Whole System Demonstrators Update

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Whole System DemonstratorsUpdate

• Tim Ellis
• Service Design, Long Term Conditions, Department
  of Health

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Session Aims

• WSD outline
• Evaluation and its process implications
• Workshops from the three sites
• Whole System Action Network

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White Paper Commitment Whole System
Demonstrators
WSDs will explore the exciting possibilities
opened up by truly integrated health and social
care working supported by advanced assistive
technologies such as telehealth and telecare.
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WSD Sites
NEWHAM
KENT
CORNWALL

• The poorest County in England, with a dispersed
  rural population
• Population of gt500,000
• 46 of the population live in settlements of
  lt3,000 people
• 99.1 White British
• 10.3 of the population are aged 65 7.2 75
  and 2.6 85
• 21 of the population report a limiting long term
  illness

• One of the most deprived areas in the UK
• Population of 270,442 - GP registered population
  of 300,000
• Population increasing at a higher rate than the
  London average
• 2nd most diverse population in the UK - gt68 BME
  gt140 first languages
• 8.5 of the population are aged 65
• 17.3 of the population have a limiting long term
  illness
• Highest death rate from stroke and COPD
• Highest diabetes rate in the UK
• 2nd highest CHD rate in London

• Combination of rural and urban populations
• Population of 1.37m (excluding Medway UA). Two
  areas already piloting telehealth Ashford /
  Shepway population of 211,100 Dartford /
  Gravesham / Swanley population of 210,000
• 3.5 BME
• 17.3 of the population are aged 65 8.4 75
  and 2.2 85
• Within the target population, individuals report
  having an average of 1.6 of the three target
  conditions of HF, COPD, Diabetes

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WSD Evaluation

• What we believe to be the largest randomised
  control trial of telehealth and telecare to date
• c6000 users.
• Real time
• Pragmatic
• Cluster design based on practices
• We want to know to what extent the WSD model of
  care
• promotes individuals long term well-being and
  independence
• improves individuals and their carers quality of
  life
• improves the working lives of staff
• is more cost effective
• is more clinically effective
• provides an evidence base for future care and
  technology models.

