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Empowering people,
transforming services
The TEC Programme Annual Report
2017-18
b Technology Enabled Care Programme
Technology Enabled CareOur vision is that Scotland is an international leader in technology enabled care, supporting more people to live longer healthier lives at home or in community settings.
Technology enabled care is a cornerstone of he Digital Health & Care Strategy. Centred around the citizen, it focuses on improving access to services by using digital technologies, including the ability to self-manage remotely.
The Technology Enabled Care Board with its cross sector membership provides leadership, encouragement and challenge to our work.
Our four strategic priorities this year have been
• Preparing for the future – identifying and testing new approaches that offer the potential to achieve change at scale.
• Developing approaches ‘Once for Scotland’ – developing approaches that have been shown
to be effective, supporting scaling up across Scotland and addressing barriers that require national level action.
• Building capabilities and supporting improvement – championing, supporting, gathering and promoting the evidence of what works, to develop the culture and skills that recognise and use digital TEC including through developing business cases, supporting strategic planning and delivery.
•• Transforming local systems – supporting exemplars that are seeking to transform local health and social care systems using digital technology to shift local systems upstream to prevention and self-management.
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0Mar 15 Jun 15 Sep 15 Dec 15 Mar 16 Jun 16 Sep 16 Dec 16 Mar 17 Jun 17 Sep 17 Dec 17 Mar 18 Jun 18 Sep 18
84,000 citizens
Monthly
Cummulative
Citizens benefitting from TEC
End of Y1
End of Y2
End of Y3
Annual Report 2017-18 1
Digital technology is a cornerstone for change and improvement in our health and care services, offering citizens choice and control. It helps people improve and manage their own health, remain independent and safe, and supports them to find the right care and treatment at the right time. At the same time it has the potential to improve the quality and reduce the cost of services.
We have been very encouraged by the acknowledgement given to our contribution and achievements from both the international Expert Panel and by the Health & Sport Committee. The Expert Panel noted that Scotland is already an international leader in technology enabled care and now needs to transform health, housing and social care services using digital technology. The Health & Sport Committee applauded the TEC initiatives around telehealth/ telecare, video conferencing and virtual clinics and sought to build on these achievements in its conclusions and recommendations.
We are now at the point where the challenge is no longer about proving the value of technology enabled care: rather it is achieving widespread adoption so that technology enabled care underpins the redesign of services and pathways and is ‘business as usual’.
This year’s Annual Report illustrates that much has been achieved. Numbers continue to grow of those who benefit from Home & Mobile Health Monitoring and from telecare, and uptake of Attend Anywhere has exceeded expectations. Our ‘Tests of Change’ challenges have generated interest from across Scotland, and our international team have brought investment and recognition.
Partnership is at the centre of what we do and how we do it – the Programme has only achieved what it has because of that collaboration with partners at national and local level. Central to that over the past year has been our partnerships with NHS24’s Scottish Centre for Telehealth and Telecare (SCTT) and the Local Government Digital Office. We have also had effective cross sector leadership from NHS Boards, Health and Social Care Partnerships, the housing sector and many other national organisations.
We are delighted with what has been achieved through the Programme already and we look forward to supporting the delivery of the Digital Health & Care Strategy and the Health and Care Delivery Plan over the coming years.
Foreword Another year and plenty more progress. In our third year, the Scottish Government’s Technology Enabled Care (TEC) Programme has continued to drive change and improvement in digital health and social care.
Margaret WhoriskeyHead of Technology Enabled Care and Digital Health innovation
John BurnsChair, Technology Enabled Care Board
2 Technology Enabled Care Programme
At a glance
Attend Anywhere benefits people using services
Reducing travel
Less time
More convenient
“….unlikely the technology development, deployment and adoption
could have happened independently.”
TEC EVALUATION“A number of successes have been achieved in
specific areas, including using technology
enabled care (TEC) in prevention and early
intervention (for example, in the management of
hypertension)” EXTERNAL EXPERT PANEL
“….the TEC programme is already applying many established
implementation strategies that are consistent
with international best practice.”
TEC EVALUATION
“Scotland is already an international leader...
in technology enabled care….”
