Competition opens: 3 April 2017

Information session for interested applicants: 19 April 2017, Edinburgh. Register here by 10 April 2017

Registration deadline for entering competition: 15 May 2017

Phase 1 application deadline: 29 May 2017

The goal of this challenge is to create a new approach or mechanism which will enable:

• Clinicians and the NHS to identify individual patients or groups of patients and obtain their responses to questions at specified time points in their cancer care pathway. Questions may be about their health, their quality of life, their experiences of care, their treatment or associated outcomes.
• Patients to conveniently respond to questions and provide information to the NHS in a safe, secure, private and trustworthy way.
• The NHS and clinicians to efficiently and easily collate, analyse and use information reported by patients in a timely way and within the existing NHS infrastructure.

The purpose of the innovation will be to integrate patient reported outcome and patient experience data into Scotland-wide health care processes to:

1. Improve experiences of treatment, care, and personal outcomes
2. Understand the clinical and psychosocial impact of new and established cancer treatment
3. Make better use of NHS resources by reducing waste and inefficient practices
4. Accelerate the adoption of new technologies into the NHS through efficient evaluation mechanisms
5. Create high value research infrastructure with global reach

A solution is required that is well designed and simple to use, both for patients and health care professionals, which is accessible from within existing components of the eHealth architecture. We do not seek to duplicate existing solutions or research showing how PROMS and PREMs can improve care and are of value to clinicians, patients and health services. The key goal of this challenge will be to provide an implementable solution that can directly benefit Scottish patients and is acceptable and desirable for use by patients, clinicians and policy makers.

In this competition, we are not funding projects that:

• duplicate existing solutions or research showing how PROMS and PREMs can improve care and are of value to clinicians, patients and health services.

To lead a project you must:

• be an organisation of any size based in the European Union (EU) and can demonstrate a credible and practical route to market
• work alone or in collaboration with others (businesses, research base and third sector)

The Cancer Innovation Challenge has allocated up to £325,000 (inc VAT) to fund innovation projects in this competition.

This is divided across 2 Phases:

• up to £125,000 (inc VAT) is for Phase 1
• up to £200,000 (inc VAT) is for Phase 2

Phase 1

In Phase 1 you will show the technical feasibility of your proposed innovation. Projects can range in size up to a total cost of approximately £25,000 (inc VAT) each. Development contracts for feasibility studies should last up to 3 months. Phase 1 will have total funding of up to £125,000 (inc VAT).

In the Phase 1 proposal, applicants should include their goals and an outline plan for Phase 2. This should cover testing in a live NHS system in Scotland. Proposals should also include an explicit plan for full commercial implementation.

Phase 2

Phase 2 is only open to applicants that have successfully completed Phase 1. In Phase 2, you will develop and evaluate prototypes of the more promising projects completed in Phase 1. Projects should last up to 6 months. Projects can range in size up to a total cost of £100,000 (inc VAT) each. Phase 2 will have total funding of up to £200,000 (inc VAT). Phase 2 should involve testing the shortlisted solutions in live healthcare settings. Relevant NHS Scotland contacts will be provided to applicants to arrange this. Successful proposals must demonstrate the ability to test at these facilities.

To apply:

Register and apply online. Please note that you once registered, you can submit more than one proposal.

• Read the Invitation to Tender and other associated competition documents (accessible once you register to apply) 
• Register online to attend the information session for interested applicants on 19 April 2017
• Complete and submit an online application for Phase 1. You must complete a separate application form for each innovation proposed

We will not accept late submissions. Your application is confidential.

A panel of selected experts will assess your proposal. We will then choose the best proposals from those that meet the aims of this competition.

If you need more information, please contact info [at] cancerchallengescotland.com (subject: PROMs%2FPREMs%20funding%20call%20query)

Read the general Guidance for Applicants (accessible after registration) carefully before you apply. It will help your chances of submitting a quality application.

What are PROMs?

Patient Reported Outcome Measures (PROMs) are “standardised validated instruments (question sets) to measure patients’ perceptions of [factors such as] their health status (impairment), their functional status (disability), and their health-related quality of life (well-being)”. p1, A Guide to Patient Reported Measures– Theory, Landscape and Uses, Monmouth Partners

What are PREMs?

