1. Andrew Copley Director Of Finance & IM&T ~ Airedale NHS FT Care Anywhere the story so far…..

2. Telehealth, e health, digital health…..  Telecare  Telecoaching  Telemonitoring Teleconsultation

3. tele medicine Tele consultation/medicine

4. 9 th year offender health care in patient’s homes nursing and residential care end of life 24/7 clinical hub improving patient experience changing patient flow reducing costs Our teleconsultation journey

5. Revolutionising ways of working

6. Scale and opportunity Can expansion of telemedicine keep more people out of care homes and hospitals and reduce this? Reduce costs whilst in care homes? One A&E admission costs ±£2400. Cost of making one care home tele- ready is same for one year In our service area:

7. Current position 250 Nursing/Residential Care Homes + 100 in implementation Supporting > 8000 residents

8. Provide, safe, effective high standards of care To support residents to stay at home Support residents/nurses/carers in the planning, and delivery of care Escalate to community teams out of hours Aim of the service

9. -37% Care Homes – outcomes emergency admissions

10. Care Homes – outcomes A&E visits -45%

11. Return on Investment 27 Nursing/Residential Care Homes CCG Contract Payments Service charge £110,200 Consultations £ 66,846 TotalCost £177,046 Impact on Contract Income Net impact on reduced £1.158M Admissions Income Net Impact on A&E attendances £0.036M Total net Income Saved £1.194M Return on Investment £1.194M/£0.177M = 6.75 Invest £1 and get £6.75 back

12. Further Benefits to be quantified across the whole health Economy Opportunity for Reducing beds ~ Reduced admissions & improved LOS Re-invest Income reductions into different services Diagnostic/Hotel costs Community travel costs Ambulance Costs Extension of the Service Gold Line ~ Reducing further admissions GP Triage ~ Freeing GP Capacity Potential for replacing out of hours GP services/or a mixed model reducing duplication Better co-ordination of workforce ~ Integrated Consultants using Teleconferencing Virtual MDT`s Redesigning Outpatients Non Financial Benefits Improved Patient Care Supports deliver of Quality and performance targets

13. last year of life help vulnerable patients to remain at home improve experience – coordination of care across health settings. to increase the number of patients who die in their usual place of residence reduce hospital bed days Gold line

14. Gold line – early outcomes internal analysis – AWC and Bradford CCGs Patient Disposition after Call Number of Calls May 2014 Apr 2015 AWC CCG275451 Bradford CCGs 292515 iPAD2130 Caseload

15. Place of death National Data 2011 England % Bradford and Airedale PCT GSF register/Gold Line 2013-14 Home20.1%20.3%41% Hospice5.2%3% **23% Care home17.8%26.1% **22% Hospital54.5 %48.2%14%

16. Intermediate care hub launched November 2014 24/7 referrals from health professionals MDT approach to triage aim to support people to remain at home with bed based intermediate care if 24/7 enablement required average 23 referrals per day

17. Clinical assessment by Hub nurse Onward refer if required to HCP for home visit Request prescription GP surgery informed by NHS secure mail Extension of Telemedicine in Nursing Homes GP Triage ~ Taking All calls

18. GP visits - very early data February 2014February 2015 Practice A – 27 (35)Practice A – 17 (56) March 2014March 2015 Practice A – 30(36)Practice A – 12(36) Practice B – 41Practice B – 26 (Requests)

19. GP Feedback "Of all the changes in the 15 years I have been working this is the greatest change which has reduced workload I can remember. I don't mind the extra "late" duty doc visit as this is more than made up in the drop in other visits. A big thank you to all involved."

20. connecting primary & secondary care now connecting whole health & social care economy tomorrow Clinical history, medication, providers shared integrated health record

21. Shared record Registered practitioners Visual contact Success - sum of the parts In Care Setting Proven Success Scale Ambition Enhanced Health

22. Using data to reduce variation & change clinical practice Using Data to evaluate Clinical practice ~ Greater standardisation Reduce duplication & waste Using Real Time data ~ Improve productivity Maintain standards Improve clinical Outcomes Change clinical practice Outcome Measures Improve LOS Reduce Drug prescribing Reduce Pathology & Radiology Requests Theatre Throughput

23. How Can Technology Drive Efficiencies Electronic Patient Records E Observations Order Communications Reduce Medical Records workforce. Reduce Administration Review workforce & skill mix on wards Reduce waste and duplication on Tests and prescribing. Validation prompts to reduce errors and clinical risks Integrated PAS between Primary Care & Secondary Care & Teleconferencing Technology Redesign of Outpatients Different Approach to making appointments Virtual MDT`s Network of Virtual Consultants providing flexible capacity. Better demand managment

24. Technology Enabled Health & Care the art of the possible…. Questions?