EXTERNAL EXPERT PANEL
“….the TEC programme is highly valued (by
implementers)” TEC EVALUATION
“We applaud these (telehealth) initiatives…”
HEALTH AND SPORT COMMITTEE
Technology enabled care
Young people’s ideas for TEC
Augmented reality app
Digital doctors surgery
Mental health chat service
Health and wellbeing online resources
HousingWebsite with video clips
and links to key resources about housing
Digital Telecare
shifting from analogue
working with 17 partners
8,400 more people last year using
home monitoringOver 2,700 video consultations
13,500 new users of telecare
€8.7 EU project mPower launched
Annual Report 2017-18 3
Tests of Change
Our work to support local tests of change has generated increasing levels of interest since their beginning in 2016. We have increased our investment in response.
Our aim is to identify approaches that have the potential to offer significant change and improvement at scale. The focus is on identifying approaches to support service change, rather than on the new technology itself.
Test of Change funding has supported cross Scotland interest in initiatives that have shown the potential for national scale up –
• remote consultations using Attend Anywhere• remote blood pressure monitoring • Intensive Care Portal to support recovery for
those receiving critical care
It is very encouraging that using tests of change has contributed to these approaches offering digital technology solutions at scale in Scotland.
Preparing for the future
“….it is allowable and often a good thing when things
don’t quite go to the original plan it allows us
to learn from the experience, question why things happen and
pass on that useful insight to others.”
TEC: Tests of ChangeIdentify, nurture and prepare technology enabled service improvements for national scale-up.
DHI
SAS
SCTT NHS24
NHS
Fire
LA
HSCP
Housing
3rd sector
Once for Scotland
Assess Ideas
Proof of Concept
Stage 1 Prove it works
Proof of Local Scale & Local Reception
Stage 2 Demonstrate value
Feasibility / Business Case
Stage 3 Case for scale
Cal
l for
pro
psal
s
Recycle Reject
4 Technology Enabled Care Programme
Young People and TECAugmented Reality App An app to allow users to download and apply different augmented reality maps over the street map on their mobile phone to encourage users to increase their level of physical activity.
Digital Doctors Surgery A website which provides multiple functions to enable easier access to frontline health care. It would provide comprehensive information on every GP surgery.
Mental Health Chat Service A multi-platform service providing a digital live chat service to young people where they could connect with a mental health professional to talk about their mental health and receive guidance and support.
Health & Wellbeing Online Resources The Young Scot website would act as a one-stop-shop for young people, signposting them to useful apps and services. It would demystify services, explaining how to access them, how long you might have to wait, rights are around confidentiality and service standards, and what to expect.
Listening to young people
The Technology Enabled Care Programme commissioned Young Scot to bring young people from across Scotland together to look at how digital technology could improve young people’s health and wellbeing.
Over several ideas development sessions, young people identified some key concepts for technology enabled care.
Intensive Care Portal – testing and growingEdinburgh Napier University was awarded £7,894 in February, 2017 to implement a test of change (ToC). The aim was to increase the numbers of NHS Lothian patients, family members and clinicians using a novel e-health innovation (or website: criticalcarerecovery.com) by 40% over a 3 month period at two Intensive Care sites in NHS Lothian. Website use was measured with in-built Google analytics. The Test successfully increased the number of users from 54 to 709 and the proportion of new users from 19% to 65% month-on-month over project duration. There has subsequently been a successful application for Health Foundation funding and the website use has been spread to an additional 3 Scottish Intensive Care Units.
Annual Report 2017-18 5
Learning and sharing – our global reachOur international team have engaged with international colleagues working in the field of digital health and social care, establishing positive relationships and building on Scotland’s global reputation for the quality of our digital health and care services.
Engagement is vital to
• identify development opportunities for Scotland
• continue to represent Scotland in relevant international networks
• learn from our colleagues, and capture and share good practice locally, nationally and internationally as appropriate.
The majority of contact has been with European partners, but we have also worked with stakeholders from Australia, Canada, New Zealand, India, Israel, Singapore and the U.S.A, demonstrating the high level of interest in Scotland’s digital health and care agenda. In preparation for the UK’s departure from the
mPowermPower is a €8.7m, five-year EU Interreg VA funded project operating in the border counties of Northern Ireland, Republic of Ireland and Scotland. It will create a network of Community Navigators, who will work with people referred from health and care services to develop wellbeing plans connecting them to activities in their community, as well as to technology to support health and wellbeing.
