Summary of the outputs

1
First meeting of the Reference Group16th 17th
November 2006Dunblane Hydro

• Summary of the outputs

2
Agenda

• Setting the scene
• Objectives for this meeting and the role of
  Reference Group
• Setting priorities and identifying the criteria
  for priority-setting for SCT
• Making it happen
• Next steps for this group

3
Reflections from the SCT Launch Conference
Setting the scene

• It was hugely positive, with lots of ideas and
  enthusiasm
• We heard from people with vision
• But there needed to be more shape around a plan
  for moving forward
• Theres a lack of patient involvement we need
  this early on to set the tone, to get engagement
• We need telehealth to play a part in transforming
  the Scottish health system, to make it
  sustainable
• We are looking for the SCT to provide the
  leadership to give some direction, to ensure
  there is robust evaluation, to encompass the
  diversity of telehealth, to promote the benefits
• So whats next? Need to move telehealth from
  being an exotic pet to being a familiar figure
  like a collie!
• Ken Proctor, Nora Kearney, Anna Gregor

4
Role of SCT - pointers from sub-group 1
Objectives role

• We need to get from the meeting
• Why we are here (as the Reference Group)
• What is our role
• How we will work together

5
Objectives for the meeting pointers from
sub-group 2
Objectives role

• Positive messages and public involvement
• The role of the reference group
• Need for public involvement
• Why bother?
• Need to take away key message(s) from the two
  days about what telehealth can deliver
• Timelines and outcomes
• Implementation of priorities for health
• What are the measures for success? What are the
  outcomes?
• What are the timelines?
• Boundaries
• Test out the boundaries i.e., service and
  geography, the accepted way of doing things
• How do we (Reference Group) help and work
  together?
• Terms of engagement for this group
• National centre
• Need for integration with partners
• Start with the service perspective first

6
Issues for SCT - sub-group 3
Objectives role

• Make it transparent that SCT is a country-wide
  organisation image, marketing, personnel
• Role of telehealth to integrate with other
  services (e.g., NHS24), move to own homes
• Clinical need drives technology
• Wrest free from the bonds of the past ensure we
  are not simply digitising 20th century medicine
  instead of creating 21st century medicine. Need
  a real long-term vision and a way of getting
  there.
• Dont let minority view prevent implementation
  which may benefit the majority of patients.
  Overcome bureaucratic resistance and artificial
  barriers to patient care and between
  organisations.
• Liberate patients from dependence on traditional
  medical structure
• Happy secure patients.
• Low end high volume and high end low volume
  consider the economic implications
• Develop relationship with commercial sector the
  starting-point being clinical need (and equipment
  to be developed) minimise economic risk
• Reduce number of interfaces in health services
  primarily e-health but telehealth is about direct
  clinical delivery
• Funding must encourage implementation - rather
  than fragment
• Utilisation of different health care providers
  resistance to redesign
• Incorporation of requirement to assess potential
  redesign/technology into job plans/contracts
• Develop outcome measures for different areas.

7
Areas of priority for SCT sub-group 1
Setting priorities

• Strategy
• Pause before setting out criteria get the
  foundations right in the first year
• Engage with the Boards there is still
  uncertainty in the system. What is telehealth
  all about, how does it relate to e-health, what
  is the role of SCT?
• In year 1 seek cohesion and coherence ensure
  that telehealth projects are tied in with
  existing local Health Board Delivery Plans and
  with meeting targets
• Demonstrate how telehealth can help what are
  the benefits and how can these be evaluated?
• Start implementation in year 2 and demonstrate
  evaluation in year 3.

• Characteristics of projects
• Filling gaps
• Demonstrate clear added value
• Be applicable pan-Scotland, i.e., wider
  applicability
• Address clinical need
• Identify some quick wins do some things in
  parallel in first year
• Staff retention
• Evaluation from the outset
• Dont concentrate on five projects

8
Criteria for selecting areas of priority for SCT
sub-group 2
Setting priorities

• What are the benefits to patients? Can the
  benefits be realised can they be evaluated?
• What are the early deliverables and what are the
  expected outcomes? How will these be evaluated?
• Is the project sustainable? Is it value for
  money? Will it allow for better use of
  resources?
• Is there a level of enthusiasm and buy-in that
  goes beyond one person? Can we identify agents
  of change?
• Will it contribute to developing learning?
• Will it contribute to developing collaboration?
• Can the project be implemented?
• How does it fit with existing contractual
  arrangements?
• Does it maximise use of existing infrastructure?
• What funding is available at local, regional or
  national level?
• Does the project fit in with the essence of
  Delivering for Health?
• Will it alleviate inequalities in health? Will it
  alleviate inequalities in access?
• Is there benefit to the NHS? What is the added
  value?
• What are the timescales?
• Can the project be rolled out pan-Scotland?

