This case study features in the NHS Innovation Accelerator’s year three research report, Understanding how and why the NHS adopts innovation.
Sleepio uses the latest digital technology to deliver the ingredients of Cognitive Behavioural Therapy for insomnia (CBT-I) – the gold standard approach to treating insomnia. CBT-I is a talking therapy involving learning cognitive techniques to address the ‘racing mind’, and behavioural strategies to help re-set sleep patterns naturally. CBT is traditionally delivered face-to-face but there is a shortage of in-person CBT within the NHS.
Sleepio users are guided through a series of weekly interactive sessions by ‘The Prof’, a virtual sleep expert, and his narcoleptic dog, Pavlov. Sleepio is clinically proven to help overcome the worry and negative emotions that accompany the experience of being unable to sleep. Sleepio can be accessed via both web and mobile applications. It also offers access to electronic research articles, online tools and an online peer-support community. Sleepio has also been used to treat common mental health disorders and has exceeded national recovery rates for anxiety and depression .
Background to the Good Thinking Service
For some time, London CCGs and local authorities had been aware of the scale of mental health problems across the capital and that there were long waiting lists for accessing psychological services (IAPTs).
The then London Health Board – a grouping chaired by the Mayor of London, with representation from local government, NHS and Public Health England (London) – were keen to identify digital solutions to address the high rates of unmet mental health issues in London. Under the Board’s auspices, a working group developed a business case for a digital mental health solution.
This aimed to develop a preventive approach where people could get 24/7 access online to peer support and digital evidence-based interventions. Funding was obtained from London’s CCGs and over half of its local authorities, with in-kind support from Public Health England and NHS England. Originally known as the London Digital Mental Wellbeing Programme, it was later branded (following work with users) as ‘Good Thinking’.
The aim of Good Thinking was specifically to target people with common mental health problems who do not necessarily want or need to see their GP, but who could benefit from peer-to-peer and self-help online support. Recognising the stigma of accessing services for ‘mental health’, the programme decided to begin with a generic issue common to a number of mental health issues, and one which carried no stigma: sleep.
Looking at the demographic least likely to engage with offline services, Good Thinking aimed to target young men, aged 18-44, who were online, in medical distress and who could be directed to online support. The services wanted to incorporate a range of apps that Londoners could then select from.
Having made the decision to focus on sleep, Good Thinking looked to the market place for available sleep/insomnia apps.
Tower Hamlets CCG was appointed as the lead commissioning organisation. A mental health commissioner at the CCG who had experience of working on several digital projects, was recruited to develop and implement this new digital mental health program. The mental health commissioner sought to manage risks by engaging in conversations with different digital service providers with credibility, and with well-developed products that had already been through various types of NHS assurance processes.
They were looking to include interventions where there was evidence that people wanted to use them, with good user experience and clinical validity. One of those interventions was Sleepio. Initially, discussions were informal to identify teams, companies and organisations that would be interested in working together to test online journeys and public demand. Sleepio responded positively and worked collaboratively towards developing and testing a solution that would meet the aims of the project.
Individual champions: A number of individual champions (such as personal interest, previous experience of digital projects, working in the field of mental health) from a range of disciplines, from different parts of one organisation, and from different organisations, working collectively to a shared agenda.
Focussed senior level steering group: The establishment of a high-level steering group with clear drive and vision, and the continuity of the same senior people from across the partner organisations within this group to maintain focus, secure funding and oversee implementation.
Credibility of the innovation: A well-developed product, with high-quality evidence, had an established network within the NHS, and had endorsement from bodies such as the National Institute for Health and Care Excellence (NICE) and the NHS Innovation Accelerator (NIA).
User-driven development, utilising iterative methodology and having a strong collaborative relationship between the innovator and the adopting organisation(s). Both Sleepio and the Good Thinking team working iteratively to develop an optimal approach.
Following detailed negotiations and partnership activity throughout 2017, a contract was signed towards the end of 2017. Unlimited access to Sleepio is now available to NHS patients living and working in London via the Good Thinking portal. This portal is aimed at both preventing mental ill health and enabling Londoners to access evidence-based online self-help treatment. Sleepio has a significant presence on this portal. The impact with regards longer-term beneficial population outcomes will require more time and further investment to support detailed evaluations.
The adoption of Sleepio as part of the wider Good Thinking service proved to be a highly dynamic and iterative process. It has required extensive stakeholder management and considerable resource to maintain the commitment of the partners throughout a long development phase. A pooling of funding contributions from CCGs, Local Authorities along with in kind support from Public Health England and substantial resource allocation from Sleepio, has played a significant part in facilitating the various stages of development and in maintaining momentum towards adoption.
1. Sophie Bostock, UK Innovation Lead, Sleepio, and NIA Fellow
2. Dr Richard Graham, Clinical Director, Good Thinking
3. Paul Plant, Deputy Director, Public Health England, co-initiator of business case for Good Thinking, and Lead of Public Health England’s evaluation of Good Thinking
4. Name withheld, East London Health and Care Partnership, Good Thinking (previously)
5. Name withheld, Harrow CCG, Good Thinking
6. Name withheld, Kings College London
7. Name withheld, Office of London CCGs, Good Thinking
8. Name withheld, Public Health England, Good Thinking