European Union in April 2019, the Team has continued to focus its engagement efforts on activities that will strengthen Scotland’s ongoing relationships with key European regions post Brexit.
We launched the EU Interreg VA Programme project, mPower, in June 2017. This is an important initiative that provides a cross-border service for people aged 65 years and older with long-term conditions.
6 Technology Enabled Care Programme
Remote consultations – Attend AnywhereAttend Anywhere has caused a fundamental shift in our ability to undertake remote video consultations. Funded and managed by the TEC Programme, video consultations are now being held across Scotland’s health, care and support sectors.
The Attend Anywhere workflows mimic the way that people access health and care today, just without the need to travel. The user simply enters a waiting area from the service’s website or from a simple web link sent via SMS or email.
From there, the authorised service provider can pick them up from the waiting room. All that is required is a device, a web browser and an internet connection.
By September 2018, Attend Anywhere clinics had been established in all but one NHS Board as well as a range of Health & Social Care Partnerships and third sector organisations. Over 2,700 Attend Anywhere consultations have been held to date. This is leading to a reduction in travel for both staff and citizens, is more convenient, is taking less time and is avoiding people having to taken time off work to attend appointments.
Developing approaches ‘Once for Scotland’
Annual Report 2017-18 7
In autumn 2018, we launched the Attend Anywhere challenge to commence wider scale-up on the back of the success of the pilot programme.
Saved travelling
More convenient
Took less time
Saved me money
I did not have to wait as long for an appointment
Did not have to take time off work
Did not have to take someone with me
Because of my condition, it was safer / easier
Did not have to arrange childcare / care of a relative
Other
0 50 100 150 200 250 300
Benefits for People Using Attend Anywhere
Attend Anywhere – locally NHS Highland Near MeWith funding from the TEC programme, the initial test phase of the NHS Near Me programme focused on reducing the 10,000 patient journeys for outpatient consultations between Caithness General Hospital in Wick and Raigmore General Hospital in Inverness.
During this phase, three Near Me consultation rooms were established in Wick and 26 clinics held over 10 specialities . This benefitted 112 patients. The evaluation showed a high level of both patient and clinician satisfaction.
Rape Crisis GrampianAttend Anywhere counselling sessions are routinely offered, with over 70 sessions held to date. Feedback from both service providers and service users has been very positive, with the waiting list of one provider reduced by two thirds.
8 Technology Enabled Care Programme
“It is being implemented in a specific way to remove
the need for some out-patient appointments and, in particular,
to alleviate pressure on individual patients who might otherwise need to travel to
meet appointments.” JEANE FREEMAN,
CABINET SECRETARY HEALTH & SPORT
over 2,700 consultations up to June 2018
Home & Mobile Health Monitoring – continues to grow
Numbers of people benefitting from Home & Mobile Health Monitoring continues to grow steadily, averaging an additional 700 new users every month – nearly 8,500 new users in the year. The team are celebrating scaling to the 18,000th person – an impressive milestone for local and national partners.
We have a launched a new programme with NHS 24’s Scottish Centre for Telehealth and Telecare and the British Heart Foundation (BHF) Scotland to integrate remote monitoring of blood pressure using a digital health solution.
Nearly 30% of adults in Scotland have high blood pressure, and our digital health solution allows readings of blood pressure taken by citizens at home, for an agreed period, to be simply texted to the digital health system. The new programme will expand the use of HMHM in NHS Lanarkshire, NHS Lothian and NHS Western Isles, employ telehealth assistants to increase capacity and develop a greater understanding of this approach to support diagnosis and management of hypertension.
In autumn 2017, a National Minimum Dataset was launched. Over time, this provides a rich source of data that will support an indepth understanding of the use and impact of HMHM. Over the past year, it is already showing how HMHM is supporting self management and remote monitoring, particularly diabetes, Chronic Obstructive Pulmonary Disease and mental health.
