Telecare

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Telecare Telehealth - Supporting the vision for
Long Term Conditions and exploring opportunities
identified in the Our Health, Our Care, Our Say
White Paper.

• Manchester, 29th November 2006
• Tim Ellis, Department of Health
• Commissioning Directorate

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Aims of the Presentation
Whole System LTC Demonstrators
NATIONAL POLICY CONTEXT
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White Paper key themes

• Tackle inequalities
• Better prevention earlier intervention
• More support for people with long term conditions
• Whole system approach enabling people to live
  independently at home
• Care outside hospital
• Technology as an enabler - pilots

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Direction of travel

• Increasing emphasis on care outside hospital
• Intelligent Agile Commissioning
• Stronger role for GPs Primary care
• Patient Client centred care
• Information technology as powerful enablers

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An Opportunity

• Not about technology or equipment, but whole
  solution
• Redesign user centred services across whole
  patient pathway
• Significant role people with long term
  conditions
• Huge potential

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White Paper Whole System LTC Demonstrator
Programme
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Our health, our care, our say  a new direction
for community services

• The Our health, our care, our say a new
  direction for community services White Paper set
  out a new direction for the whole health and
  social care system. There will be a radical and
  sustained shift in the way in which services are
  delivered, ensuring that they are more
  personalised and that they fit into peoples busy
  lives.
• Chapter 5 of the paper is about supporting people
  with long term needs. This chapter on ongoing
  care and support includes discussion on
• empowering those with long-term needs to do more
  to care for themselves, including better access
  to information and care plans
• investment in training and development of skills
  for staff who care for people with ongoing needs
  
• new supports for informal carers including a
  helpline, short-term respite and training
• collaboration between health and social care to
  create multidisciplinary networks to support
  those people with the most complex needs.

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Rationale for the Demonstrators

• Local services are central to supporting
  independence and quality of life for the growing
  numbers of people with long-term needs, for whom
  care begins in the home.
• To deliver this vision of community-based care,
  we need to see a significant change in the way
  care is delivered, away from the one size fits
  all approach of reactive care, often delivered
  in a hospital setting to a person-centred,
  responsive, adaptable, flexible service. We
  also need to take full advantage of the exciting
  new possibilities opened up by electronic
  assistive technologies.
• This requires a significant change across the
  whole system of care. Not only do we need to
  support the shift in the location of delivery,
  but also shifts in the roles that
  patients/service users, commissioners and
  providers play in care, the relationships within
  the care system and the technology we employ to
  support care.
• Our challenge is to demonstrate that such
  significant shifts from hospital care are
  possible on a wider scale and that more people
  can be supported to retain their independence in
  the community.

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Evidence - VHA Programme for Heart Failure has
achieved dramatic benefits
There is now reliable international evidence,
supported by small scale pilots in this country
that significant improvements in the health and
well-being of those with complex long term
conditions can be achieved through comprehensive
care approaches.

• Results
• Hospital admissions were reduced by 66,
• Bed days of care by 71,
• Emergency visits by 40.
• There was significant improvement in vital signs
  and medication doses

• Elements
• Dialogue Development for Acute Heart Failure
• Focus on Vitals, Signs and Symptoms
• Daily Self Management Education
• Early Intervention
• Improved Adherence to Guidelines

• Testimonials
• If it wasnt for this program I wouldnt be
  here, alive right now. I am so grateful that the
  VA has someone watching me everyday, and helping
  to keep me on track and is available when I have
  a concern.
• I have learned that monitoring myself and
  adjusting my fluids and diet I can feel better. I
  have to keep at it but this system helps me
  manage daily. I keep learning new things all the
  time about my disease.