9
Possible priority areas sub-group 2
Setting priorities

• Cancer services - Delivering for Health and work
  is already in place
• AE in Ayrshire Arran or Lanarkshire
• NHS24

10
Criteria for selecting areas of priority for SCT
sub-group 3
Setting priorities

• What is the level of passion for the process /
  development by the Board? Is there clear
  leadership and vision?
• What is the stage of development? Is there a
  good platform on which to build, is there
  engagement across all stakeholders?
• What will be the impact of success? Will it make
  a significant difference? (volume or focus)
• What is the level of risk? Is this acceptable
  (i.e., not too high or too low)?
• What is the level of input required by SCT? Can
  SCT cope with implementation?
• What is the level of funding available and can it
  be easily identified?
• Are there measurable outcomes? How will these be
  evaluated? How transferable is it? What is the
  potential to spread?
• How innovative is it? Does it require input from
  SCT?
• How does it fit with national priorities? Will
  it help to hit national targets?
• What is the patient perspective / level of
  engagement? Is there commitment to engage
  patients?
• What is the potential for cross-Board
  collaboration?
• What are the workforce requirements (scale,
  skills and capabilities)? Are these readily
  available?
• What are the technology requirements? What is
  already available?

11
Possible priority areas sub-group 3
Setting priorities
12
Possible priority areas sub-group 3 (continued)
Setting priorities
13
Possible priority areas sub-group 3 (continued)
Setting priorities
14
Criteria for selecting areas of priority for SCT
Summary
Setting priorities

• Benefit to patients
• Engagement of stakeholders
• Innovation
• Readiness for implementation
• Availability of funding
• Sustainability
• Strategic fit (health policy targets)
• Pan-Scotland application
• Outcomes
• Evaluation

15
Day twoMaking it happen
From exotic pet
to an essential part of the team
16
A worked example in unscheduled care
telemedicine network for minor injuries / illness
questions issues
Making it happen

• Whats in it for them? What is the source of
  resistance?
• What is the payback?
• How long did it take people in the satellites to
  become engaged?
• What is the impact (for take-up) of the rural
  setting? Would this work in the Central Belt?
  Is this a question of physical distance or ease
  of access?
• What about issues of scale and volume? If run on
  a national basis, would it still deliver speed
  and ease of access to care?
• What is the problem we are trying to solve right
  now? And, how does the telemedicine network
  solve the problem? Is it really about long-term
  conditions, chronic disease management (rather
  than minor injuries only)? Is minor injuries /
  minor illness a big enough hit?
• There must be demonstrable benefits to patients.
  What else would you use a telemedicine network
  for? E.g., scheduling time for access to other
  specialists (e.g., rheumatologist diabetes
  network, support group)
• Need to separate out the technology and focus
  on what we would do with it
• Think through the protocols who uses the
  network and for what? How do we engage staff in
  using it? Need to tackle / break down
  professional boundaries

17
A worked example in unscheduled care
telemedicine network for minor injuries / illness
questions issues (continued)
Making it happen

• This is about redesign and modernisation of
  healthcare NOT just the technology (though the
  kit and networks must be tested and they must
  work)
• This is a human problem its about changing
  working practices, getting over the resistance to
  change, changing behaviours
• Its about education informing nurses and
  doctors what its about and engaging them
• Role of education and training getting
  telehealth to be a part of the normal working
  day, changing working practices (e.g., NHS24
  Nurse Practitioners)
• Getting people on board how to get staff to see
  why this should be a part of their job. Build
  mutual trust and belief. Risk management, case
  law?
• What gets people to buy in to this? For example,
  in running a regional network it was about
  building up trust, establishing relationships,
  engagement
• Economic pressure e.g., health systems with
  pressure to close AE can demonstrate that MIU
  with telemedicine support could result in better
  care

18
A worked example in unscheduled care
telemedicine network for minor injuries / illness
questions issues (continued)
Making it happen

• Primary outcome should be improvement in service
  to patients. Need to identify the wider
  applicability (i.e., to long-term conditions) and
  make the linkages (e.g., to NHS24)
• Focus should be about delivery of service
  rather than superb kit. Get clinicians in first
  to define need and outline processes / system.
• How to change behaviours of clinicians only
  when there is a change or pressure
• Get patients on board engage them, get them to
  demand services
• SCT role how to promote telehealth and engage
  with patients (users) and public (wide community)
  and how to engage with clinicians
• Draw on the science of how to change behaviour
  within systems
• Have clear protocols and collect information in a
  systematic and professional way against these
  protocols
• Systematic auditing and feed back clear audited
  results
• Education comes in the medium to long term
• For diffusion of innovation need audited
  data need to influence communities

