TELECARE – A NEW MODEL OF MANAGING CHRONIC DISEASE Dr Beverly Castleton Associate Medical Director, North Surrey PCT 22 ND September 2006

Introduction Model of Care – CDM – “Out of Hospital” Connecting for Health Agenda and Telecare Pilot to Practice – Mainstream Telecare Evaluation and Commissioning Conclusion

Across the whole triangle Professional Care Self Care Case Management Disease/Care Management Supported Self Care Level 3 Complex co-morbidity Level 2 Poorly controlled single disease Level 1 Well controlled (70-80% of LTC population) Population Wide Prevention

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).

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

LOGISTIC & INFORMATION PATHWAY OF A TELECARE SERVICE Entry (Re) Assessment of Need (SAP) Care Package Development Home survey Telecare Prescription and a Response Protocol Equipment Provision Installation and Maintenance Monitoring Call Handling Community Response Review

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

3 MIGRATION PATHWAYS REDESIGN IT Asst Interagency Skills Work Integration Clinical Networks Whole System Delivery

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

TELECARE – The Challenge Limited mainstream telecare in England as yet, no joint commissioning – telecare not provided as a ‘care option’. Single assessment still a vision rather than a reality in many areas – telecare not in the current summary record for SAP 150 SSDs, 152 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning utilising SAP/CAF with information sharing

TELECARE – The Challenge Common Assessment Framework (CAF) –Based on SAP –Health & Social Care delivery –Tools needed to include Telecare assessments –For all client groups

TELECARE – The Challenge Some processes could be lengthy – project managers, ethics, charging, procurement, agreements, training, information sharing protocols etc – need to start NOW Paper systems too complex for SAP – must use IT to aid the integration of care Timely accurate information flow essential Lack of clarity over what are the ‘assessed needs’ that can be addressed with telecare – do we have the evidence?

“ There is the tantalising possibility for public policy to meet more people’s 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

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)

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

PARKINSONS DISEASE MANAGEMENT PDLN EPICS/Comm. Matron Day Resource Unit Pt with PD Neurologist Geriatrician Primary Care Team Arrows indicate flows of information, skills and care PD Society

THE PARKINSON’S DISEASE SUPPORT NETWORK New Electronic Support Network for People with Parkinson’s Disease A collection of linked websites, or “virtual communities” to help patients, their families and healthcare professionals to support sufferers of Parkinson’s Disease

The Workload Caseload of c.800 patients with approximately six new patients registered each month. In the year ending April 2006, the two nurse specialists made over 950 home visits and received over 3,000 phone calls from patients. Out-patient clinics 1-2 weekly with the Consultant Specialist and GPwSI Since 2003 there has been a sharp rise in patients seen in both in- and out-patient departments.

Objectives of the PDSN To assist in the management of the workload To provide patients quicker access to information and assistance To provide patient links to their healthcare professionals To link healthcare professionals to one another

Features of the Website Bulletin Board (Local events, service update, PD in the news) Discussion Forum (topic specific discussion between patients) Health enquiries (general health questions from patients) My PD Nurse (secure area for personal communication between patient and professional) Professional Site (secure communication between PD specialists)

Home Page

Pilot Phase Launched September 2004 Evaluated April 2005 – April patients and carers with own PC registered as users 20 health professional registered as users

Evaluation Impact on: –Patients and carers –Health professionals –PD Society policy implementation –NHS Policy implementation

Patients and Carers Monthly use of the site has stabilised at around seven hits and six pages per person ‘I am grateful for this service, it makes me feel that I have a contact close at hand and gives me information as and when I need it. I hope it continues. Thank you for asking me to take part.’ ‘The website is just fantastic – so easy to use and has answered lots of questions. I will certainly be using it a lot in the future.’

Healthcare Professionals Professionals found that their communication with patients is easier and quicker as the patients have a better understanding of their condition and treatment goals, saving time during clinic sessions. Phone contact minutes for a five month period before and after PDSN was established show it is possible that a 21% saving in contact costs could be achieved over a year.

Implementation Challenges Scaling up the service would require dedicated time to train and register patients and professionals on to the system. The system needs to be kept alive for patients with prompt responses to questions and by regularly updating the bulletin board. Further work is required to demonstrate the benefits of PDSN to healthcare professionals to improve the assimilation into mainstream. There will be a requirement to investigate other delivery modalities and funding for home equipment through the local budget for assistive technology.

Implementation Challenges PDSN platform is in place –Database now required for PD patients Frailty registers for other chronic disease management groups could follow Medication compliance project is being planned and could be appropriate for all client groups

Partners North Surrey Primary Care Trust Medixine The Parkinson’s Disease Society Pfizer (Educational Grant) Tanaka Business School, Imperial College, London

“PERFECTION IS THE ENEMY OF GOOD” Let’s be iterative Ref:

Research & Evaluation & Commissioning

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 Telecare enhances delivery – it is an adjunct to the system not a substitute for care and hands-on delivery 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

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

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 , April 2005 Department of Health Application of Telecare and Long Term Care Telecare Alliance, Website address: Wanless Social Care Review, King’s Fund, 2006