“[Eastern AHSN have] been helpful with establishing system links which might have not been top of our priorities list, they might have been more difficult for us to establish because we don’t have them as existing networks, whereas they were able to bring them in."
Project Group Member
Overview

JustOneNorfolk.nhs.uk is a trusted multimedia educational initiative (e-learning / website, community forum, helpline, confidential chat service for children) available 24/7, empowering Norfolk parents to achieve the optimum health and wellbeing of their children (0-19 years).

Topics focus on community needs, for example materials for expectant and new parents to support the critical first 1,000 days – the foundation of a child’s health.

Partners include NHS Norfolk Children and Young People’s Services and Norfolk County Council.

Independent evaluation established:

  • Surveyed parents reported an increased confidence in managing their child’s health (Patient Activation Measure) by 3.8 points for those using the website
  • A quarter of professionals reported a reduction in unnecessary appointments. There was an 8% reduction in GP attendances by children and young people between September 2017-August 2018 and September 2018-August 2019 which represents a potential annual cost saving of £522,784 across the region. However, it is not possible to state that this reduction is specifically due to the Just One Norfolk approach
  • 88% of professionals reported the online resources replaced the need for printed materials.
Challenge / problem identified, and actions taken

Parents and carers reported a lack of confidence assessing their child’s health needs or selecting appropriate healthcare routes, citing consultation information as hard to digest and recall. This was predominantly due to if English was a second language, literacy and/or if the parent felt distressed or distracted.

Literacy is a key contributor. In England, 43% of working-age adults don’t have the adequate literacy to understand and make best use of everyday health information (known as ‘health literacy’)[1]. Children growing up in areas of Norfolk with weaker literacy levels can also expect to have shorter life expectancies.

The goal was to make information readily available, both to support consultations and to reduce unnecessary face-to-face visits with a health or care professional.

[1] 6 Rowlands, Protheroe, Winkley, et al. (2016), A mismatch between population health literacy and the complexity of health information: an observational study. British Journal of General Practice, 65(635): e379-e386

Actions taken

Key activities led by Eastern AHSN

Pre-launch:

  • Provided seed funding to develop, design and launch the initiative
  • Hosted monthly steering group calls to ensure sound strategic direction
  • Introduced a specialist maternal support group to help determine the best way to provide a peer support community
  • Supported a strategic launch communications plan.

Post-launch:

  • Supported a social media strategy to drive engagement, including buying Facebook reach, which proved highly effective in promoting the website and has changed the trust’s overall communications activity
  • Commissioned University of Essex to act as an independent evaluator of the initiative’s impact, including the introduction of patient activation measures to confirm an increase in parental confidence
  • Showcased the initiative to our networks and secured a shortlisting in the 2019 Health Tech Awards
  • Commercialisation support to develop a business model and enable further adoption and spread across the UK.
Impacts / outcomes

Quantitative outcomes

Since launching, JustOneNorfolk.nhs.uk achieved over 85,000 users, indicating there are at least 12,000 active users. Videos are a highly popular format and on average, after watching one video users went on to watch two or three more.

The resource has been utilised predominantly by non-English speakers, with Polish, Portuguese and Spanish being the most translated languages.

Parents using JustOneNorfolk.nhs.uk scored themselves at PAM (Patient Activation Measurement – used to assess patients’ confidence in understanding health) level 2 dropped slightly from 17 at baseline to 13 at review. There was also a corresponding increase in those scoring themselves at PAM level 4. At review, almost two thirds scored themselves at PAM level 3 or 4, an increase from just over half of parents.[1]

[1] Patients with lower levels of activation use significantly more health services. Healthcare costs therefore rise with decreased activation and reduce with increasing activation. US research has shown that healthcare costs reduce by 8% when PAM levels increase by 1 level and reduce by 15% when increased by 2 levels. Correspondingly, costs rise by 9% when PAM levels decrease by 1 level and by 18% when decreased by 2 levels.

Qualitative outcomes from focus groups

  • Healthcare professionals appreciate the additional support and as a reminder to the advice and information they would be giving.
  • This site can change font sizes, high resolution formatting for extra magnification and translates into 80 different languages. JustOneNorfolk.nhs.uk can also alter the language or read the page out loud.
  • Commissioners can see the benefits to outcomes for children and families from having a digital approach to universal services to free up or refocus clinical resource.

Highly commended at the Health Tech Awards, Self-Care Week Awards and the Leading Healthcare Award 2019 for Innovation of the Year.

[1] 6 Rowlands, Protheroe, Winkley, et al. (2016), A mismatch between population health literacy and the complexity of health information: an observational study. British Journal of General Practice, 65(635): e379-e386

Patient involvement

Public and patient involvement has been vital to the success of this initiative and we have been focussed to include the views and needs of members of the public, who have diverse health needs throughout.

Based on insights that peer support was of great value to this audience, we ensured that wherever possible the voice of patients was present to help parents feel they are not alone. This included the development of videos showing the experiences of local parents and an online support community, which has Community Ambassadors trained to manage queries that may arise on the site and ensure a positive and supportive community is maintained.

Parents continue to be involved with future developments of the site and we’re currently conducting further focus groups to help evaluate the project and establish its future direction.

Sustainability plans for the future

The project was awarded two years additional funding from Norfolk County Council Public Health (NCYP) to help the team continue working with other organisations to develop and introduce additional resources. NCYP plan to integrate the website as a permanent resource and are upskilling staff to maintain the website rather than employing external contractors.

Eastern AHSN will play a key role in supporting NCYP to develop a commercial model and identify other organisations who wish to implement a similar resource. Key to this will be the development of marketing materials to help enable other regions to collaborate on a similar initiative.

Which national clinical or policy priorities does this example address

Health and wellbeing  

The project supports the NHS Long Term Plan (2019) agenda to give children and young people a strong start in life and to improve maternal and neo-natal outcomes. (Chapter 3)

NHS England has a plan for supported self-management – to increase the knowledge, skills and confidence a person has in managing their own health. Eastern AHSN has extended this to include the self-care of children.

3.44 states that children and young people account for 25% of emergency department attendances and are the most likely age group to attend.

Where did the innovation originate from?

Frontline NHS team: www.justonenorfolk.nhs.uk

Which AHSN priorities does this example cover?
  • Mental health of children and young people
  • Reducing pressures on workforce.
Start and end dates

Start – April 2017

Eastern AHSN involvement end – November 2019

Continued support for commercialisation of product.

Contact information

Project contact for further information

Lou Jopling, Commercial Director

louise.jopling@eahsn.org

Media contact for further information

Charlotte James

Charlotte.james@eahsn.org

01223 661500