A vibrant Community of Practice has provided invaluable support to the workstream with, for example, newsletters containing updates on local activity and learning events. This has allowed partnerships from across Scotland to showcase an impressive range of local examples where HMHM is being used
During Digital Health and Care week in Scotland, the Scottish Centre for Telehealth and Telecare (SCTT) in collaboration with the Technology Enabled Care Programme hosted a Knowledge Exchange Symposium focusing on sharing learning, outcomes and evidence from scaling up of Home and Mobile Health Monitoring across Scotland. The theme of our event Transformation in Practice showcased examples of ways in which HMHM is being used to enable self management , support early intervention/prevention and improve health and care outcomes for citizens whilst driving forward service improvement & productivity gains.
Annual Report 2017-18 9
NHS Western IslesThis “tell it as it is” video produced by NHS Western Isles, features Diabetes and Heart Failure patients Erin and Chris along with Lead Nurses Jane Macaulay and Debra Vickers discussing their experiences of working with Florence. Western Isles NHS Medical Director Angus McKellar rounds up, explaining that the experience in the Western Isles shows ‘potential for patients to be looking after their health in a radically different way’ with emerging local evidence of ‘real measurable improvements in individual patient care’.
To find out more visit https://vimeo.com/155503756.
Evaluation of the HMHM work stream over the past three years has concluded that there is good evidence of NHS resources being used more effectively and efficiently and hospital admissions avoided through use of HMHM.
More people are self-managing
their health and care
Condition-control (Treatment
Adherence) improves Face to face contacts (appointments) are
optimised
Access to services increased
10 Technology Enabled Care Programme
Digital telecare – the big opportunityTelecare provides a ‘lifeline’ service to over 175,000 people in Scotland. There were around 13,000 new users of telecare in the past year, the majority being over 75 years.
The switchover to digital telephony is a key opportunity and a challenge facing all telecare providers. Across the UK, the telephony network is being upgraded from its existing 1970s analogue infrastructure to a fully digital internet-based infrastructure. In partnership with the Scottish Centre for Telehealth & Telecare (SCTT) and Local Government Digital Office (LGDO) we have supported scoping work to test, evaluate and create the conditions to transition and scale digital telecare in Scotland.
Over the past year, the programme has shifted from planning to delivery. The involvement of 17 partnerships has enabled the sector to gain experience of digital telecare.
The next phase will provide a clearer understanding of the factors involved in a digital telecare service; guidance on how to safely transition from analogue to digital; and a telecare community with increased skills and confidence to make informed decisions.
Technology enabled care in housing Social landlords (local authorities and housing associations) provide around 500,000 homes across Scotland in nearly all locations and communities. This reach, together with their contact with people who aren’t currently receiving formal care services but may in the future, provides an opportunity to take forward a preventive agenda through technology enabled care (TEC).
Since 2016, the TEC Ready programme, hosted by the Scottish Federation of Housing Associations, has been working with a large number of housing organisations and individuals to promote and support the contribution that the housing sector is making to the use of TEC in housing. Three projects have been given grant funding
• Tighean Innse Gall (TIG) – A Tablet for the Patient
• Albyn Housing Society – support towards TEC development for ‘Fit Homes’
• Angus Care and Repair – self-help app, ‘Rally Round’, to encourage people to address their own family/friend/carer support needs.
Annual Report 2017-18 11
Dementia Circle finds, tests and shares products to help people living with dementia stay independent for longer in their own homes. Products are tested by families with a person with a diagnosis of dementia and feedback is shared through a dedicated website that includes
• Everyday Living – simple everyday products for day to day living
• Staying Connected – helping people stay in touch with family and friends
• Safe & Secure – helping people feel safe and secure and to keep independent
• Out and About – helping people get out and stay physically active
• A Meaningful Life – helping people create and share information about their lives
• Purple Alert – a community minded app that helps find people living with dementia if they lose their way
Purple Alert is a free app designed by people living with dementia and carers, Alzheimer Scotland staff, Police Scotland, Social Work, Dementia Friends Scotland, Health and Social Care Partnerships and telecare services.
September 2017: 100 people ‘Join the Dots’ at housing event
A new website www.techousing.co.uk has been developed as part of the Technology Enabled Care (TEC) Ready programme. The website showcases video clips and provides links to key resources.
September 2018: 120 people hear about Creating Housing Solutions
through Technology
Dementia circle – Alzheimer ScotlandOur partnership with Alzheimer Scotland has continued to drive forward new opportunities for people living with dementia, and their carers.