19
A worked example in unscheduled care
telemedicine network for minor injuries / illness
questions issues (continued)
Making it happen

• How to overcome professional inertia, e.g., lack
  of take-up by dermatologis
• Referral guidance why isnt this used? Need to
  use the evidence on referral practices,
  demonstrate how professionals are doing relative
  to others (not naming and shaming, rather a
  demonstration of benchmarks of practice)
• Technology do need to think about what exists?
  What about procurement? Ensure the network is fit
  for purpose
• Use of technology / of telehealth should be
  included in GMS contract, in job plans.

20
What needs to happen? feedback from group 1
Making it happen

• Managed evangelism
• 3 years is not a long time, and there is not much
  funding so SCT needs to target where there is
  an open door
• Go back to Chairs Chief Executives in the NHS
  Boards get their buy-in and get them to drive
  through implementation. Its for others to pick
  up the implementation
• Pick on very specific priority areas make a
  real difference quickly
• Influence by example and allow others to
  follow. Dont spread yourselves too widely or
  thinly
• Approach from a whole system perspective health
  social care must be joined up
• Focus on management of long-term conditions

• Potential areas to focus on
• Western Isles
• Looking at home to bring health services into the
  21st century
• Rationalise and moderinise services
• Interim CE is Malcolm Wright, CE of NES
• Ayr
• With enhancement of the AE in Kilmarnock, Ayr
  Hospital will not have full AE
• Open door? To discuss at high level how minor
  injuries unit could be enhanced?
• Stranraer Hospital
• 75 miles from main hospital
• Advise on investment on imaging equipment and
  ensure it is being used to full potential
• Challenges of unscheduled care chronic
  conditions

21
What needs to happen? feedback from group 2
Making it happen

• Carrots
• Need for incentivisation of telehealth to
  promote adoption
• Importance of stories how you communicate
  with patients
• Diffusion mechanisms
• Relate telehealth to Health Board targets
• Managed clinical networks provide informed
  technical advice about what can be digitalised
• GP promote self-care techology
• Patient miles give a value to patient to
  demonstrate costs benefits of telehealth

• Sticks
• Importance of measuring impact
• What are the dimensions / measures?
• Quality of service needs to be at least as good
  as, if not better than conventional services
• Need to engage with constituencies patients,
  Health Boards, primary secondary care
• Need to engage with existing bodies e.g., QIS,
  Delivery Unit

22
What needs to happen? feedback from group 2
(continued)
Making it happen

• Art of the possible or how to get across
  shark-infested waters
• Systematise how SCT could set priorities and
  maximise the use of resources
• Map out the patient journey and demonstrate at
  which points telehealth can be used (see chart by
  Anna Gregor on page 23)
• Underpin by education and workforce needs feeds
  into strategy and planning

23
What needs to happen? feedback from group 2
(continued)
Making it happen
24
What needs to happen? feedback from group 3
Making it happen

• How to diffuse innovation into general use?
• Start at the beginning use technology in
  training (of doctors, AHPs, nurses) for clinical
  skills training. Training should be
  multi-disciplinary.
• Use of technology in education is pivotal
  relevance for remote rural teaching
• Need unrelenting positivity
• Use clinical management information to inform and
  change behaviours
• Use patient power to influence change
• Contractual change to drive behaviour
• Make the delivery of clinical care fun!
• Telehealth needs to become normalised into
  practice, e.g., use of telephone and video
  conferencing for education and training

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What needs to happen? summary
Making it happen

• Convergence of
• Heads
• Hearts
• Politics

26
Role of Reference Group
Next steps

• Dual role
• Each member has a formal role in the service
  this is invaluable in influencing through
  networks and across the service
• Each member also has an area of interest and
  professional expertise hear what the SCT is
  saying and challenge
• Meetings
• An annual meeting just after the Conference (next
  one in November 07)
• Quarterly meetings to check in with SCT Core
  Group on progress and specific issues
• Meeting in January 07 to review Work Plan
• Communication and engagement
• Use technology for meetings e.g.,
  teleconferencing Web (gather info on
  e-facilities available for each reference group
  member)
• Development of website. Blog?
• Use email to invite specific feedback from
  members of reference group
• Identifying a nominated interface in each Health
  Board area.