A HEALTHy VIEW OF SOCIAL CARE IN SURREY INTEGRATING HEALTH AND SOCIAL CARE TO DELIVER TELECARE SOLUT

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A HEALTH(y) VIEW OF SOCIAL CARE IN SURREY
INTEGRATING HEALTH AND SOCIAL CARE TO DELIVER
TELECARE SOLUTIONS

• Dr Beverly Castleton
• Consultant Physician Care of the Elderly
  Specialist in Movement Disorders
• Surrey Primary Care Trust
• 15 November 2007

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• Introduction
• Model of Care CDM Out of Hospital
• Pilot to Practice Mainstream Telecare
• Evaluation and Commissioning
• Conclusion

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MODEL OF DELIVERY FOR CHRONIC DISEASE

• Out of Hospital
• Single Assessment Process Delivery
• Common Assessment Framework
• Risk Management
• Reshaping Patient-Centred Care
• White Paper Our health, our care, our say
• A New Ambition for Old Age
• Our NHS Our Future

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Future Health Care Trends - Burden of Disease
A TRANSFORMATION IN THE MODEL OF CARE
Source KPCMI 166
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Across the whole triangle
Case Management
Level 3
Complex co-morbidity
Level 2
Disease/Care Management
Poorly controlled single disease
Professional Care
Self Care
Level 1
Supported Self Care
Well controlled (70-80 of LTC population)
Population Wide Prevention
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TELECARE DEFINITION

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

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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
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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
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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
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PARTNERS IN PROVISION

• 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
• Care Managers
• Home Care
• Intermediate Care/Older Peoples Services
• Nursing Residential home staff

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PARTNERS IN PROVISION

• Flexible Systems
• Quality
• Not necessarily hours

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TELECARE IS AN ADJUNCT TO THE SYSTEM NOT A
SUBSTITUTE FOR CARE AND HANDS-ON DELIVERY
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3 MIGRATION PATHWAYSREDESIGN

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

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TRUSTED ASSESSOR
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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
  social alarm service,
• Numerous trials shed light on implementation
  problems and individual outcomes

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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

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TELECARE The ChallengeMainstreaming

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

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SINGLE ASSESSMENT PROCESS

• Common Assessment Framework
• Who Leads?
• What Criteria?
• All Levels of Need

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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

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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)

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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

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MAJOR SWOP/STOP NETWORKS
AE MAU
Wards
Specialist based assessment
SWOP System
Rehabilitation
Community
Social Services
Information, skills flow
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PARKINSONS DISEASE MANAGEMENT
Primary Care Team
PD Society
Day Resource Unit
Pt with PD
Geriatrician
Neurologist
EPICS/Comm. Matron
PDLN
Home Care?
Arrows indicate flows of information, skills and
care
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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
• Medixine/North Surrey PCT

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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?

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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).
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• 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.

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CONCLUSIONS

• Major Service Redesign
• Whole System Integrated Approach
• 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
• Patient and Carers need to be part of the team
• Accuracy of Data essential
• Win Win

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• Research
• Evaluation Commissioning

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PAYOR
DATA
PATIENT ( CARER)
PROVIDER
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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

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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
• Our NHS Our Future October 2007