Whole System Demonstrator Action Network Tim Ellis, Department of Health WSDAN, Integrated Care using Telecare and Telehealth, Birmingham March 2009

Session Aims Reminder of WSD goals Details of the implementation process - Issues from the programme to date Links to wider DH LTC Policy

Three WSD sites The poorest County in England, with a dispersed rural population Population of >500,000 46% of the population live in settlements of <3,000 people 99.1% White British 10.3% of the population are aged 65+; 7.2% 75+ and 2.6% % of the population report a limiting long term illness CORNWALL 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 - >68% BME; >140 first languages 8.5% of the population are aged % 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 NEWHAM 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, % 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 KENT

WSD Evaluation We want to know to what extent the WSD model of care: promotes individuals long term well-being and independence improves individuals and their carer’s quality of life improves the working lives of staff is more cost effective is more clinically effective Provide an evidence base for future care and technology models.

Large Scale What we believe to be the largest randomised control trial of telehealth and telecare to date anywhere. Up to 6000 users Real time Pragmatic Cluster design based on practices (over 200 involved) Multiple academic bodies involved in most complex DH Evaluation to date.

Process Implications Practice Consent Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Assess if necessary Install Light Touch Visit Ongoing data collection Interview at 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Randomis ation Organisational Readiness Recruit Equip Monitor

Mainstream vs Trial Practice Consent Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Assess if necessary Install Light Touch Visit Ongoing data collection Interviewa t 3 months Patient goes live Early Monitoring & Calibration Training Interview at 12 months Randomis ation Organisational Readiness

Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Organisational Readiness Build understanding – changing landscape Ensure engagement – senior commitment Governance – fit for purpose Recruitment - & retention Defined roles & responsibilities - targets Section 75s - funding SSISAs – new partners Pathways - comms Project Mgmt. Regularly Reinforce Commitment (Visits)

Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Mainstream – incentivise Trial – sell/encourage PCT, PEC, LMC, CM, SN engagement. Demonstrations - champions. Briefing materials/events. Evaluation/DH input External support provided. MOU signed & returned. Organisational Readiness Build over time. Targets change. Champions. Drop.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Evaluators informed of practices signing-up to be involved in WSD programme. Practices randomised into 4 groups. Randomisation takes into account practice size, condition prevalence, deprivation etc. Organisational Readiness Locality bias. Controls & interventions may be out of step temporarily

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Mainstream – remote extraction Trial – practice visit QOF criteria A searched – condition & severity. Data cleansing/cross checks Criteria B searched – use of unplanned care. GP/CM review of eligible list - Monitor Organisational Readiness No crossover. Use other sources: clinics, falls, memory, case review, 3S, referral

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Mainstream – promote, opt out Trial – no promotion, opt in Practice identify addresses & sent letters Wait - follow-up. Provide Admin Support. Demographics. Organisational Readiness No Response. Not interested. Too ill. Not ill enough. Stigma/reminder. Existing user. Sheltered. Out of the country. Language. Not their job. To onerous Cohabit.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Practice & Social Care 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) Organisational Readiness New demand Baseline COPD Exclusions. Practice Variation.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Mainstream – optional Trial – evaluation explained Book, Visit & Brief. Check environment for installation. Gain consent for installation. Seek consent for evaluation interview. Organisational Readiness Site and Team Variation. Core script. Training.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live Early Monitoring & Calibration Training Interview at 12 months Evaluation team contact willing individuals to arrange a date for baseline interview. Visit to conduct condition specific baseline interview. Organisational Readiness 2000 Monitor feedback. Retrain. Drop out.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months If not currently known to the service then arrange for a needs assessment - includes specialist assessment for telehealth and telecare. Agree case manager responsibility/pathways. Update care plan. Organisational Readiness Resource constraint. OOH. Not fit for trial.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months 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. Organisational Readiness Supplier failure. Recall. OOH. No Show.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live Early Monitoring & Calibration Training Interview at 12 months Training materials provided. Answer any queries and requests for support. Monitor usage e.g. increased anxiety. Telephone support. Organisational Readiness Existing Users.

Organisational Readiness Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live Early Monitoring & Calibration Training Interview at 12 months Review readings over a two week period. Ensure thresholds set appropriately. Ensure case manager aware of responsibilities. Reading/Monitoring Frequency.

Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live Early Monitor & Calibration Training Interview at 12 months 80 Days Organisational Readiness One blockage impacts flow throughout.

Organisational Readiness Process Implications Practice Consent Assess if necessary Data Search Practice Letters & Follow Up Consent Gained Eligibility Confirmed Baseline Interview Light Touch Visit Randomis ation Install Ongoing data collection Interviewa t 3 months Patient goes live on trial Early Monitoring & Calibration Training Interview at 12 months Further MORI interviews. Pseudonymised data collection. Combined Model. Parallel interviews with professionals, carers, organisational leads. Combined Model – Perf. mgmt. Drop out – move, RIP, condition

WSD Action Network Developing the lessons from the 3 WSD sites and the 12 WSDAN members Croydon Birmingham Barnsley Southampton Nottingham Leicester Leeds East Riding Norfolk Lincolnshire Lancashire Hull

Thank you