Patient reported experience measures (PREMS) are used to understand patients’ views on their experience while receiving care, rather than the outcome of that care. Using information on both patient experience and outcomes enables us to have a broader understanding of service quality from patients’ viewpoint. It may be possible to have a service which provides good outcomes but a poor experience, or a good experience but poor outcomes. Reay N. How to measure patient experience and outcomes to demonstrate quality in care. Nursing Times 2010; 106: 7

The goal of this challenge is to create an approach or mechanism which will enable:

• Clinicians and the NHS to identify individual patients or groups of patients and obtain their responses to questions at specified time points in their cancer care pathway. Questions may be about their health, their quality of life, their experiences of care, their treatment or associated outcomes.
• Patients to conveniently respond to questions and provide information to the NHS in a safe, secure, private and trustworthy way.
• The NHS and clinicians to efficiently and easily collate, analyse and use information reported by patients in a timely way and within the existing NHS infrastructure.

The purpose of the innovation will be to integrate patient reported outcome and patient experience data into Scotland-wide health care processes to:

1. Improve experiences of treatment, care, and personal outcomes
2. Understand the clinical and psychosocial impact of new and established cancer treatment
3. Make better use of NHS resources by reducing waste and inefficient practices
4. Accelerate the adoption of new technologies into the NHS through efficient evaluation mechanisms
5. Create high value research infrastructure with global reach

In addition to saving lives or improving survival, the treatment of cancer aims to improve the quality of life for people who are affected. Quality of life is influenced by most aspects of cancer and its treatment. Many people are familiar with the symptoms of cancer, side effects of drugs and radiotherapy or complications of surgery, but these can affect people in different ways. Other aspects can also influence quality of life such as the experience of the NHS service, effects on families, personal finances or other psychological and social factors. Once treatment is over, patients often have to deal with physical, psychological and practical changes affecting everyday activities, relationships, work and wellbeing. Some of these changes can pose long term challenges and difficulties.

Many of these ‘outcomes’ are personal to the individual and are best evaluated by the person themselves, rather than by members of their health care team. Patient reported outcome and experience measures (PROMs and PREMs) have been developed to enable patients’ subjective reports and experiences of health, illness and treatment to be measured consistently and accurately.

The routine use of PROMs and PREMs offers a real opportunity to improve the relevance and value of NHS cancer care. There are two main ways that this may be possible:

1. The capture and analysis of PROMs and PREMs across local or national populations of patients, alongside other outcomes such as complication rates, waiting times and survival, in order to improve the quality of NHS care through policy and service design.
2. The capture and recording of PROMs and PREMs within the clinical record for direct use by a clinician in the care of an individual patient (for example, in the same way as clinicians might use the results of blood tests). 

We seek solutions which would allow patients to provide PROMs and PREMs routinely and integrate these into relevant NHS datasets. The objective is to enable health care professionals to use PROMs and PREMs alongside clinical data, to understand the daily difficulties that patients face on a daily basis and to enable the NHS to plan more effective care and interventions across Scotland. We seek to use PREMs alongside other health service evaluation metrics.

A solution is required that is well designed and simple to use, both for patients and health care professionals, which is accessible from within existing components of the eHealth architecture. We do not seek to duplicate existing solutions or research showing how PROMS and PREMs can improve care and are of value to clinicians, patients and health services. The key goal of this challenge will be to provide an implementable solution that can directly benefit Scottish patients and is acceptable and desirable for use by patients, clinicians and policy makers.

• Information Governance and data protection: A clear strategy needs to align with current NHS frameworks.
• Sustainability: Long-term maintenance (technology, cost), compatibility with existing infrastructure, future-proofing the solution.
• Adaptability: There needs to be an ability to change the questions that are asked, and change the mechanism of capture over time, vary this over time and be relevant to both PROMs and PREMs capture.
• Compatibility: Current NHS technology standards and software versions are variable.
• Equity of access: Variability in socio-economic, literacy, ethnicity, rurality, age, disability, long-term conditions, co-morbidity and other sources of inequality all need to be considered.
• Human factors: Integration into patient lifestyle and clinical workflow is essential for adoption. Clinicians are unlikely to have time to log into a bespoke system.
• National policy and analytics integration: There is a need to be mindful of rolling analytical and audit processes and how cancer PROMs will contribute to this.
• Training: How will adoption of the solution be supported
• Scottish National policy context: There is a need to be mindful of the National Cancer Strategy, the Montgomery review, integration of Health and Social care and the Scottish CMO’s report Realistic Medicine, in line with the Choosing Wisely global initiative.

