15 Nov 2022
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The future of AI: how Artificial Intelligence can transform health and social care service delivery
Artificial intelligence (AI) is already shaping the future, but what role will it play across health and social care research? And how can UEA Health and Social Care Partners support the development of digital innovation across our region?
Alex Church, Senior Programme Manager at NHS Norfolk and Waveney Integrated Care Board (ICB) introduces his new Partnership funded project AI System Support In Service Triage (ASSIST) and discusses how digital innovation has the potential to transform delivery across regional children and young people’s mental health services and beyond.
Collaborators on this project include Norfolk and Suffolk NHS Foundation Trust, University of East Anglia, MAP and Cambridge Community Services NHS Trust.
Could you tell us more about the need for this tool within our region’s children and young people’s mental health services?
Meeting the mental health needs of children and young people (CYP) is an urgent priority given recent steep increases in the prevalence of mental health difficulties and a corresponding escalation in demand for care.
In 2021, a national longitudinal survey of the mental health of CYP in England found that one in six children aged 5 to 19 years had a probable mental health disorder, increasing from between one and nine and one in ten in 2017. The same study found that 39.2% of 6- to 16-year-olds and 52.5% of 17- to 23-year-olds had experienced deterioration in their mental health since 2017.
Increased demand for support creates a major challenge for the already stretched children and young people’s mental health system.
Limited resources and increasing demand have resulted in long waiting lists for treatment across the UK, and a recent survey of GPs suggests that thresholds for accessing child and adolescent mental health services have increased in most areas of the country to prioritise those with only the most severe needs.
This creates a major barrier to help-seeking and to accessing care, often resulting in further deterioration in mental health and escalation in risk. Correspondingly, several studies have documented increases in the number of CYP presenting to emergency departments in mental health crisis since the start of the COVID-19 pandemic.
In Norfolk and Waveney, there are currently over 3000 CYP on waiting lists for mental health services. Without innovative whole-system solutions, we anticipate that waiting times for treatment will continue to rise as demand continues to outweigh capacity.
At present, considerable clinical capacity in the CYP mental health system is dedicated to managing and triaging referrals. When a referral is received by a service, a clinician must manually assess and triage each referral, a process that can take up to three hours.
Often referrals either do not contain sufficient information for a safe triaging decision to be made or do not meet the criteria for that particular service and will subsequently be returned or rejected. Currently 60% of CYP mental health referrals from primary care in Norfolk and Waveney are rejected.
This wastes many hours of professionals’ time (both the mental health clinician’s and the referring professional’s) that could be spent providing care and support. Moreover, resultant delays cause considerable distress for CYP and their families who can face a wait of 18 months or more before receiving the support they need.
We believe that digital innovation has the potential to transform the referral and triage process across the CYP mental health system. This project would contribute to this transformation through exploring the role Artificial Intelligence (AI) could play in supporting clinicians to triage and assess referrals more efficiently.
This would free up additional clinical capacity, thereby ensuring that more CYP are able to access the mental health support they need, when they need it.
How can digital innovation, particularly Artificial Intelligence, improve service delivery in this context?
The vision for children and young people’s mental health in Norfolk and Waveney includes the principles of ‘no wrong door’ into services, the elimination of gaps in service provision, and system ownership of the person in need.
To achieve this vision, it was clear that a core element of the future service model must be easy access via a single phone number and website, with a single initial screening/assessment process for all CYP with mental health needs, i.e., an integrated front door (IFD).
This project would explore the potential for Artificial Intelligence (AI) algorithms to be used within the IFD to help clinicians screen referrals and recommend the most appropriate pathway of support.
Research capacity building funding from UEAHSCP would enable us to bring together the team’s existing networks of CYP mental health clinicians, operational managers and commissions, academics, innovation specialists and industry professionals.
These stakeholders would work together to develop the clinical scoring system and service inclusion/exclusion criteria framework that would be needed to build a prototype AI algorithm. We would then test the effectiveness of the AI module in a sample of referrals in preparation for future research.
We would also explore the feasibility of creating a live dashboard to inform the IFD team on any changes to provider circumstances that may affect their ability to process referrals in a timely manner. This would require all providers to flow regular metrics to allow us to keep this dashboard updated.
How will your work make a difference across our community?
The impact of our project will support CYP, and families receive the right support at the right time and help professionals navigate the complex offer of support for CYP MH across health and social care, including the voluntary and community sector.
Consultation with families and CYP has made us aware of how difficult it is for families to understand the offers of care available and how to access them. Primary care colleagues have also feedback that they are unaware of other offers of care available and often default to referring to specialist CAMHS services, risking the referral being rejected or the young person being placed on a long waiting list.
Developing the framework and mapping our services will allow us to open up referrals wider than specialist CAMHS and use innovation and technology to support the referral processes.
How do you plan to disseminate the results to make sure you can share the impact of the work at scale to benefit other regions outside of East Anglia?
I have spoken to different CYP MH systems from the Midlands, Yorkshire, London and the East of England who have all expressed an interest
in this work and can see how effective it could be in supporting referrals into CYP MH services. I have committed to keep them all updated on progress and present as and when milestones have been reached.
I have also discussed the possibilities of a national community of practice with colleagues at NHS England. Any technology developed can effectively be lifted and shifted to work in other areas and we will factor in interoperability with other systems during the scoping and wireframing phase.
What are the key challenges we are currently facing in developing research culture?
I feel our ability to work at pace across organisational boundaries can often be quite challenging, we are also sometimes reliant on people’s time who are supporting the project whilst often juggling many other commitments.
It is vital we work through these barriers as best as we can though, as conducting research allows us to trial new ideas and innovations that can often make a positive impact on the communities we serve.
Alex’s Biography:
Most of Alex’s career has been focused on digital transformation, innovation and system transformation. This has been as a consultant, an SME owner, a leader on behalf of the system, and within the NHS.
It has been working independently, but also leading multi-agency, multi-disciplinary teams. He was the Founder of two health and care digital innovation organisations and a social enterprise which focuses on youth development, co-production, social mobility and employment.
Alex is also a trained psychotherapist / counsellor and uses his clinical understanding to aid his transformational programmes as well as supporting individuals. In his current role working for Norfolk and Waveney ICB, Alex leads a team delivering on a system wide transformation programme focussing on improving access, pathways, digital interoperability and data within Children and young people’s MH services.
To find out more about this project, contact alex.church@nhs.net.
You can connect with Alex on LinkedIn.
Alex Church’s ASSIST project was awarded funding as part of UEAHSCP's latest funding round, which saw nearly £165,000 invested in ten regional research projects which address deep-rooted issues across local health and social care services.
The funding, made possible by UEAHSCP’s partner organisations, will provide a launchpad for researchers to develop ideas that can tackle the most pressing challenges facing local health and social care services.
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