child. The current system used by NHS 111 involves call handlers going through a series of pre-written questions (NHS pathways) to decide what is required. Unfortunately, this process almost always results in parents being advised to seek a face to face appointment with a doctor. However, at this face to face appointment, most parents are simply told that their child requires no specific treatment and that they can be managed at home. This process is often inconvenient and frustrating for parents and children alike.
We secured funding from NHS England in 2019 to create a new way of delivering NHS 111 services for children. Phone calls about children with common illnesses such as sore throats, ear infections, rashes and cough and colds will be filtered into a specific children's service (paediatric desk) where trained paediatric nurses and GPs will decide whether they can be managed at home or not. If they can, they will provide you with clear information on what to look out for and what to do at home to keep your child comfortable (safety netting).
Phase 1 of the project was completed in July 2019 and the results from it can be accessed by clicking here.
Phase 2 began in October 2019 and finished in January 2020. It involved an expansion of the pilot to children of all ages as well as those presenting with a broader range of illnesses. It also included the ability for the paediatric desk staff to 'talk' to a parent with a video call if required; this allowed the clinician to gather even more information about the child before they made their decision about whether they needed to be seen in person or not. Evaluation of the pilot once again involved comparing the outcomes of children managed by the paediatric desk to those managed using the standard NHS 111 pathways. The results can be seen below:
Based on this successful pilot, a dedicated paediatric NHS 111 desk was introduced across Hampshire and the Isle of Wight in June 2021.
Antibiotics can be lifesaving in children with severe infections. This includes conditions such as sepsis and meningitis. However, overuse of antibiotics results in antibiotic resistance; which means that the normal antibiotics used to treat your child may be less likely to work when your child needs them most. Most mild infections in children get better by themselves; antibiotics rarely make a difference to how long your child will take to get better. For this reason, a project was set-up between pharmacists and general practitioners in West Hampshire to improve antibiotic prescribing in young children.
The intervention involved pharmacist-led in-house training based on the Healthier Together resources and regional antibiotic guidelines, as well as review of antibiotic prescribing data within each GP practice.
The results show that this simple intervention was highly effective in improving antibiotic prescribing in primary care. It is planned to roll-out this approach across Hampshire and Dorset.
For more information, watch this video by clicking here.
Improving psychosocial screening using the HEEADSSS app
Supporting the psychosocial wellbeing of young people remains a priority. HEEADSSS is an acronym that stands for: Home, Education and/or employment, Eating, Activities, Drugs, Sex, Suicide Safety. The recently created HEEADDDS app allows health and social care professionals to screen against these criteria. The reason for this project was to evaluate the role of the app in self-screening by young people.
We surveyed 100 young people and 33 Children’s emergency department staff members to fulfil 3 main aims:
1. To discover what the experience of adolescents undergoing self-administered HEEADSSS screening is
2. To understand staff attitudes and experience with HEEADSSS screening and the HEEADSSS app
3. To understand the barriers to HEEADSSS screening in the Emergency Department
What young people think:
The experience and understanding of staff:
Ideas generated by this project:
To see our full report click here
For more information about the HEEADSSS app, please email Dr David James ([email protected])
In February 2018, the Mental Health Foundation released
worrying statistics that 1 in 10 children suffer from depression or anxiety
related issues, with almost half of cases involving children under the age of
14. What is of greater concern is that over half of schools in the UK are not in
a position to help these children even though they are often the first point of
contact for anxious parents looking for help.
The Healthier Together team decided to partner with the
charity Simon Says in 2018 to develop
educational resources to support teachers and children about mental health. The
“Let’s Talk About Mental Health” project aimed to:
The resources were piloted in 6 schools across Hampshire,
with 30 teaching staff involved and nearly 400 year 3 and 4 pupils (aged 7 to 8
To view the resources developed, click here.
The feedback from teaching staff included:
Children were surveyed before and after the project:
To view the final report, click here.
The resources are currently being reviewed by the education
and public health teams from across Hampshire to decide how best to integrate
them into the school curriculum.
The aim of this quality improvement project was to empower parents and provide reassurance on managing everyday childhood illnesses through workshops delivered by children’s centre staff. A pre-project questionnaire, completed by 85 parents, demonstrated that the reason most parents take their children to the emergency department is to seek reassurance that their child is not seriously unwell. This finding justified the focus on common illnesses in children. The workshops were piloted in Sure Start centres and through feedback and co-design with parents, evolved from a teaching session to an interactive game played by parents and facilitated by health visitors.
Examples of the resources developed include the following:
Flash cards for parents:
Feedback from parents included the following:
‘If I had known this before I wouldn’t have worried’
and ‘It’s good to have people coming into groups to talk to parents about things like that’.
Feedback from the children’s centre staff was that they felt confident to facilitate the sessions.
The full report can be access here (hyperlink to PDF)
Based on this project, we are planning to run a larger study looking at the impact of common illness workshops by primary care staff.
To access and download the full project report, please click here.