The NHS has recently approved a new and very expensive immunotherapy for advanced lung cancer. A key factor influencing the approval decision was improvements in quality of life demonstrated in clinical trials. Because the Scottish NHS routinely collects quality of life PROMs from patients who go on to receive the treatment, it is able to monitor the effects of the drug on quality of life in a routine NHS setting. This enables the NHS to confirm that patients and taxpayers are getting the expected value for money from the treatment.

Tom completed radiotherapy and chemotherapy for head and neck cancer two months ago. Although he is starting to feel a bit better, his swallowing has been badly affected by his treatment and he is unable to swallow any solid food. He lives a long way from the cancer centre and he is completing a patient reported outcome measure called the MD Anderson Dysphagia Inventory each week on his phone. This is transferred to the Speech and Language Therapist and Dietitian at the hospital, who are able to suggest more appropriate exercises, diet and support for Tom so that he can continue to recover.

Ken is a widower and has been treated for depression in the past. He had treatment for prostate cancer a year ago, which resulted in some urinary problems and a worsening of his depression. His GP calls in to see Ken every six months to find out how he is getting on, but he knows that Ken tries to put on a brave face when he visits. Ken fills in an online questionnaire about his health every 3 months as part of a national cancer survivors audit programme. Because this data forms part of Ken’s clinical record his GP is able to get a detailed picture of how he is really getting on before he visits. One questionnaire assesses his urinary function, and the other assesses how his depression is affecting him regularly. Several years on, the same data will alert the Scottish NHS to the fact that rates of urinary problems after prostate cancer treatment vary a lot between hospitals. This has enabled a programme of service improvement in underperforming hospitals.

Gina has recently undergone a major resection of her bowel after a cancer diagnosis. She is getting used to managing a stoma and is just getting comfortable with this. She is now having an initial assessment for chemotherapy and her Clinical Nurse Specialist is concerned that the drugs may cause diarrhoea. She wants Gina to monitor her bowel movements daily, alongside other side effects of chemotherapy. Because Gina is able to record this directly on her phone using an app, her nurse is able to keep an eye on things and phone Gina to offer timely advice that prevents the diarrhoea getting out of hand.

Elsie completed her treatment for breast cancer six months ago. She has put on a lot of weight and thinks this is due to her hormone therapy. She really wants to lose weight and asks to attend the breast cancer exercise programme available in her area. Using her PROMS app, she can record weekly weights, exercise diaries and quality of life assessments on her phone. She finds it motivating to see how much things are improving. Because cancer survivors across Scotland are recording the same information using a variety of apps, diaries and also at clinic appointments, the Scottish NHS has become aware of the problem and acts by setting up dedicated lifestyle classes for cancer survivors.

Hamish has advanced lung cancer with a secondary cancer deposit in the bones of his spine. The pain had improved significantly after radiotherapy 4 months ago but is now getting worse again. The community palliative care team are finding it difficult to get the dose of his morphine right as the pain seems to fluctuate considerably from day to day. Hamish has started to use a smartphone app to record his pain level every time he needs to take extra morphine. This app is helping him and his palliative care team to get his pain better under control. Because his oncologist at his local cancer centre is also able to monitor his pain scores she knows that it is time to send Hamish a clinic appointment to discuss a second dose of radiotherapy.

The future could look like any or all of these… or something else entirely.

SBRI provides innovative solutions to challenges faced by the public sector. This can lead to better public services and improved efficiency and effectiveness. SBRI supports economic growth and enables the development of innovative products and services. It does this through the public procurement of research and development (R&D). SBRI generates new business opportunities for companies and provides a route to market for their ideas. It also bridges the seed funding gap experienced by many early-stage companies.

Applications must have 50% of the contract value attributed directly and exclusively for R&D services.

R&D can cover solution exploration and design. It can also include prototyping and field-testing the product or service. R&D does not include:

• commercial development activities such as quantity production
• supply to establish commercial viability or to recover R&D costs
• integration, customisation or incremental adaptations and improvements to existing products or processes

You can also see some FAQs about SBRI on the SBRI Framework page

Directions on how to enter this competition can be found in the Invitation to Tender document available after registration.

If you want help to find a project partner, contact the Knowledge Transfer Network or Scottish Enterprise

If you need more information, contact info [at] cancerchallengescotland.com (subject: PROMs%2FPREMs%20funding%20query)

 or submit a question on the Q&A page and an answer will be published shortly.

We recommend that you watch the video of the proceedings from the Information Session held on 19 April 2017