Changing the conversation about health

The TalkLab

CoM Tags:

reading for health, get into reading, college of medicine,

Adolescents and front line professionals have co-designed a web based ‘app’ to coach professionals in how best to meet the communication and health needs of young people.

Everyone is welcome to see and download the app here.



Year established
Number of staff
1 paid staff (F/T equivalent).  2 days a week of a freelance design team who worked over 3 months to create the app.50 volunteers – young people, parents, front line workers from health, third sector and commissioning.
Number of users
Project went live in February 2013, in the process of specifically targetting three hospitals in North West London and rolling out to paediatric outpatient departments.
Is there a charge to users?
Free to users
How do you make your project sustainable environmentally and financially?
• The Paediatric Department of St Mary’s Hospital has committed to funding Sara Hamilton, to the project lead, to carry out postdoctoral research as an academic clinical fellow, 2 days a week for two years (Sept 2013-15). The focus of this role is service transformation, specifically in the area of patient involvement and keeping children out of hospital.• Our Paediatric department has recently applied for and been awarded Regional Integrated Care funding from NHS London, which has been matched by the 4 local CCG boards. There are very specific purposes of this funding which will support continuation of our project, namely:1) To embed local integrated care initiatives into commissioning strategies, particularly out of hospital strategies

2) To scale up and spread local initiatives

3) To provide funding for economic evaluation of integrated care initiatives of which this project is an example

4) To create the business case for developing more integrated care across the acute, primary and community and a governance structure to support that.

The NHS London work will draw directly on the learning from this co-production project.

User demographics
The project was funded by the London Deanery with training of Paediatrics doctors as the primary remit, but the relevance of the project to all professionals who work with young people is indicated by the breadth of audiences.We have already been asked to present to groups ranging from third sector to Special Educational Needs workers to GPs:National Childrens Bureau ‘Giving children and young people a voice in health: from good practice to common practice’ 25.3.13

Training day for SENCO workers on ‘Managing Difficult Conversations’ 20.3.13

GP training day on Adolescent mental Health April 2013

Allergy Nurse Specialist training day September 2013

How is the project innovative?
• We harness the potential within two huge ‘resources’ available to transform provision of care in the NHS – frontline staff and services users. The app takes a whole systems approach to improving patient experience and outcomes, the fact that it is being co-designed with patients and professionals ensures a product that is more likely to result improving engagement at an age when setting life long behaviour is key.• Socio economic status remains the biggest determinant of health at every age. Long term conditions represent the current ‘epidemics’. Our project tackles these two challenges by demonstrating that it is working with communities that the greatest potential exists to optimise care of long term conditions and incorporate lifestyle changes to prevent disease. Reactive medicine, set in the silos of primary and secondary care, needs to adapt and develop into a thoughtful, collaborative and integrated system of care, where patients contribute in equal partnership to the discussions and execution of plans on an individual or population basis.• The challenge we face is the dissemination and uptake of the app: we aim to do this by rolling it out across three outpatient departments and promoting the app via posters and lanyards for young people reinforcing the recommendations of the app
Patient centred, whole person preventative approach
‘The health and well-being of today’s children depend on us having the courage and imagination to rise to the challenge of doing things differently, to put sustainability and well-being before economic growth and bring about a more equal and fair society.’ Michael MarmotWe are seeking funding to empower adolescents to become ‘co-producers of health; autonomous partners in treating, managing and preventing disease.’

We face a challenge to use the finite NHS resources to meet the changing health demands of our population. The greatest burden of disease for local children consists of chronic disease and those in the lowest socioeconomic backgrounds have worse outcomes.

We have a choice: to allow the financial pressures to result in decreased quality of care and worsening staff morale, or to use them as a lever to fulfill the potential for interdisciplinary collaboration within the wider healthcare system and mobilise the full potential of our service users and local communities.

This project builds on work already carried out by the Paediatric Integrated Care Team. We harnessed the expertise and ideas of our frontline workers, our local community and the adolescents themselves and came up with the idea to create a coaching too in the form of a smartphone app.

This project is one of three projects we have successfully gained funding for based to recommendations the adolescents made. We are about to start work on co-designing a ‘transition’ app as a result of adolescents saying that the lack of for reliable information about their disease, pitched in an age appropriate way inhibits them from taking amore active role in their health at an earlier age.

Our third project addresses the issue of stigma, and this month we are performing at the Big Bang, the UK’s biggest science festival, a piece of physical theatre/high fidelity simulation co-designed with young people and health care workers showing a young person having an asthma attack and their pathway from school through to hospital and GP. This work will be taken to local school in May to inform their peers about what it is like to have a long term condition as many still suffer the consequences of stigma

Evidence-informed practice, audit and evaluation
The imperative to involve children and young people in decisions about their care is clearly documented in recent reports (Listening to children’s views on health provision A rapid re
view of the evidence Ivana La Valle and Lisa Payne May 2012).In on year since we first held co-production workshops we now have three grants executing the three main recommendations young people made about improving their well being.Our Definition of Co-Production – We believe that where professionals and users jointly design, deliver and resource solutions, then we all get a better deal (including better health outcomes for users and a better provider experience for professionals).

We recognise that people have huge resources themselves and through co-production we encourage the active use of those resources to work together to reshape services. We are in the process of evaluating whether we:

1) Treat all people as assets

2) Build social networks so that people get more connected

3) Make the most of people’s expertise gained through experience

4) Ensure the professionals’ behaviour reflects their role being to help people help themselves

5) Promote reciprocity or ‘give and get’ so that people who use services have a chance to ‘give’ as well as ‘get’ support

6) Reward peoples involvement in a way that values & respects their contribution

Multi-disciplinary collaboration, communication and professional practice
To target the key determinants of health: home, school and social environment, we formed relationships beyond the hospital boundaries in order to form an integrated care network. We have successfully engaged the expertise of: commissioners, third sector (eg. sickle cell society), BME groups, primary care, community champions as well as the adolescents themselves.
Some quotes from participants
Feedback from service users about what they gained from taking part in co-production workshops:‘good to be positive about things and talk about things more with other younger people’ GN aged 14 years‘ we can tell our stories ie speak for ourselves’ TT aged 17 years

‘to be believed’ FW aged 15 years

‘generate awareness that just because we don’t look like we aren’t sick or in pain, it doesn’t mean we’re not’ TB aged 16 years

‘its been very helpful just to know!’ IM aged 15 years

‘fabulous inspiring sessions’ FH aged 19 years

‘true participation- giving the people who have a condition a voice and a way of sharing what they need’ ZT aged 25 years

‘My daughter and I had a look at all the clips from the video and I just wanted to congratulate all those who was involved. The clips are great and informative, tailed for both professionals, young people and parents. Having looked at them all, have really allowed me to think about my role as a parent during my daughter’s consultation and the importance of encourage her to take a more active role. I have event started allowing her and entrusting her to attend some of her out-patients appointments by herself, which gives her more independence and control of her health care/ life. My daughter actually feels great about attending these appointments for her self and having to liaise with the professional without having to rely on me.’ A parent


Contact details
The TalkLab
Paediatric Department
St Marys Hospital
Praed Street
W2 1NYt: 078343 996 524