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Delivering this Whole System Approach to care and
support

• For people with complex long term health and
  social care needs, we plan to bring together
  knowledge of what works internationally, with a
  powerful commitment to new, electronic assistive
  technologies to demonstrate major improvements in
  care and support. This will include
• a strong emphasis on service user education and
  empowerment
• comprehensive and integrated packages of
  personalised health and social care services
• joint health and social care teams, 24/7 contact
  and an information system that supports a shared
  health and social care record
• good local community health and care facilities
• health and social care commissioners with the
  right incentives to deliver better care for those
  with complex needs
• mandatory risk stratification to identify those
  most at risk, and
• intensive use of assistive and remote monitoring
  technologies.

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Benefits of the Whole System Integrated Care
Approach

• The White Paper Whole System Demonstrators will
  deliver care that
• promotes individuals long term independence
• improves individuals and their carers quality
  of life
• improves the working lives of staff
• is more cost effective
• is clinically effective
• addresses diversity and equality issues and
• provides an evidence base for future service
  design and care reform.

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Demonstrator Sites

• We will ensure that the total resident population
  covered is at least one million and from a
  variety of demographic and geographical contexts.
  It is anticipated that there will be up to three
  pilots each serving a resident population of at
  least 300K. This will ensure that we can pilot in
  areas with different health and social care
  configurations.
• The pilots will run for a minimum of two years
  and will be subject to a rigorous real time
  evaluation process.
• The pilots will be on a scale significantly
  greater than anything undertaken in England to
  date in the region of several thousand
  telehealth and telecare installations over the
  two year period across all of the sites.

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Demonstrator Technology

• The technology employed by the pilots will need
  to be a mix of telecare, telehealth and
  information integration.
• Pilots will need to demonstrate that
  installations are in areas and populations where
  they can make a significant difference to health
  and social care outcomes.
• To reduce the burden of procurement and provide
  true value for money, organisations will be able
  to use the new Telecare National Framework
  Agreement to source potential suppliers of
  telehealth and telecare equipment, together with
  monitoring and response options. NHS PASA have
  negotiated the Agreement with fifteen suppliers
  and will provide support to the pilots in
  achieving the optimum procurement outcomes.
• Dti and CfH role in Demonstrators.

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Demonstrator Target Population

• We are planning to focus on two patient/user
  groups
• people of any age who are at risk of current or
  future hospital admission, due to at least one of
  the following conditions chronic heart disease,
  COPD or diabetes.
• the frail elderly who are at risk of current or
  future hospital admission, who have complex
  health and social care needs. They may have one
  or more of the above conditions.

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Demonstrator Technical Vision
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KEY ELEMENTS THAT WILL INFORM AN APPLICATION

• Existing Track Record
• evidence of existing health and social care
  partnership working in provision of services and
  care for those with long term conditions (LTC)
• evidence of working with the voluntary,
  independent and acute health sector to provide
  care for those with LTC
• existing investment in telecare and/or
  telehealth, and plans for the future

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KEY ELEMENTS THAT WILL INFORM AN APPLICATION

• target population for integrated health social
  care supported by telecare/telehealth services
• organisations with whom you will partner with for
  the delivery of integrated health social care
  supported by telecare/telehealth. How any joint
  proposal will be developed and managed
• plans to manage the remote monitoring and
  response to telecare alarms and vital signs
  measurements
• details of how you intend to communicate details
  of the new services with patients to ensure
  sufficient take-up and usage
• active senior management engagement from all
  stakeholder organisations to drive the
  implementation of telecare/telehealth

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KEY ELEMENTS THAT WILL INFORM AN APPLICATION

• development of pathways that highlight how
  integrated health and social care supported by
  telecare/telehealth will function. Consider, in
  particular, how you will achieve ethical approval
  and clinical governance for new pathways
  involving remote support
• integrated care will involve sharing information
  between different agencies (such as GP,
  intermediate care, secondary care specialists,
  ambulance service, social services, housing,
  social alarms service, telehealth service
  provider). How will you achieve the sharing of
  information between agencies and how will you
  address confidentiality and user ID issues?
• description of the outcomes and benefits
  (including cost savings) that you envisage being
  delivered through the use of telecare/telehealth
  in an integrated health and social care service

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Thank you