Interviews with parents confirm that many parents lack confidence in managing common childhood illnesses and seek input from healthcare professionals. This can be hugely stressful and time consuming for families and children. Children from the most deprived families are most likely to have childhood illnesses and are most likely to be brought to the attention of healthcare professionals.
Home-Start is a local charity in Portsmouth that support families with children aged 0-5years old. Volunteers are trained to work alongside families in their homes and out at groups; non-judgmental, compassionate , confidential help and support is offered. Home-Start has 118 volunteers and support over 300 families a year for one on one support and over 1000 at stay and play groups. They offer regular ‘in service’ training to their volunteers so they are up to date on emerging information that is useful in their work with families. Portsmouth is a deprived city and Home-Start works regularly with families living in poverty and would be considered to be living in ‘vulnerable’ circumstances
In the first instance, the Healthier Together team arranged a scoping meeting with voluntary sector organisations (including Home-Start) and local authority volunteers to discuss the challenges and barriers faced by families trying to access healthcare. One important aspect that was highlighted was the importance of maintaining the trust that had been developed between families and volunteers and the opportunity to disseminate health information via volunteers.
Voluntary sector organisations were keen to engage because they believed that following the training sessions, their volunteers would have more time available to support families. They also hoped that by offering knowledge and skills to the voluntary sector, some pressure would be reduced on the health system. They felt that the more people within a community who are able to provide consistent health messaging, the better for the families.
Intervention – A 1 hour training session on common illnesses were offered to volunteers, so they felt confident in using the flashcards as well as being able to signpost to content on the Healthier Together website (including translating into different languages) and supporting families with accessing healthcare information. 4 alternative dates/times were offered.
Volunteers reported the information provided on Healthier Together was easy to navigate. They found the simplicity of the traffic light system easy to explain for families and the QR codes on the parent handouts very useful. They found the ability to offer information to families in their native language extremely beneficial and they perceived this to have broken down many barriers for families. Their overall impression was that teaching volunteers how to use the system effectively was invaluable to the families they were supporting.
Quotes from Home-Start Volunteer who attended the training:
“I would certainly recommend it to all Home-Start volunteers to share with their families, and to encourage mums/dads to download the app, as this is after all where a lot of mums spend their time, namely on their phones. If we can get this at their fingertips, then hopefully it will reassure families on what to do in case of childhood illness and ultimately reduce the number of visits to Emergency Departments, who have seen the number of visits, especially from disadvantaged families, increase year on year.”
“I have just attended one of these online workshops. The concept of the online health info specifically aimed at mums with young children is well thought through with a red amber green programme of what to do in each case whether an emergency (red) or something that can be dealt with at home (green).”
“If volunteers do not know about this scheme, then I would say go for it, and enrol for the online workshop. It's just an hour, very informal with the chance of interactive chat.”
Due to the nature of the individuals being trained i.e. volunteers, there needs to be flexibility with the times and dates that training is offered in order to capture them all. We were able to offer sessions at different times. One could consider recording a session for volunteers who were unable to attend the real-time session. Future plans could improve including more voluntary sector organisations to increase the reach of this work across local communities. In addition, expanding the range of topics to include mental health/emotional wellbeing in children and maternal health was requested by volunteers.
Overall, the benefits were significant. This collaborative approach between Healthier Together and voluntary sector organisations enables upskilling of volunteers already supporting the most vulnerable families within local communities to better support these families by offering information on health and wellbeing to the most deprived areas. This approach expands the number of people who know how to access high quality information ensuring that not only health professionals able to give out improve parental health literacy. We have achieved increased confidence levels in volunteers and are working towards a more self-reliant and well-informed community.
When we work with and alongside children and families,
rather than make decisions for them, we deliver far better care. This is the basis
of restorative practice; it is founded on the principles of working ‘with’
people, rather than doing ‘to’ or for others. If done well, it helps to build
trust between families and the organisations which are there to help them, encourages
families and young people to make safe and healthy decisions and decreases
crime and antisocial behaviour.
This project has brought together leaders from various
organisations involved in supporting families, including the NHS, local
government, social services, education and the criminal justice system. By
working together, they can improve the way that services are delivered across
This short video was produced by the Wessex maternity, children and young people clinical network
Clear to watch a video from Wessex Clinical Senate and Networks on Restorative Practice
1) Lees A, Tapson K, Patel S. A qualitative evaluation of parents’ experiences of health literacy information about common childhood conditions. Self Care 2018;9(1)1-15.
This article reports the findings from a
qualitative service evaluation of health literacy resources for parents of
children aged 0-4 on six common paediatric conditions (abdominal pain,
asthma/wheeze, bronchiolitis, diarrhoea/vomiting, fever and head injury). These
have been launched across Wessex as part of the Healthier Together (HT) project
and consist of a website and paper-based resources designed to provide easily
accessible facts about common childhood conditions, advice on actions to take
in the event of certain symptoms and when and where to seek medical help.
