Carelink provides platform for Berkshire Healthcare NHS Foundation Trust

It was designed by patients and clinicians at Berkshire Healthcare NHS Foundation Trust and has been in use for seven years. It benefits from accumulated, evaluated evidence and data from patients, NHS clinicians, NHS professionals, relatives and carers, service users, ex-service users, voluntary service professionals and other professions such as social workers.

The first of its kind and funded by the NHS, SHaRON stemmed from a sense of frustration at the idea of ‘office hours’, when mental health issues can strike at any time day or night. To address this, an always available, 24/7 solution was required.

As well as the limitations of ‘office hours’, there was an understanding that those with mental health issues or eating disorders rarely share their journey. People weren’t getting to hear from others in a similar situation who may have got well again.

In addition, once someone was deemed well enough to leave therapy, there was no constant place for them to go for support, often leading to crisis again. Berkshire Healthcare wanted to provide a safe, secure and comfortable environment for service users, relatives and carers alike to talk and support each other. From recent surveys carried out, over 80% of SHaRON users agree that it has been helpful in their recovery and national re-referral rates for Anorexia are 30-50% compared to Berkshire’s figure of less than 10%.

Jonathan Burton, Digital Services Manager at Berkshire NHS Trust says: “It is not unknown for people with eating disorders to be in and out of treatment for tens of years. A lot of resources get invested into helping patients in treatment but then they go back into the real world with little ongoing support, and hit crisis again – it’s like a revolving door. With SHaRON, we can help address this and track progress. Someone may use the application heavily, and then eventually stop. If after a time, they return, this will be flagged to us and we can intervene early to catch them before their situation becomes serious. In addition, because we are also able to track key words such as ‘cutting’ or ‘purging’, we are able to manage those most at risk.

“From a user perspective, think of SHaRON like a building. You need a key to get in, and once you’re in that building, your key will let you into specific rooms. As a clinician or moderator, you will have access to every room. As a patient, you will have access to the rooms or information directly related to your illness. For example, it would not be appropriate to have those with anorexia in the same room as those with bulimia, so they are in separate rooms. Within the building, there is a ‘living room’ where patients can talk in real time to others undergoing treatment and those who have recovered. They will also find a ‘library’ where they can view relevant accredited documentation about their illness and a ‘television’ where they can view video content on self-support and home therapies.

“The application is also used by our own staff anonymously – to report bullying, and whistleblowing and for general mindfulness.”

A regional Health Economics study has shown net savings per patient (18+) per year of ?4,496 for Berkshire when compared with other services in the region. This amounted to total savings per year of ?715k for Berkshire’s Clinical Commissioning Groups (CCGs).

No cutting corners

The SHaRON application is provided and supported by Carelink. It’s a robust, mission-critical, secure platform, hosted on high availability virtual servers with resilient SAN storage, holding a vast amount of hugely sensitive data related to its patients and clinicians.

Mr Burton said: “We think of the Carelink infrastructure like our bank vault. The data centre level of security provided by Carelink is no different – it’s as resilient as it could possibly be – we believe it to be world class. Of course, you do pay for infrastructure such as this, but for the level of service, value and return on investment (ROI) it’s worth it. When you’re dealing with data as highly sensitive as ours and delivering a service that patients depend on, you don’t cut corners.”

Referring to the recent WannaCry NHS ransomware breaches, Mr Burton continued: “We had no issues whatsoever with WannaCry. We heard some bad stories and a few organisations got hit really badly. That’s why we invest in our secure infrastructure.

“Of course, the data we’ve got on our system is extremely sensitive but we know it is safe with Carelink, who we’ve been working with since 2005. They have been so supportive. We have direct access into senior teams and they make us feel safe.”

Carelink also holds regular penetration testing activities – trying to find any possible weaknesses within SHaRON. If found, the issue is immediately patched and the Berkshire Healthcare team updated. It’s because of features like this that Burton says he is ‘reluctant to move elsewhere’.

An exemplary application

SHaRON has been successfully integrated into Berkshire Healthcare's Eating Disorders, Talking Therapies services and as a support to relatives and carers of those with mental health conditions since 2010.

Berkshire Healthcare was awarded Global Digital Exemplary (GDE) status by NHS England - SHaRON was included as a part of that application. This status delivers a funding stream of ?5m over three years into the Trust help to deliver digital transformation.

There are also plans to expand the use of SHaRON into four additional mental health services at Berkshire Healthcare, as well as making it available to other interested NHS Trusts. This innovation was a finalist for the EHI Awards in 2013.