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The target population
Individuals with health care needs
Individuals with social care needs
Individuals with health social care needs
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Randomisation of practice into 4 groups
Technology mix is determined by eligibility
criteria and practice membership.
Group B
Group C
Group D
Group A
Group A
Group A
Group A
Group A
People with healthcare needs
People with healthcare needs
People with healthcare needs
People with healthcare needs
People with social care needs
People with social care needs
People with social care needs
People with social care needs
People with health and social care needs
People with health and social care needs
People with health and social care needs
People with health and social care needs
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Control and Intervention in each group
Group A
Group B
Group C
Group D
PHASR ONE
Social Care needs receive usual care (CONTROL
GROUP)
Social Care needs receive telecare
Social Care needs receive telecare
Social Care needs receive usual care (CONTROL
GROUP)
LTCs receive telehealth
LTCs receive telehealth
LTCs receive usual care (CONTROL GROUP)
LTCs receive usual care (CONTROL GROUP)
Social Care needs and LTCs receive telecare
Social Care needs and LTCs receive usual care
(CONTROL GROUP)
Social Care needs and LTCs receive telehealth
Social Care needs and LTCs receive telecare
telehealth
PHASE 2 control group individuals eligible for
telecare and/or telehealth as appropriate
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
PCT support. PEC, LMC, CM, SN engagement. Demonstr
ations. GP champions. Briefing materials/events. E
valuation support provided. WSD team Support
provided. Data sharing agreements in place. MOU
signed returned.
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Evaluators informed of practices wishing to be
involved in WSD programme. Practices randomised
to either group A, B, C or D. Randomisation
takes into account practice size, condition
prevalence, deprivation etc.
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Query definition. Book Practice visit. QOF
criteria A searched condition severity. Data
cleansing. Criteria B searched use of unplanned
care. GP/CM review of eligible list.
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Practice identify addresses. Prepare letters
post. Wait 10 days. Follow-up letter sent to
non-responders. Wait 6 days. Follow-up call. List
of Yes/No/No responders.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Practice review all eligible people. Practice
staff identify exclusions. Practice notify
evaluators of ve responses. (If last baseline
readings not within 6 months then they should be
taken again) Cross check social care records.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
WSD team visit eligible individuals. Briefing on
nature of programme. Check suitability of
environment for installation. Gain consent for
installation at some future date. Seek consent
for evaluation interview.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Evaluation team contact willing individuals to
arrange a date for baseline interview. MORI
visit to conduct condition specific baseline
interview. Consent gained on the day.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
If not currently known to the service then
arrange for a needs assessment - includes
specialist assessment for telehealth and
telecare. Agree case manager responsibility/pathw
ays. Update care plan.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Arrange suitable date for installation. If
necessary arrange for broadband
installation. Install team visit and install
appropriate equipment and provide
training. Record on asset register.
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Training materials provided. Support network of
existing service users in place. Answer any
queries and requests for support. Monitor usage
e.g. increased anxiety.
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Review readings over a two week period. Ensure
thresholds set appropriately. Ensure case
manager aware of responsibilities. Notify
evaluators.
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
80 Days
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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Process Implications
Further MORI interviews. Pseudonymised data
collection. Parallel interviews with
professionals, carers, organisational leads.
Practice Consent
Data Search
Practice Letters Follow Up
Consent Gained Eligibility Confirmed
Baseline Interview
Light Touch Visit
Randomisation
Assess if necessary
Ongoing data collection
Interview at 12 months
Install
Interviewat 3 months
Patient goes live on trial
Early Monitoring Calibration
Training
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WSD Workshops
NEWHAM
KENT
CORNWALL
Andrew Forrest
Martin Scarfe
Jeremy Blackman
TD1 Concept to Reality Andrew how to get
started, processes to get in place, barriers
how to overcome them. Martin Patient
recruitment/ Consent - how to do it. Jeremy
Benefits/evidence local results national
plans. Plus audience choice of final subject.
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WSD Action Network Launched 9 July 2008

• Whole System Demonstrator (LTC) Action Network
• Launched by Ivan Lewis
• Commissioned by DH
• Kings Fund and CSIP Networks provide operational
  activities
• Evidence base for telecare and telehealth
• Action research for 12 sites

What is the aim of WSDAN?WSDAN aims to combine
research, educational and experiential learning
opportunities to examine the progress and impact
of telecare and telehealth in enabling long-term
conditions management. In addition to the
website, a key element will be to provide
networking events and research and development
activities. What does WSDAN do?WSDAN comprises
an action research programme involving 10-12
member sites. In addition it provides an
integrated point of access for published
materials on the evidence base in the development
of telecare, telehealth and community based
telemedicine. WSDAN will share learning from the
three White Paper Whole System Demonstrator sites
(Cornwall, Kent and Newham).
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WSD Action Network Action Network initiated
October 2008
Croydon
Leeds
Birmingham
East Riding
Barnsley
Norfolk
Southampton
Lincolnshire
Nottingham
Lancashire
Leicester
Hull
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WSD Action Network sign up

• Whole System Demonstrator (LTC) Action Network
• Hundreds of registrations
• reading rooms
• news updates
• Mailbox case studies
• Categorisation of evidence underway with search
  facility
• Monthly newsletter

wsdactionnetwork_at_kingsfund.org.uk
Why is WSDAN different to other networks in this
area?WSDAN will concentrate on the evidence
associated with the use of technologies that
support integrated care for long term conditions
in its broadest sense. It will be the formal
route for dissemination of learning from the
three main demonstrator sites will bring
together progress from other key case sites
showcase the findings of a major ongoing review
of the available literature and provide
structured access to research from a broad
implementation base. How will WSDAN link to other
networks in this area?There are many well
established and emerging networks on telecare and
telehealth and WSDAN will seek to make links with
other strategic networks and forums to ensure
continuity, consistency and reduce duplication.
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Thank you