Cathy DorrianService Development Manager

National MH Programme

Scottish Centre for Telehealth & Telecare, NHS 24

Overview of Presentation

• Background – SCTT & NHS 24• National Delivery Plan 2012-15• Business Plan 2012-15• Telehealth & Telecare in Scotland –

multichannel approaches & examples• Questions?

Background - SCTT & NHS 24

• SCT funded by SGHD - operational 2007 hosted by NHS Grampian

• Reviewed in 2009 and merged with NHS 24 in 2010

• Telecare (JIT) joined SCT in 2010 – now SCTT• National Delivery Plan launched for 2012-15• SCTT Business Plan 2012-15

The NHS in Scotland is facing growing demand for its services and NHS boards need to consider new models of care such as telehealth to help manage current and future demand. Targeted appropriately, telehealth offers the potential to help NHS boards deliver a range of clinical services more efficiently and effectively. NHS boards should consider the use of telehealth when introducing or redesigning clinical services.

internetTV

telecare

Face2

FaceSMS

video

mobile

phone

Definitions…..“Telehealth” is the provision of health services at a distance using a range of digital and

mobile technologies. This includes the capture and relay of physiological measurements from the home/community for clinical review and early intervention, often in support of self management; and

“teleconsultations” where technology such as email, telephone, telemetry, video conferencing, digital imaging, web and digital television are used to support consultations between professional to professional, clinicians and patients, or between groups of clinicians.

Definitions…..

“Telecare” is the provision of care services at a distance using a range of

analogue, digital and mobile technologies. These range from simple personal alarms, devices and sensors in the home, through to more complex technologies such as those which monitor daily activity patterns, home care activity, enable ‘safer walking’ in the community for people with cognitive impairments/physical frailties, detect falls and epilepsy seizures, facilitate medication prompting, and provide enhanced environmental safety.

Definitions…..

• “Telehealthcare” is used as an overarching term to describe both telehealth and telecare together.

Teleneurology

• “ The use of modern communication technology to enable neurology to be practised when the doctor and patient are not present in the same place, and possibly time” (Patterson 2005)

• First piloted in Aberdeen 2005/6• Study confirmed the feasibility of seeing patients

using videoconferencing technology• Demonstrated safety, effectiveness & acceptability

to staff and patients• Since then: sustainable services to Orkney,

Shetland, Banff, Wick, Ft. William, Portree, Stornoway, Benbecula and Dumfries & Galloway –

• New service to Oban from SGH in development

Inverness

Glasgow

AberdeenSkye

Shetland

Wick

Orkney

W. Isles

Teleneurology Services

August 2013

Benbecula

Standard Statement 2 – Access to Neurological Health Services – Quality Dimensions

• Safe – feasibility established• Effective – evidence based• Patient Centred – acceptable, high patient satisfaction rates• Timely – reduces waiting times for patients and avoids

Consultant travel• Efficient – reduces costs & the NHS Carbon footprint in rural

areas• Equitable – delivering care regardless of patient geography

and mobility issues

Carer in Inverness

“ I don’t think we would have been able to see the Doctor (Neurologist) if we didn’t

have this appointment……it would have just been too difficult for us to travel”

Prior neurology service• Bi-monthly neurologist visit to WIH, Stornoway

– 6 visits / year– 18 clinics a year

• Inpatients– Care at WIH– Emergency transfers to INS, Glasgow

• Issues with the service:– Waiting times for outpatients– Waiting times for investigations– Wait for further review / results / rx– Retirement in 2009

– Need for change

New Conversational Service

• July 31st 2009• Tandberg 880MXP @ Neurology, Glasgow

• Neurologist

• Tandberg 95Edge system @ WIH, Stornoway / Benbecula• Patient + Nurse

• No fresh installation costs

Service outcome• Waiting times reduced – average 6 weeks

• 23/41 discharged• Further Follow Up

• 1 MS clinic• 1 standard clinic review at Glasgow• 10 teleneurology fu – all accepted

Patient feedback

Question Disagree No opinion either way

Agree Response %

I was able to say all that I wanted 0 1 38 Disagree 0%Agree 98%NOE 2%

I felt shy & nervous about speaking 23 6 10 Disagree 59%Agree 26%NOE 15%

I could hear everything that the Neurologist said 1 0 38 Disagree 2%Agree 98%NOE 0%

I was worried that others might be watching or listening 35 4 0 Disagree 90%Agree 0%NOE 10%

I felt the Neurologist understood my problems 0 0 39 Disagree 0%Agree 100%NOE 0%

I felt the Neurologists explanation of my symptoms was satisfactory

0 3 36 Disagree 0%Agree 92%NOE 8%

I felt the OP appointment with the Neurologist was useful

0 1 38 Disagree 0%Agree 98%NOE 2%

I had confidence in the way that the Neurologist addressed my problems

0 1 38 Disagree 0%Agree 98%NOE 2%

I found the neurology appointment via tele-link acceptable & would agree to be seen by this method again if necessary

1 4 34 Disagree 2%Agree 88%NOE 10%

Conclusions

• A conversational clinic works

• Patients– High degree of satisfaction

• Service– Targets and objectives can be achieved

• Environment– 83,120 minutes of gas-cooking– Cumulative benefit

Telecare & physical disability

• Using telecare effectively in the support of people with severe physical disabilities and long-term chronic conditions

• Telecare is not an alternative to direct care by carers, although it can reduce the need for check visits, ‘supervision’, or visits to clinics.

