Support Hope and Recovery Online Network

Key Instrument

The SHaRON system came online in 2009 and has been a key instrument for changes in how the Eating Disorders Service is delivered in Berkshire Healthcare Foundation Trust, so much so that other departments have now chosen to adapt the SHaRON system for use in their services; the Perinatal Subnet based on the SHaRON Platform was launched in March this year and has already supported 350 users.

The Clinical Innovation Adoption team identified the SHaRON system for inclusion in our first list of innovations for adoption within the region based on it being an excellent solution that supports a difficult to manage condition that results in patients often rotating in and out of hospital for many months/years and having little or no support once discharged from mental health care.

Selection of innovations for diffusion across the region is based on a number of factors including clinical opinion and business management commitment, patient and user involvement in the design and evidence that the innovation is providing benefit in terms of quality of care and efficiency. SHaRON was a clear winner for clinical commitment and patient involvement; Also, all clinical staff within the BHFT ED service now use the SHaRON system (it’s written into their job specs); the executive are on board with its’ value: the IMT department are providing continuity of resources and significant investment – and with a great deal of insight and acted upon intuition, the system was and continues to be “co-produced” and is delivered with patients since 2009 – way ahead of recent thinking on “co-production” with patients: Surprisingly though, spreading adoption has been extremely challenging.

The CIA team reviewed barriers to change for this innovation. One of the key reasons for other trusts saying that they would not adopt was that the case had not been made on evaluated “evidence” of benefit; Other than patient experience, little attempt had been made initially to collect data on the benefits in financial terms – mainly because as a “home grown” system, the focus was more on internal service development and quality for patients.

Strengthening the case for adoption

To further strengthen the case for adoption elsewhere in the region, the CIA Team worked with Janssen and Janssen and BHFT on the health economics based around comparators such as the number of ED patients who stay out of hospital or suffer with relapses across the region. As service configuration was mainly the same within different regional providers – patient data was cleansed to compare numbers patients with ED from local areas (Berkshire, Bucks, Oxford and Milton Keynes) against inpatient and outpatient bed days. The SHaRON system remained the key difference and enabled us to get some indication as to whether 24/7 support for Eating Disorder patients actually made a difference to their recovery and the bottom line. The tables below gives an example of the key findings.

Commissioning of Young SHaRON service

“Young” SHaRON was commissioned by Berkshire West CCGs for development and use by the wider Children Young People and Families workforce, including perinatal services, health visitors, school nursing, Looked After Children, Children’s Services and Child and Adolescent Mental Health Services. This will be a long term transformational change, expected to cover a period of 5 years with Young Person’s SHaRON as a central component of the transformation plan. Young SHaRON is up and running for perinatal and CAMHS.

Other Developments

The SHaRON platform is made up of secure subnets for individual services and more services are thinking about how the system could support them. SHaRON subnets now include:
CAMHS/Local Authority training for teachers on how to detect distressed children and CBT basic techniques now use a subnet as a safe learning space that is shared with schools, social workers, police and the trust.

• There are subnets for carers for both Eating Disorders and Perinatal care clients.
• A subnet for Trauma services for veterans
• A subnet for relatives and carers of people with Aspergers. A charity for Aspergers in Berkshire has volunteered to work within a subnet with social workers and other LA professionals to support families facing difficulties.
• “First Step” Subnets are for patients and carers awaiting their appointment for any Mental Health Service. Patients are assigned to the appropriate subnet where there is information on the condition, the service, videos and other advice and guidance.

Future Adoption

Best Practice – National Collaborating Centre for Mental Health (NHSE commissioned) – guidance July 2015

The Early Intervention for Young People with Eating Disorders publication in October 2015 and the funding provided to pump prime implementation of quicker access has created a renewed interest in the SHaRON System.

There has also been some serious expressions of interest to adopt the system from Trusts and regions outside of the Oxford AHSN region. The door remains open for others to adopt SHaRON and the CIA team will continue to support this project as required by the Trust.