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Outcome measures (DIALOG and HoNOS)

Measuring outcomes provide a way for patients, clinicians and the health and care systems to understand the impact of the care provided. Outcome measures can be used to identify patient needs and understand the effectiveness of any care or treatment. They can also be used to measure health outcomes for a local population through ‘system process’ outcome measures.

In London, we are supporting the implementation of DIALOG as the London patient reported outcome measure (PROM) which is an assessment of health status and health-related quality of life that comes directly from the patient.

What is DIALOG?

DIALOG is a set of 11 questions where service users are asked to rate their satisfaction and needs for care across different parts of their life and treatment. It helps to guide a structured conversation between a health professional and service user that is patient centred with a focus on change.

Why does DIALOG exist?

DIALOG is simple to use and it enables proactive, personalised conversations at an individual level, supporting self-management and helping service users move forward with their journey of recovery. It has also been used to help inform the redesign of care planning processes within mental health services.

Capturing this information also gives a powerful indicator of patient satisfaction levels where health and social care services need to focus for improvement.

How to use DIALOG

Service users are asked by health professionals to complete this survey using pen and paper, or on a computer, iPAD or phone.

Who is DIALOG for?

This survey was initially rolled out for people within early intervention services and for those receiving a Care Programme Approach (CPA) package of care. The use of DIALOG can be extended to other mental health services including adolescents, older adults and primary care.

How often should DIALOG be used?

As a minimum, it is recommended that DIALOG is completed at the start of an episode of treatment, at review and at the end of an episode.

What is DIALOG+?

DIALOG is the tool and DIALOG+ is a specific intervention that uses the DIALOG scale and a 4- step approach based on solution-focused therapy.

DIALOG+ helps the person and the clinician to structure a conversation to explore their needs and wishes, support their care plan and help service users to actively problem-solve to support their recovery.

DIALOG resources


New Models of Community Mental Health programme

What is the New Models of Community Mental Health programme?

 The New Models of Community MH Programme is a London-wide programme that supports all of London’s Integrated Care Systems (ICSs) to change the way that mental health services are delivered in the community so that it is more joined-up, uses whole-population approaches and supports care that is more personalised to a person’s mental health needs.

The programme has an overarching aim to support London ICSs to develop ‘robust models of community MH transformation’

Policy and background context

This programme of work has come from the Community MH Framework for Adults and Older Adults that was developed by NHS England that aims to support people with serious mental illness or complex MH conditions in the community. London Integrated Care Systems (ICSs) are committed to transforming the way community MH services are delivered to ensure that people with complex MH needs are supported well in the community.

To find out more read the NHS Long Term Plan

Overview of governance structures

The London MH Transformation Board agreed to establish this programme in July 2020. This Board has oversight and accountability for the delivery of this work.

As part of this programme, we have established a Community of Practice (CoP) to bring together London’s mental health leaders across different sectors and organisations including mental health providers, commissioners, ICS transformation leads, voluntary care sector and people with lived experience.

We will use this network to share learning on approaches, challenges, different expertise and experiences across all London ICSs.

Programme workstreams

There are a number of workstreams based on key themes. Click on the tabs below to find out more information about our work.


Perinatal mental health in London

What is perinatal mental health?

The perinatal period is usually defined as the time between conceiving a baby and one to two years after giving birth. About one in every five women experience mental health problems during this time, making this a relatively common experience. Women may experience mental health problems prior to pregnancy and/or develop mental health problems during pregnancy or in the postnatal period.


Mental health transformation

At Healthy London Partnership we want to shift from focusing on treatment of mental health issues to prevention and helping Londoners stay emotionally, mentally and physically well at all ages. When care is required we want people to be able to easily access services and be treated promptly. We want mental and physical health needs to both be met and to ensure individuals experience high quality integrated and seamless care across all settings. Through this we aspire to eliminate the inequality in life expectancy of those with serious mental illness.

 

At Healthy London Partnership we want every Londoner to stay emotionally, mentally and physically well at all ages. 

We want to transform the way that mental health services are delivered, so that every Londoner receives high quality care, with good outcomes, which fully meets their needs as an individual. We want to improve prevention and early intervention to support Londoners to stay mentally well and thrive in their communities. We want to tackle the inequalities faced by some Londoners in their access to and experience of mental health services. We also want to support London’s health and social care workforce, by expanding the mental health workforce itself, and increasing access to dedicated mental health support for staff in all services.

Our mental health programme has a broad focus across perinatal and maternal mental health, children and young people, adults, and urgent and emergency care. We also link very closely with other programmes at Healthy London Partnership and have a range of resources to support our partners, which can be explored below.

If you require mental health support now, please click here.

Support in early life
Support for adults
Adult specialist services
Nurse talking to a patient
Support for the workforce
Urgent and emergency support
Other resources and related programmes

Fast-Track Cities initiative

What is Fast-Track Cities?

Fast-Track Cities is an international initiative to end new cases of HIV by 2030. Over 200 cities across the world are part of this movement to get to zero new cases of HIV, zero preventable deaths, zero stigma and discrimination and a better quality of life for people living with HIV.

In January 2018, The Mayor of London, Sadiq Khan, signed the Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic, along with London CouncilsPublic Health England and NHS England.

Jump to section

  1. An introduction to Fast Track Cities
  2. Targets of the programme
  3. Why is this initiative important?
  4. What are the challenges?
  5. What is involved in the initiative?

An introduction to Fast Track Cities

 

Targets of Fast-Track Cities

London has already made great strides towards achieving the United Nations (UN) targets for the Fast-Track Cities initiative. In 2016, for the first time in London, all the UN’s 90:90:90 targets were met. London is only the third city to achieve this target so far – joining Amsterdam and Melbourne. We have now reached:

  • 95% of people living with HIV infection diagnosed
  • 98% of people diagnosed receiving treatment
  • 97% of people receiving treatment being virally suppressed.