12 Technology Enabled Care Programme
Sharing knowledge
Knowledge sharing is a crucial element in supporting scale up of any new or existing TEC. In the past year, the Programme hosted or contributed to more than 20 learning events. Events are interactive and adopt an ‘all teach all learn’ ethos.
The whole of programme national learning events attract a growing number of local and international delegates. The rich knowledge exchange is supported by newsletters and online resources, for example, the National HMHM Community of Practice. Feedback from partners identified specific supports they found valuable:
• Signposting to peer support, advice and good practice examples
• Learning events and networking with other partners and other sectors
• Support for evaluation and benefits realisation
• Opportunity to participate in the Digital Leadership Course
• Regular calls, emails and newsletter articles of interest
• Accessible resources on the knowledge hub• Horizon scanning and direction on future
challenges• Reporting and help to reflect on progress
“This has been the most supported and collaborative work stream I have worked on, and I think we can attribute most of our success to this sharing and
collaborative approach.” ALZHEIMER SCOTLAND
“Sense of being part of an overall national programme rather than
working alone” HIGHLAND
“The many and varied TEC events have been a real source of
interest, learning and inspiration as well as great networking
opportunities. There are a range of things we have heard about or seen at these events that we have brought back and put
into practice.” NHS LANARKSHIRE
Building capabilities and supporting improvement
Annual Report 2017-18 13
Developing the workforce
The TEC Programme commissioned NHS Education for Scotland (NES) to undertake national research to help understand current and future workforce development requirements. This stream of work has informed the workforce domain in the Digital Health & Care Strategy.
Supporting Scotland’s Workforce published by NHS Education for Scotland (NES), emphasises the critical role of the workforce if Scotland is to meet its ambition for the transformation of health, care and wellbeing services through the use of digital technologies. A Scottish workforce survey completed by 635 members of staff from across health, care, housing and support services captured their views, experience, learning needs and future expectations of using technology to deliver care.
The survey highlighted changes in culture and behaviours needed, if new ways of working are to be embraced and organisations and staff are ready to deliver digital health, care and support services. The main reasons highlighted for not using technology included a lack of knowledge and skills, workplace availability and perceived lack of opportunities. However, there was enthusiasm for learning how to improve knowledge, skills and confidence and to understand the benefits.
Recommendations in the report include:
• National ‘Once for Scotland’ approaches to learning and development
• Leadership and management initiatives to support cultural change
• Supporting a ‘digital by default’ ethos and the mainstreaming of digital technologies in health and care
The action research workforce stories will be presented as a range of AV and written materials that illustrate how different staff use TEC and the difference this has made in their roles. This work draws on the links with the NES Digital Health Leadership Programme. Since January 2018, nine non-clinical TEC Leads have commenced this programme.
14 Technology Enabled Care Programme
Local Pathfinders
The TEC Delivery Plan includes a commitment to develop two or three local pathfinders using digital technology to shift delivery of health and social care upstream to prevention and self-management. These will support the Service Transformation agenda set out in the Digital Health & Care Strategy.
The Call for Expressions of Interest in an initial ‘discovery’ phase, issued in mid 2018, set out expectations for the pathfinder areas
• Existing involvement in transformational change using the power of digital technology
• A commitment to empowering citizens to manage their health and wellbeing
• Cross sector collaboration in a strong local partnership where all are equal
• Committed leadership support and active engagement in technology enabled care, with an ability to address barriers and obstacles as they arise.
• A readiness to shape, and modify, existing investment programmes (capital and revenue) to achieve a shared, common goal/ambition/vision
• Commitment to the Digital First service standards and Digital Participation Charter.
Fourteen partnerships will be participating in the initial stage to co-design the
pathfinder initiative, its specific objectives and deliverables.
TEC implementation support – using Implementation ScienceWe commissioned a data review and evaluation options study of the TEC Programme during the year. The study by Just Economics looked at the nature, quality and relevance of existing evidence and identified a range of options for a further phase of evaluation.
The study found that the Programme had adopted many good practices in our approach to evaluation. It also found that stakeholders recognised and valued the implementation support provided by the TEC Programme. Recommendations focused on improving the evidence on implementation and scale up, recognizing that evaluation technology enabled care interventions require timely data, flexible and adaptable methodologies and attention to context.
