“Our work with Refero (based on work done with Health Innovation Manchester and others) will enable us to offer a common, collaborative platform of engagement between our team and other agencies looking after children and young people, enabling us to keep children and young people at the centre of everything we do."
James Evans, CEO and Director of Education at Community Mentoring and Support (CMAS)

Refero connects clinical workforces to patients, other carers and citizens, quickly, simply and cost effectively. It has been proven to work across organisational boundaries and is now NHS approved and is designed to work with standard technology toolsets already used (like NHS wide Contract Ref N365/Teams – which is Office 365, WebEx).

Refero augments and overlays them with minimal change and can be customised to fit clinical use cases/service lines already in place. Using Refero clinical Multi Disciplinary Teams (MDTs) can work anywhere, any time, on any device – putting the patient at the centre of care pathways.


  • Interoperates with standard systems of record (e.g. PAS/EPR), front-end systems.
  • Knits people, processes and appropriate data together – across locations.
  • Across local/regional organisations (to national level).

The key outcomes from the current use of the Refero system at St Helens and Knowsley NHS Trust (STHK) and other sites are:

  • Regional Secondary Care is now active across 60 STHK clinical service lines.
  • It has reduced DNAs by 70% – 180 per user, saving around £27,000 per user/pa.
  • It has been fully integrated into PAS.
  • It has reduced unnecessary travel – by up to £4,000 per user/pa.
  • It has provided improved clinical insight leading to better patient experience.

There has been 100% patient satisfaction, adoption/engagement (in appropriate settings).

Challenge/problem identified

The challenge addressed is better team working, to put patients at centre of connected care experience by improved communications between care provider teams and patient, with appropriately shared information and insight to improve patient outcomes. Long Term Condition (LTCs) account for around 70% of care budgets, 50% of GP appointments and 70% of bed days.

The impacts on patient health and wellbeing, caused by organisational boundaries (often with specific focus on single clinical pathways) are well understood. They (and associated risks) transcend local, regional, and national boundaries and create global health inequalities.

Refero’s solution needed to take account of many factors where boundaries needed to be deconstructed providing patients with more engagement in their own care experience. MDTs, often working separately, required bringing together and legacy systems and  interoperability issues needed accounting for.

Actions taken

Health Innovation Manchester (HInM) introduced Refero to key stakeholders and shared observations led to iterative development and testing of the platform, commercial model, and service delivery for use cases.

HInM coached on procurement processes, value proposition development, targeting different audiences and introduced Refero to stakeholders across regions (having identified relevant use cases).

Issues with systems interoperability were solved, mapping to individual use cases was much improved, making the platform work across all care settings. Outcomes were measured, and benefits realised, captured and scaled at pace, using a cloud based service-led approach.

HInM also introduced appropriate suppliers within their remit, to explore and develop ecosystem partnerships. This collaborative approach allowed further development relating to new and novel approaches for connecting patient families to the clinical staff when in isolation due to the coronavirus (COVID-19) pandemic. In care homes, connecting the carer (as a proxy) for the patient was developed. In a diabetic setting, a new and novel way of screen sharing information between clinician and patient (across disparate and locked-in systems of record) was developed.

HInM also identified Innovate UK funding (for an ICU setting, which was subsequently secured).

Evidence base


  • “For diabetes, patients benefited by avoiding journeys to hospital and allowing staff to see the patients’ surroundings, which can be useful, for example in diabetes, reviewing contents of their fridge at home” – Trust quote. A further benefit in the elderly was the reduced need for relatives to take time off to take them to hospital.
  • Patient responses were 100% positive – “I will never go back” to the old way.
  • Travel time (and associated) stress/cost impact reduced and/or eliminated (for patients/family).


  • Better physiological insight provided to clinician.
  • Proven reduction in DNAs. Measured cost: 180 per worker pa, saves around £27,000 pa.
  • Unnecessary travel, saving up to £4,000 per worker.
  • Unnecessary home visits. Measured time saving, up to six hours per visit.
  • Remote consultation. Measured time saving, up to 50% per session.

Economic Benefits

  • Acute – STHK from Proof of Concept on two use cases signed a new contract of £250,000 which extended across 60 service lines, and was embedded into Electronic Patient Record (System C). Service lines from primary care tbc.
  • Mental Health & Community – Essex Partnership University NHS Foundation Trust. Lessons learned from HInM and STHK translated across to establish a new contract of £150,000.
  • GP/Community – Sandbach, Middlewich, Alsager, Scholar Green and Haslington (SMASH) Care Community. Lessons learned translated across to secure contract of £15,000.


  • Innovate UK – £32,000 awarded. York Teaching Hospital. Use case: critical care patients in Isolation ICU.
  • Ecosystem partner around £50,000. Integration into Microsoft stack. Embedded into O365/Teams etc.


  • Two full time employees, two apprentices, one business development in 2020/21, likely to rapidly scale up.


  • Community Mentoring and Support (CMAS). Engagement re vulnerable excluded children.
  • Digital Health coverage.
  • Finalist HSN Health Tech Awards 2020.
Plans for the future

The Refero platform has been developed at pace and scale and service lines in use have expanded from two to over 60, across clinical use cases (and associated services). N365 is now a de facto standard. Refero is working in partnership with Microsoft to embed Refero within their standard Teams offer. This will allow Refero to be adapted and tailored to fit specific clinical use cases, at speed/scale across local, regional, and national settings. Once this programme is completed, Microsoft is looking to help promote adoption and benefits realised through co-selling mechanisms.

Which national clinical or policy priorities does this example address?
  • Care and Quality
  • Funding and Efficiency
  • Health and Well Being through better ways of working (and learning)
  • Driving Economic Growth through job creation.
Where did the innovation originate from?

Refero started in secondary care in the NHS, then primary and GP, and has encompassed industry developments by utilising standard global products (from market dominant players, like Microsoft and Cisco), then tailoring them to fit the specific requirements needed at local/regional level.

Refero is now moving into local authority (including social care and public health, for example vulnerable children services). Based upon lessons learned above as well as moving to higher education institutions (for student health and wellbeing, once away from their home settings).

Start and end dates
  • Started in December 2017, and accelerated through Step into Health workstream in 2018.
  • Next major step point is with symbiotic partnership involved in Microsoft development (Refero, Sota Consulting Group and Microsoft, taking account of work already done with Cisco).

Project contact for further information:

Nick Allen FCIPS, Industry Procurement Adviser, Health Innovation Manchester

E: Nick.allen@healthinnovationmanchester.com

T: 0161-276-5805

Media contact for further information:

Lucy Williams, Senior Communications Officer, Health Innovation Manchester

E: Lucy.Williams@healthinnovationmanchester.com

T: 0161 509 3872