Our digital therapeutic toolkits provide support for patients promoting the type of behaviours that result in improved outcomes and reduce the burden on the health system. Here is a selection of recent outcomes, publications and awards demonstrating how the ICST Toolkits are transforming healthcare.
Dr Simon Barry, National Respiratory Clinical Lead, NHS Wales
Benefiting millions of patients
Since 2020, ICST and NHS Wales’s asthma app has transformed self-management across Wales, reaching patients in 100% of GP practices. Delivered through the digital respiratory toolkit, the app led to marked improvements in asthma control, particularly among the most deprived communities.
Between 2018 and 2024, Wales demonstrated the most significant shift towards low GWP inhaler prescribing, increasing from 30.8% to 41.1%, leading to a carbon footprint reduction of 20,303 tonnes CO₂ equivalent. This success was largely driven by the implementation of a national digital respiratory toolkit, integrating education, guidelines, and patient engagement, which proved more effective than financial incentives alone.
The TRACHES toolkit is a national digital education resource improving tracheostomy care across NHS Wales, providing video tutorials, assessments, and certification. Since 2020, it has engaged 976 professionals with 19,000+ interactions, supporting standardised, multidisciplinary training.
A 5-year tracheostomy quality improvement (QI) initiative at Cardiff and Vale University Health Board has successfully reduced adverse events and improved patient outcomes. Focusing on education, clinical oversight, and data collection, the initiative led to fewer complications, enhanced patient experience, and annual cost savings of £364,726.
To address the evolving clinical challenges of COVID-19, Wales implemented a national COVID-19 hospital guideline across all 18 acute hospitals in March 2020. Instead of traditional dissemination, the Institute for Clinical Science and Technology (ICST) deployed the Simple Implementation Science (SIMPSI) framework, a digital implementation model ensuring rapid adoption, real-time tracking, and clinician engagement.
This study assessed 53 asthma apps for quality, functionality, and alignment with GINA guidelines, revealing that most lacked core features recommended for self-management. Asthmahub was one of only three apps rated as high quality, scoring over 4 on the MARS scale and achieving a perfect 11/11 IMS functionality score, making it a standout tool for clinicians and patients alike.
This study highlights the impact of a digital implementation framework, developed by the Institute of Clinical Science and Technology (ICST), in coordinating a national TB screening program for Ukrainian refugees in Wales. The system enabled real-time data collection, remote access to screening results, and rapid adaptation of guidelines, ensuring efficient coordination across multiple health boards. By digitally streamlining public health interventions, ICST’s platform provided a scalable, adaptable model for managing healthcare responses in humanitarian crises.
The NHS England Safer Tracheostomy Care Improvement Programme, implemented in 180 hospitals, has led to estimated reductions of 33 hospital days per patient, improving safety and efficiency. Extrapolated findings suggest £1.9 million in savings per hospital annually, reinforcing the value of national quality improvement initiatives in patient safety.
This study demonstrates how the Institute of Clinical Science and Technology (ICST) successfully implemented a national COVID-19 guideline across Wales using a digital implementation framework. The video-based platform, requiring user registration, ensured rapid dissemination, real-time engagement tracking, and frequent evidence updates. With over 4,500 registrants, 170,000 page views, and nearly 100% of relevant consultants engaged, this scalable digital approach offers a proven model for future guideline adoption and implementation science.
The ICST Respiratory Toolkit reduces the burden on frontline services. Among regular users of the ICST respiratory apps, 36% reduce their visits to the GP, and 19% reduce their admissions to A&E, following improved wellness scores..
This study demonstrates that Implementation Science Software (ISS) can significantly accelerate the adoption of healthcare innovations, achieving full implementation of quality-assured spirometry testing in six months—a process that traditionally takes years. Compared to standard dissemination, ISS resulted in a nine-fold increase in engagement and 60% of GP practices meeting fidelity criteria. The findings highlight the power of digital tools in overcoming implementation barriers, offering a scalable, efficient approach to integrating new clinical practices.
By bringing asthma reviews into primary schools, this initiative empowers children, educates parents, and equips schools to better manage asthma. A key element is the NHS Wales ‘Asthmahub for Parents’ app, which provides trusted information, a digital asthma action plan, and guidance on managing worsening symptoms. Early results show improved asthma control, fewer emergency visits, and better school attendance. Following its success, the project is now being expanded across 52 primary schools in Pembrokeshire, integrating structured asthma care into the community with digital tools ensuring long-term support.
As a trusted partner of the NHS during the COVID pandemic, ICST delivered high-quality digital toolkits in a matter of weeks to the healthcare professionals that needed it, when they needed it.
Minister for Health Eluned Morgan outlines the benefits the NHS Wales COVID Recovery app has brought to patients suffering from long COVID in her 2021 report on the Aferiad programme. The Long COVID app was a success of co-production with patients.
This study demonstrates how a national digital clinical guideline was rapidly developed and implemented in Wales to standardise COVID-19 care. By using digital tools, active facilitation, and real-time updates, the initiative successfully engaged 45% of medical consultants. Variability in uptake across Health Boards highlighted the importance of early implementation and strong facilitation. Wales’ lower COVID-19 mortality rates suggest that rapid, structured guideline deployment can improve patient outcomes, providing a scalable model for future healthcare interventions.
Implementation Science methodology results in positive outcomes when implementing a National Clinical Guideline to standardise the management of acute COVID-19 in Hospitals across Wales.
The 2021 NACAP Audit showed an increase in referrals to pulmonary rehab for patients with COPD in Wales, supported by the National Respiratory Toolkit.
This study highlights the higher mortality risk of nosocomial COVID-19 in Wales, with hospital-acquired cases occurring in older, frailer patients and leading to increased deaths compared to community-acquired infections. The findings suggest a need for stronger infection control measures and early interventions, such as inpatient vaccination, to reduce hospital transmission risks.
Detailing how ICST are supporting clinicians to provide the best, evidence-based care for their patients, The COVID toolkit was praised by the Chief Medical Officer in his 2021 “Protecting our Health” Report.
Asthma UK endorsed the respiratory apps in a press release titled ‘Alone, breathless during lockdown – the app that offered hope and support’, describing how the app became a vital lifeline for many during the pandemic.
This paper highlights the need for improved accuracy and standardisation of spirometry in Wales due to widespread misdiagnosis of COPD and its associated costs. A national digital spirometry training programme was developed, successfully enhancing diagnostic accuracy, reducing healthcare costs, and leading to adoption by NHS England for wider implementation.
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