TELECARE POLICY TO PRACTICE

1
TELECARE - POLICY TO PRACTICE

• Dr Beverly Castleton
• 16th February 2006

2

• Introduction
• Policy context
• Model of Care CDM Out of Hospital
• Connecting for Health Agenda and Telecare
• Pilot to Practice Mainstream Telecare
• Evaluation and Commissioning
• Conclusion

3
POLICY CONTEXT

• The NHS Plan
• The National Beds Inquiry
• NSFs
• Information for Health
• Information for Social Care
• Shifting the balance of power
• National Programme for IT (NPfIT)
• Building on the Best
• Supporting People with Long Term Conditions
• White Paper Our Health, Our Care, Our Say a
  new direction for Community Services 30th
  January 2006

4
CONTEXT

• At least 12 major government reports since 1998
  have called for telecare
• Delivering 21st century IT support for the NHS
  home telemonitoring to be available in 100 of
  homes requiring it by Dec 2010
• 80m in Comprehensive Spending Review for
  developing telecare and social alarm services
• The elements of a telecare framework are in place
  NCRS, social alarm service, ICES
• Numerous trials shed light on implementation
  problems and individual outcomes

5
RISK STRATIFICATION
Managed care in the community and hospital
settings covers all levels of the triangle
Highly complex patients
Case Management

• Disease
• Management
• Supported self-management
  
• 70-80 of people with chronic
  conditions
• Population-wide
  prevention

High risk patients
6
TELECARE DEFINITION

• Telecare is the delivery of health and social
  care services to people in their own homes using
  a combination of sensor and information and
  communication technologies (ICT).

7
COLUMBA

• LESSONS LEARNT
• 1997 - 2006

8
TELECARE
Prevention
Safety security monitoring, e.g. bath
overflowing, gas left on, door unlocked
Mitigating risk
Personal Monitoring Physiological signs
Activities of daily living
Information Communication, e.g. health advice,
triage, access to self-help groups
The individual in their home or wider environment
Prevention
Improving functionality
Electronic assistive technology,
e.g. Environmental controls, doors
opening/closing, control of beds
9
THE EMERGING INFRASTRUCTURE

• Assessment referral
• Equipment
• Monitoring
• Response
• Review

The individual in their home
NCRS
Alarm !
Record event
Response protocol
Response home visit, emergency services, remote
change
Check status
Check
Response provider neighbour, relative,
ambulance, HCA, fire, police
Call centre
10
LOGISTIC INFORMATION PATHWAY OF A TELECARE
SERVICE
Entry (Re) Assessment of Need (SAP)
Care Package Development
Review
Telecare Prescription and a Response Protocol
Community Response
Home survey
Call Handling
Equipment Provision
Monitoring
Installation and Maintenance
11
PARTNERS IN PROVISION

• Intermediate Care/Older Peoples Services
• Dementia Care
• Falls Services
• Primary Care GP/DN/Out of Hours
• Community Alarm Service
• Ambulance Service
• ANPs (Advanced Nurse Practitioners)
• Community Matrons
• SWOPs (Specialist Workers for Older People)
• Specialist Nurses in Chronic Disease Management
• Patients, Carers and Relatives

12
TELECARE OR TELEMEDICINE?

• Telecare brings care directly to the end-user
• Telemedicine diagnosis or referral, usually
  focusing on specific applications
• Telecare focuses on complex individual needs in
  non-institutional settings
• It is inherently harder to implement
• See Audit Commission (2004) for detailed
  definition and categorisation of services

• Telecare
• Telehealth
• Telemonitoring
• Telemedicine
• Smart homes
• Assistive technology

13
3 MIGRATION PATHWAYSREDESIGN

• IT Asst
  Interagency
• Skills
  Work
• Integration
• Clinical Networks
• Whole System Delivery

14
TRUSTED ASSESSOR

• TRAINING

15
e-HEALTH LTC

• ICRS
• Data Registers
• Skills Development Virtual Teamwork
• Mobile Working
• Education
• Improved Assessment and Tools
• Decision Support - National Knowledge Service
• Do Once and Share (DOAS) Knowledge, Process and
  Safety Directorate, Connecting for Health
• Monitoring Telecare
• Commissioning Data

16
TECHNOLOGY IMPACT

• Reduces patient journeys, hospital visits and
  hospital admissions
• Saves the time of healthcare professionals
• Supports individuals living at home to look after
  themselves
• Improves the quality or effectiveness of the care
  or treatment that is delivered
• Helps to manage the risk

17
TELECARE The Challenge

• Limited mainstream telecare in England as yet, no
  joint commissioning telecare not provided as a
  care option
• What happens with practice-based commissioning?
• Single assessment process still a vision rather
  than a reality in many areas
• Telecare assessment is not embedded in SAP
• 150 SSDs, 152 PCTs, 238 DCs, housing assns, alarm
  providers would need to be involved in assessment
  and care planning via SAP/FACS etc with
  information sharing
• Who is the client?
• Who pays?