Examples of Telecare equipment – safety at home

Further information about Telecare….• Telecare National Development Programme in Scotland,

please contact the Joint Improvement Team via their website:http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/

• Joint Improvement Team Area 3ER, St Andrew’s House, Regent Road, Edinburgh EH1 3DG

T - 0131 244 3535e - jit@scotland.gsi.gov.ukW- www.jitscotland.org.uk

NHS Scotland – Digital TV Platform• Working to widen public access to NHS Scotland on new

channels on digital TV• NHS Scotland services on Freesat & Sky: • Go to Channel 539 (Community Channel) • Press RED• NHS Scotland services on Virgin: Interactive Channel• Also available to download as an app on android and i-

phones by texting postcode or 'NHS24' to 61061

NHS Scotland - Digital TV Platform• Service Delivery Benefits: • Helping people to self serve• Efficiency savings • Fewer GP ‘no-shows’• Delivering services on popular devices• Using trusted technologies to deliver health services for older people - TV• Bridging the digital divide• For more information about the service or how to be involved: • Head of Health Information Services, NHS 24

• Delivered by Health Information Services team:– Strategists– Content Managers– Technical Development and Design– User Engagement and Partnership– Health Information Advisors

• Delivering services via the following channels:– Website– Digital TV Channel– Mobile site– Telephone line

NHS Inform – Team and Channels

Physiotherapy Led Web-Based Rehabilitation for People with Multiple SclerosisDate: 2/26/2013

piloted in NHS Ayrshire & Arran

Dr Lorna Paul Reader in Rehabilitation Nursing & Health Care School University of Glasgow

• SCTT Learning Network webcast – open access http://www.video3uk.com/default.aspx

http://www.video3uk.com/sctt

Tony McLaren: National Coordinator

Breathing Space and NHS Living Life

What is NHS Living Life?

Living Life is a free telephone service provided byNHS 24 for anyone aged 16 and over who is feeling low,

depressed or anxious.

The service can:• help you develop additional coping skills• support you with helpful workbooks and resources• provide telephone support sessions at times that suit you• refer you on to other services where appropriate

If you would like to know more about Living Life askyour GP for a referral or alternatively call us directlyon 0800 328 9655.

You can also find further information at:

www.nhs24.com/UsefulResources/LivingLife

Opening Hours:

Living Life is open from Monday to Friday 1pm -9pm

What to expect in the community?

You will be:

• asked to complete a short questionnaire to see if the service is best suited to your needs

• Offered a series of telephone support sessions which occur weekly or fortnightly over 4-12 weeks.

Scottish Government MH Strategy 2012 - 2015

• Commitment 6– Effective use of new technologies

• Commitment 13– Faster access to Psychological therapies

• Commitment 14– Equality of access to services

Wait time – Referral to IA (Days)

Oct ‘12 20

Nov ‘12 20

Dec ‘12 25

Jan ‘13 10

Feb ‘13 10

Mar ‘13 12

Apr ‘13 8

Feedback: What did you find useful?

• Reading materials• Telephone sessions, being able to talk• Access form my house and in the evening• Other materials recommended• Everything explained clearly• Focus was on looking forward; changing my mindset and thinking

was a very positive experience• Coach always phoned me and was always on time• Prompt arrival of workbooks and materials• Coach/Therapist was a good listener and a very helpful &

understanding person to talk to• Help with recognising my problems and identifying the emotions

involved in situations• Chance to break down my distress into manageable chunks and to

work through these • 1 by 1Therapist helped me accept my situation and build on my

self-esteem• Therapist was very understanding, supportive, patient and easy to

talk to. • Never felt rushed….

Feedback“ Without the help offered by Living Life I would have been unable to identify and deal with issues that needed to be dealt with. Living Life has aided my recovery."

"I was able to work on tools and mind-set to help me deal with the life stresses that came my way.“

"I feel much happier. I am now a much stronger and more confident person."

“The first time was really helpful, I was at a very low point and he

(advisor) got where I was coming from and each point I made, he

reacted to what I said and it was as if he had suffered depression himself or had been dealing with or worked

with depressed people for a very long time, he had a deep

understanding……”

"It gave me confidence to get out of the door although I felt happy that I didn't have to visit any surgery.

Confidentiality was very important to me and the weekly talks were great. I was able to see progress."

Mission StatementBreathing Space is a free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.We are here in times of difficulty to provide a safe and supportive space by listening, offering advice and information.It is our belief and hope that by empowering people they will have the resources to recover.

Breathing Space is a COSCA (Counselling and Psychotherapy in Scotland) recognised counselling skills organisation.

Call Volume

• Circa 7000 answered calls per month

• Total calls – 650,000 since February ‘04

• Open between 6pm and 2am Mon – Thurs. From 6pm Fri to 6am Mon

• Calls average 20 mins• 90% average call answer

Inverness Caledonian FC support Breathing Space

• Depression• Relationship difficulties• Alcohol and drugs• Gender Identity/Sexuality• Self-harm • Abuse• Bereavement• Unemployment/Debt• Prison Issues• Anxiety/Stress• Trauma• Mental Health Problems• Rurality• Isolation & Loneliness• Spiritual/Existentialist

Scene from previous TV Advert

Any questions?

Thank you!

cathy.dorrian@nhs.net