“Our data review found a strong commitment to
measurement and evaluation and its role in supporting continuous improvement of
the TEC programme.” EVALUATION REPORT
Just Economics concluded that traditional evaluation methods would not address the complex and dynamic process involved in technology enabled care interventions. They drew on Implementation Science – an approach focused on making interventions and programmes effective in real world contexts – to develop a set of nine principles.
Transforming Local Systems
Annual Report 2017-18 15
ResourcesDigital Health and Care Strategy 2017-2022https://www.digihealthcare.scot/home/strategy/
TEC Delivery Plan for 2018–19https://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/
Digital Health and Care Expert Panel Reporthttps://www.gov.scot/publications/digital-health-care-scotland-report-external-expert-panel/
Health & Sport Committee Report: Technology & Innovation in Health & Social Carehttps://digitalpublications.parliament.scot/Committees/Report/HS/2018/2/1/Technology-and-innovation-in-health-and-social-care#Introduction
Health and Social Care Delivery Planhttps://www.gov.scot/publications/health-social-care-delivery-plan/
TEC Programme Data Review and Evaluation : Summary Reporthttps://www.gov.scot/publications/technology-enabled-care-programme-data-review-evaluation-options-study-summary/
Home and Mobile Health Monitoring National HMHM Community of Practicehttps://sctt.org.uk/programmes/home-and-mobile-monitoring/community-of-practice-2/hmhm-transformation-in-action/
National Home and Mobile Health Monitoring Service Modelhttps://sctt.org.uk/wp-content/uploads/2017/05/A-National-Service-Model-for-HMHM-v1.1.pdf
HMHM workstream and community of practice national dataset reports https://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/
Optimising Remote Monitoring & Long Term Conditions Projectionshttps://sctt.org.uk/programmes/home-and-mobile-monitoring/long-term-conditions/
MDMW site: A digital story: self management videohttps://www.youtube.com/watch?v=Y21gks2I29E
Telecare
Telecare Feasibility Studyhttps://www.ehealth.scot/tec-feasibility-report-published/
March 2018 national telecare eventhttps://sctt.org.uk/programmes/telecare/national-telecare-events/tec-national-telecare-event-22nd-march-2018/
National Telecare dataset and benchmarking activityhttps://sctt.org.uk/programmes/telecare/telecare-data-collection-analysis/benchmarking-group/
Telecare monitoring returnshttps://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/
Alzheimer Scotland Dementia Circlehttp://www.dementiacircle.org/
Alzheimer Scotland Purple Alerthttp://purplealert.org.uk/
Digital Telecare webinarshttp://www.digitaloffice.scot/updates/digital-telecare-webinar-series-25
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Video Consulting
VC using Attend Anywhere Progress Reporthttps://sctt.org.uk/wp-content/uploads/2018/08/Attend-Anywhere-review-v10.pdf
Attend Anywhere Presentations and Reportshttps://sctt.org.uk/programmes/video-enabled-health-and-care/attendanywhere/presentations/
Resource Centre https://nhs.attendanywhere.com/resourcecentre/Content/ResourceCentre.htm
Attend Anywhere Progress Report: August 2018https://sctt.org.uk/programmes/video-enabled-health-and-care/attendanywhere/presentations/
NHS Highland Near Me documentationhttps://sctt.org.uk/programmes/video-enabled-health-and-care/attendanywhere/nhsnearme/
Workforce Development
NES Supporting Scotland’s Workforcehttps://nes.scot.nhs.uk/newsroom/media-releases/supporting-scotlands-workforce.aspx
Digital Health and Care Learning and Support Resourcehttps://learn.nes.nhs.scot/2198/technology-enabled-care
Housing
Technology Enabled Care in Housinghttps://techousing.co.uk/
Linstone Housing training and use of Digital Tec in Renfrewshire videohttps://www.youtube.com/watch?v=L0i4Ep_VQww&feature=youtu.be
Innovation Network :https://www.alliance-scotland.org.uk/digital/digital-health-and-care/innovate/innovation-network/
European projects
mPowerhttps://sctt.org.uk/programmes/european-engagement/mpower/
SCIROCCO resourceshttps://www.scirocco-project.eu