18
TELECARE The ChallengeMainstreaming

• Creating the organisational structure for
  implementation
• Retraining staff
• Apportioning costs
• Deciding eligibility
• NEEDS IT BACK UP TO IMPROVE INFORMATION FLOW

19
DEPARTMENT OF HEALTH

• Long-term conditions
• CAF Care Planning
• e SAP/ e CAF
• NSFs
• A Recipe for Care Not a Single Ingredient
• Whole systems demonstrator pilots

20
There is the tantalising possibility for public
policy to meet more peoples desire to remain
independent for longer, while at the same time
saving money overall

• Source Assistive Technology Independence and
  Well-being 4 Audit Commission, Feb. 2004

21
CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT

• Involve the patient and customise for their needs
• Easy access
• Manage populations through integrated databases
  screen and risk manage
• Develop robust networks between
• - patients (support groups)
• - patients and professionals
  (communities of care)
• - professionals (communities of
  practice)

22
CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT

• Training and development for patients and
  professionals
• Develop expert systems
• - expert patients
• - expert professionals
• - expert ICT with protocols, guidelines etc
  that develops shared knowledge
• Clinical governance that depends on good
  evaluation and the ability to track the patient
  in the system

23
MAJOR SWOP/STOP NETWORKS
AE MAU
Wards
Specialist based assessment
SWOP System
Rehabilitation
Community
Social Services
Information, skills flow
24
PARKINSONS DISEASE MANAGEMENT
Primary Care Team
PD Society
Day Resource Unit
Pt with PD
Geriatrician
Neurologist
EPICS/Comm. Matron
PDLN
Arrows indicate flows of information, skills and
care
25
THE PARKINSONS DISEASE SUPPORT NETWORKNew
Electronic Support Network for People with
Parkinsons Disease

• A collection of linked websites, or virtual
  communities to help patients, their families and
  healthcare professionals to support sufferers of
  Parkinsons Disease

26
KEY ISSUES

• Who is offered Telecare?
• What levels of sophistication of equipment?
• Do we need national criteria?
• Should the equipment be free?
• Should the revenue cost be means tested?
• Should it be disease led?

27
WANLESS Social Care ReviewImpact of Telecare on
the need for Domiciliary Care,2005/6 to 2014/5
Hours of care (thousands)
Potential impact of the 2006-08 Preventative
Technology Grant investment on the estimated
number of hours of domiciliary care needed in
Telecare Valley (excluding care homes).
28

• The provision of telecare has an immediate impact
  on total staffing levels. When assessing
  staffing, it is not only formal carers who need
  to be included, but also the call centre staff
  and response teams on which telecare networks
  crucially depend. The demand for staff is
  particularly high at the beginning of a telecare
  investment project when this human infrastructure
  needs to be set up, the telecare equipment
  installed and everyone trained to use it.

29
TECHNOLOGY MOVES ON

• Digital TV
• Flexible Platforms for Chronic Disease management
  delivery
• Frailty Registers
• Compliance improvement

30
PERFECTION IS THE ENEMY OF GOODLets be
iterative

• Ref www.icesdoh.uk

31

• Research
• Evaluation Commissioning

32
PAYOR
DATA
PATIENT ( CARER)
PROVIDER
33
Networks

• Telecare advisary network (CSIP)
• Telecare knowledge network
• Digital content knowledge network
• Assisted living innovation platform DTI
• Information and communication research initiative
  - DOH

34
CONCLUSIONS

• Major Service Redesign
• Whole System Integrated Approach
• For Primary and Secondary Care now read
  Generalist and Specialist Care
• Use the IT Agenda as a catalyst for change
• Single Assessment Process to mainstream Telecare
• Cross Organisational Workflow and Workforce
  required
• Managing the Risk is essential
• Clinical involvement in the Change Management
  Agenda is imperative
• Patient and Carers need to be part of the team
• Accuracy of Data essential
• Win Win

35
CONCLUSIONS

• TELECARE CAN
• Postpone and divert people from RH/NH
• Reduce the need for hospitalisation
• BUT
• Need robust data for reapportioning costs
• Lets resist short-termism getting in the way
• Telecare is a useful adjunct to care
• Needs to be part of a care prescription to reduce
  routine tasks and improve quality and flexibility
  of Care Delivery at Home

36
REFERENCES

• Audit Commission, Assistive Technology
  Independence and Well-being 4, February 2004
• Audit Commission, Older people implementing
  telecare, July 2004
• Department of Health, Building Telecare in
  England, July 2005
• Department of Health Health and Social Care
  Change Agent Team (CAT), Housing LIN Factsheet no
  5 Assistive Technology in Extra Care Housing,
  August 2004

37
REFERENCES

• Department of Health ICES (Integrating Community
  Equipment Services, Telecare Implementation Guide
  and numerous fact sheets, July 2005 onwards
• Health Select Committee, The Use of New Medical
  Technologies within the NHS, Fifth Report of
  Session 2004-05, April 2005
• Department of Health Application of Telecare and
  Long Term Care
• Telecare Alliance, Website address
  www.telecarealliance.co.uk
• Wanless Social Care Review, Kings Fund, 2006