Why is this initiative important?

HIV remains an important problem in London, with the infection impacting on Londoners more than any other part of the UK.

In 2020, there were 955 new cases of HIV, with an estimated 35,966 people living with HIV in London – almost 40 per cent of all those in the UK. Of these new cases, 349 of new diagnoses were reported among gay and bisexual and other men who have sex with men, 324 cases were among men and women who reported heterosexual sex as their probable route of infection, 14 cases were among people who inject drugs, 257 cases were among people with an undetermined exposure group and the remaining 11 were through pregnancy.

Recently, London has seen a significant fall in people newly diagnosed HIV positive, particularly in men who have sex with men. However, this fall is neither uniform across all population groups nor in all areas of the city, and rates of late diagnosis, although showing improvement, remain stubbornly high at 35 per cent. Late diagnosis significantly impacts people who are who are disproportionately affected by HIV like African, Afro-Caribbean and migrant women, trans women, gay men living with HIV who are also migrant men, men of colour and men who don’t have English as a first language.

People diagnosed late are at increased risk of developing an AIDS-defining illness and continue to have a more than 7-fold increased risk of death in the year following their diagnosis. The rate of one year mortality was 31 per 1,000 among those diagnosed late compared to 4 per 1,000 among those diagnosed promptly.

What are the challenges?

For many Londoners HIV remains a stigmatising condition that negatively impacts on quality of life. Late and undiagnosed infection rates in London remain unacceptably high (34 per cent and 10 per cent respectively) and with considerable geographical variability across the city. Prevalence varies by ethnicity and by place of residence, with disproportionately high rates among black and ethnic minority (BAME) communities in poorer areas of the city.

Read the national HIV public knowledge and attitudes survey results and blog.

What is involved in the initiative?

The Mayor and representatives from NHS England, UK Health Security Agency and Office for Health Improvement and Disparities (formerly Public Health England) and London Councils, have committed to work with partners to:

  • Continue work to exceed the UN’s 90:90:90 HIV targets (90 per cent of people living with HIV knowing their status, 90 per cent of people with diagnosed HIV on treatment, 90 per cent of people on treatment with suppressed viral loads)
  • End new HIV infections in the capital by 2030
  • Put a stop to HIV-related stigma and discrimination
  • Stop preventable deaths from HIV-related causes
  • Work to improve the health, quality of life and well-being of people living with HIV across the capital

The next steps for the capital include delivering the action plan developed with all the partners and the HIV community, working with the support of the Fast-Track Cities London leadership group. The action plan is a roadmap, which outlines how London will reach the Fast-Track City targets.

London also has a Fast-Track Cities dashboard through which all cities report their progress against the initiative’s targets as well as locally set objectives and goals.

The Mayor has made tackling the stigma attached to living with HIV a key priority in his Health Inequalities Strategy. Not only is it important to ensure those living with HIV can live their lives without discrimination, but the fear of stigma can be a barrier to early diagnosis, which in turn negatively impacts the quality of life of those living with the condition.

Signing up to the Fast-Track Cities initiative will bring together all those already working to tackle HIV across the capital. More joint working will help to ensure that communities affected by HIV can access the prevention, testing, treatment and support they need.

Find out more


Thrive LDN

We are supporting the Mayor of London’s new citywide movement to improve mental health and wellbeing in the capital. Thrive LDN aims to encourage Londoners to step up to tackle mental health so that every person in London can live happier, healthier lives.

Everyone who lives and works in London is invited to join the movement and take action on mental health and wellbeing to make London the happiest, healthiest city in the world.

About Thrive LDN

Thrive LDN is supported by the Mayor of London and led by the London Health Board, in partnership with Greater London Authority, Healthy London Partnership, NHS England (London Region), Public Health England (London Region) and London Councils.

The movement brings together health and care leaders, residents, businesses and community and voluntary organisations to improve mental health and wellbeing in the capital.

More than two million Londoners experience some form of poor mental health every year and report a lower level of life satisfaction and self-worth than the national average. Almost 10% of children and young people living in the capital aged between five and 16 experience a mental health issue and every week two Londoners take their own lives.

In 2017, Thrive LDN launched six aspirations for the capital. These include ambitions to make London a ‘Zero Suicide’ city, the development of training for youth organisations and student societies to help improve wellbeing in young people, and the development of a new programme to raise awareness of mental health and challenge stigma and discrimination.

Current projects

Since March 2020, Thrive LDN has been coordinating the public mental health response to and recovery from the coronavirus (COVID-19) pandemic in London on behalf of the Strategic Coordination Group, Public Health England London, and wider partners.

Between April 2020 and March 2021, more than 685,000 people have taken part in projects, events and activities which the citywide movement has led or collaborated on. Just some of the activities outlined in the report include funding grassroots organisations, suicide prevention training, mental health first aid training, online webinars, sudden bereavement support, and a World Mental Health Day Festival co-developed with young Londoners.

Thrive LDN’s progress report, published on Thursday, 18 March 2021, sets out what Thrive LDN and partners have done to listen to the experiences of people whose voices are too often ignored, and respond with resources to help manage what for many Londoners has been the toughest year of their lives.

In September 2019, to mark World Suicide Prevention Day, a citywide Zero Suicide London campaign was launched by the Mayor of London, Sadiq Khan, to encourage Londoners to access free, online suicide prevention training.

Since then, more than a quarter of a million people across the capital have completed the training as part of the #ZeroSuicideLDN campaign.

Get involved

If you would like to get involved with Thrive LDN, please email the team.

You can also get in touch on Twitter, Instagram, Facebook, LinkedIn and TikTok.