Eighteen semi-structured interviews were conducted to investigate parents’
experiences of and reactions to the resources. We investigated perceived
effects on parental understandings and feelings about childhood illness and
help seeking behaviours. We discuss findings under four main headings: Parental
interaction with HT resources, Parents’ anxieties concerning their children’s
health, Positive evaluation and Areas for improvement. Parents positively
evaluated the aims of the project and the information provided. A small number
gave examples of resulting behaviour change and several anticipated future
changes. Parents expressed anxiety about childhood illness and making treatment
decisions. They required simple and easy to navigate resources including
prominent risk assessment information. Communication by health professionals
that reassures and empowers parents was also seen as important. Whilst this was
a small study we believe that the findings are of relevance to others
producing, disseminating and explaining health information aimed at parents and
other patient groups.
2) Fake E, Lees A, Tapson K, Patel S. Parental views on the management of young children with respiratory tract infections in primary care – a pilot study. Self Care 2018;9(4)23-34
Local primary care data shows a 24% increase in the rate of acute
presentations with common self-limiting infections for children aged 0-4 years
between 2015/16 – 2016/17. As rates of serious illness have decreased, this
means increasing numbers of presentations could be managed elsewhere. Although
parents rarely expect antibiotics, they are often perceived to want them by
clinicians; potentially resulting in more antibiotic prescriptions and driving
future health-seeking behaviour.
To explore parent expectations, concerns and opinions about the primary
care management of children presenting with respiratory tract infections
Semi-structured interviews with parents of children aged 0-4 years
presenting to primary care clinicians with symptoms of a respiratory tract
infection. Analysis involved thematic review
Parents used experience or ‘parental instinct’ when deciding to consult;
this was due to seeing a similar illness before and receiving treatment, or
alternatively having never seen this illness and being unsure of what to do.
Parents saw the usefulness of written information describing actions to take
and when to consult when their child was unwell. There was an about even split
between those preferring paper and those preferring web-based resources. All
parents sought input from a clinician for reassurance.
Better understanding of parent expectations when consulting clinicians
with unwell children could facilitate a more effective consultation. Parents
expect reassurance about their child’s illness, but inconsistent advice and
management from healthcare professionals, such as prescribing antibiotics, act
to increase parental anxiety and potentially drives future health-seeking
behaviour. Changing the way clinicians communicate, including the use of
consistent messages, may have a positive impact during current and future acute
3) Donovan E,
Wilcox CR, Patel S, Hay AD, Little P, Willcox ML. Digital interventions for
parents of acutely ill children and their treatment-seeking behaviour: a
systematic review. British Journal of General Practice 2020; 70 (692):
Background Consultations for self-limiting
infections in children are increasing. It has been proposed that digital
technology could be used to enable parents’ decision making in terms of
self-care and treatment seeking.
Aim To evaluate the evidence that digital
interventions facilitate parents deciding whether to self-care or seek
treatment for acute illnesses in children.
Design and setting Systematic review of studies
Method Searches of MEDLINE and EMBASE were made
to identify studies (of any design) published between database inception and
January 2019 that assessed digital interventions for parents of children (from
any healthcare setting) with acute illnesses. The primary outcome of interest
was whether the use of digital interventions reduced the use of urgent care
Results Three studies were included in the
review. They assessed two apps and one website: Children’s On-Call — a US
advice-only app; Should I See a Doctor? — a Dutch self-triage app for any acute
illness; and Strategy for Off-Site Rapid Triage (SORT) for Kids — a US
self-triage website for influenza-like illness. None of the studies involved
parents during intervention development and it was shown that many parents did
not find the two apps easy to use. The sensitivity of self-triage interventions
was 84% for Should I See a Doctor? compared with nurse triage, and 93.3% for
SORT for Kids compared with the need for emergency-department intervention;
however, both had lower specificity (74% and 13%, respectively). None of the
interventions demonstrated reduced use of urgent-care services.
Conclusion There is little evidence to support
the use of digital interventions to help parent and/or carers looking after
children with acute illness. Future research should involve parents during
intervention development, and adequately powered trials are needed to assess
the impact of such interventions on health services and the identification of
children who are seriously ill.
4) Patel S,
Hodgkinson T, Fowler R, Pryde K, Ward R. Integrating acute services for
children and young people across primary and secondary care. British Journal of
General Practice 2020; 70 (693): 158-159.
Children and young people under 18 years of age currently
account for approximately 25% of attendances to primary and secondary care but
only 12% of hospital admissions. The fact that children are the most likely age
group to attend emergency departments unnecessarily suggests that high levels
of parental anxiety is driving health seeking behaviour. This observation
justifies initiatives to deliver integrated acute services for CYP which
achieve consistency across primary and secondary care. Consistent management
and safety-netting by healthcare professionals reduces parental anxiety, which
in turn reduces urgent care presentations by empowering parents to confidently
self-manage minor illnesses. Addressing this avoidable activity would relieve
pressure on our currently overstretched urgent care services, improving access
and quality of care to those who need it most.