TKN -THE WAY FORWARD A CLINICIANS PERSPECTIVE Dr Beverly Castleton Consultant Physician, Surrey PCT 9 th February 2007

Introduction Model of Care – CDM – “Out of Hospital” Pilot to Practice – Mainstream Telecare WSD – Other DOH initiatives SAP – CAF – eSAP/CAF Technological developments Evaluation and Commissioning Conclusion

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

RISK STRATIFICATION Disease Management Supported self-management 70-80% of people with chronic conditions Population-wide prevention Case Management Case Management Highly complex patients High risk patients Managed care in the community and hospital settings covers all levels of the triangle

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).

COLUMBA LESSONS LEARNT

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

Response protocol Call centre Response provider : neighbour, relative, ambulance, HCA, fire, police NCRS Response: home visit, emergency services, remote change Alarm ! Check status Record event The individual in their home Check THE EMERGING INFRASTRUCTURE Assessment & referral Equipment Monitoring Response Review

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 Home Care?

PARTNERS IN PROVISION Flexible Systems Quality Not necessarily hours

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

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

TRUSTED ASSESSOR TRAINING

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 – NCRS, social alarm service, ICES Numerous trials shed light on implementation problems and individual outcomes

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

TELECARE – The Challenge Limited mainstream telecare in England as yet, no joint commissioning – telecare not provided as a ‘care option’, what happens with practice-based commissioning? 150 SSDs, 152 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning via SAP/FACS etc with information sharing Who is the client? Who pays?

TELECARE – The Challenge Mainstreaming Creating the organisational structure for implementation Retraining staff Apportioning costs Deciding eligibility NEEDS IT BACK UP TO IMPROVE INFORMATION FLOW

PTG Walton Community Hospital Project – Physically & mentally frail patients Ward multi-disciplinary Teams Telecare Assessor – Team Member Multi-disciplinary Assessment Panels (MAPS) Community based Very complex frail elderly

SINGLE ASSESSMENT PROCESS Common Assessment Framework  Who Leads?  What Criteria?  All Levels of Need

“ 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

MAJOR SWOP/STOP NETWORKS SWOP System Specialist based assessment A&E MAU Wards Rehabilitation Social Services Community Information, skills flow

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 Home Care?

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 Medixine/North Surrey PCT/Imperial College, London

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?

DEPARTMENT OF HEALTH Long-term conditions CAF & Care Planning e SAP/ e CAF NSF’s A Recipe for Care – Not a Single Ingredient

WANLESS Social Care Review Impact of Telecare on the need for Domiciliary Care,*2005/6 to 2014/5 * Potential impact of the Preventative Technology Grant investment on the estimated number of hours of domiciliary care needed in Telecare Valley (excluding care homes). Hours of care (thousands)

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.

TECHNOLOGY MOVES ON Digital TV Flexible Platforms for Chronic Disease management delivery Frailty Registers Compliance improvement

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

CONCLUSIONS TELECARE CAN Postpone and divert people from RH/NH Reduce the need for hospitalisation BUT Need robust data for reapportioning costs Lets resist short-termism getting in the way Telecare is a useful adjunct to care Needs to be part of a care prescription to reduce routine tasks and improve quality and flexibility of Care Delivery at Home

Research & Evaluation & Commissioning

PAYOR PROVIDER PATIENT (& CARER) DATA

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