reshaping care for frail older people in scotland (ws34)
DESCRIPTION
Falkirk Council – Reshaping Care for Frail Older People in Scotland: an outcomes focused evaluation of Telehealthcare in Falkirk. Contributor: Falkirk CouncilTRANSCRIPT
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social work ... putting people first
Reshaping Care for Frail Older People in Scotland:
an Outcomes-Focussed Evaluation of Telehealthcare in Falkirk
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Content
• the research project
• evaluation research
• the major health and social care policy documents in Scotland 2005-2011
• analysis of the Scottish Government policy (the framework)
• the literature review
• telehealthcare
• methodology/method
• findings (e.g. outcomes/key themes/corresponding themes)
• recommendations at a local level/at Scottish Government level
• summary
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The Research Project
• in partial completion of a post graduate degree (Professional Doctorate) undertaken at Glasgow Caledonian University
• resource and time limited – therefore it is ‘a glimpse’ a small-scale evaluation
• this evaluation is unique in that 4 diverse groups of participants were interviewed, with the research study underpinned by a personal outcomes approach
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Evaluation Research
• this evaluation served as a lens to examine the experiences and opinions of the participants regarding telehealthcare
• in modern health and social care it is unethical to avoid or be ignorant of evaluation (Ovretveit 1997)
• evaluation is always carried out in changing times
• evaluation is not merely associated with assessing worth or value but with looking to improve the service Robson (2003)
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Major Health & Social Care Policy Documents 2005-2011
Policy Analysis – the policy documents evaluated were Scottish Government Health & Social Care policy documents 2005-2011:
• A National Framework for Service Change in the NHS in Scotland: Building a Health Service Fit for the Future (2005) (the Kerr Report)
• Delivering for Heath (2005)• Better Outcomes for Older People
(2005)• Delivering care, enabling health (2005)• Developing Community Hospitals: a
Strategy in Scotland (2006)
• Report of the 21st Century Social Work Review (2006) (Changing Lives)
• Co-ordinated, integrated and fit for purpose: A Framework for Adult Rehabilitation in Scotland (2007) (Rehab Framework)
• Better Health, Better Care, Action Plan (2008)
• A Force for Improvement (2009)• Reshaping Care for Older People: A
Programme for change 2011-2021 (2010) (Reshaping Care)
• Review of Community Health Partnerships, Audit Scotland (2011)
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Policy Analysis
The characteristics generating theory and affecting policy analysis in the research study:
• high profile issues (e.g. demographics, workforce capacity, budget resource, rapidly expanding technology solutions)
• key stakeholder involvement (e.g. service users, informal carers, assessors, technology providers)
• professionals/practitioners (e.g. hospital staff, GPs, DNs, AHPs, pharmacists and the social service workforce)
• local authority officers (e.g. policy planners, finance and human resources)• government ministers and civil servants• regulators/scrutiny bodies and strategic groups that oversee the quality
of care delivered (e.g. SSSC, Care Inspectorate, CHPs, NHS Boards, COSLA, ADSW, IRISS and Trade Unions)
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Policy Analysis
To undertake an analysis of the health and social care policy in Scotland a systematic theoretical framework was required:
• Framework: policy analysis for frail older people in Scotland
(MacNamara 2012) [adapted by MacNamara from Bardach (2005) and
Weiner (2005)]
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MacNamara (2012)Policy Analysis for Frail Older People in Scotland
adapted from Bardach (2005) & Weiner (2005)
Action:
1. understand and define the problem
2. assemble some evidence
3. develop alternative solutions
4. identify the criteria used in the decision-making framework
5. impact of the policy alternatives
6. adopt the policy
7. implement, evaluate then improve the policy implementation, disseminate findings
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The Policy Analysis Framework(MacNamara 2012)
adapted from Bardach (2005) & Weiner (2005)
1. has the history of health & social care policy in Scotland/the scope & magnitude of the changing demographics/key stakeholder/expert involvement & consultation been considered/happened
2. is their evidence of previous policy/implementation supporting services & successes?
3. is their evidence of transformational change? (e.g. a shift in the balance of care/reshaping of care)
4. have the personal outcomes for frail older people and their informal carers been considered/have fairness & equity been ensured?
5. has multidisciplinary expert opinion been considered? Who will fund/carry out services if change does not happen?
6. were groups of key stakeholders formed to implement new policies? (e.g. steering groups). Were further changes considered following monitoring?
7. has there been an evaluation? Has the policy been revised? Were successes disseminated at a local level/to the extended community/nationally?
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Literature Review
Database Search/Professional Journals/Scottish Government Websites/Professional Journals/References in article sourced hand-searched/Grey Literature hand-searched
• previous research studies• views of health and social work professionals regarding telehealthcare• views of frail older people regarding telehealthcare• the management of falls• risk factors and managing risk • unplanned hospital admission• delayed discharge/premature discharge• complementary services• CHPs/breaking down barriers/delivering a seamless service• the capacity of the workforce• culture change• the assessment process• local demographics• telehealthcare
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Telehealthcare at a Local LevelMobile Emergency Care Service (MECS) and
Telehealthcare in Falkirk
• following an initial award of monies from the Scottish Government the MECS evolved from the basic community alarm to a comprehensive MECS/Telehealthcare service
• The MECS provided a solid infrastructure and a platform to allow development of existing services and the introduction of new and innovative aspects
• the Telecare Development Programme – this monetary resource allowed the MECS Team Manager protected time to develop the telehealthcare service
• a submission was made to the Change Fund in early 2012 to allow the MECS team to expand (MECS/Telehealthcare)
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Methodology
• a qualitative methodology - a summative or outcomes evaluation that captures the impact of the service
• the effectiveness of the service is considered (outcomes can feed into future funding decisions and/or increase the body of knowledge)
• a personal outcomes approach ((Miller and Cook, 2007/2009/2011)
underpinned the design of the interview schedule for service users, informal carers, assessors and technology providers, the conversational approach to the interviews and the presentation of the findings/outcomes
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Method
• research integrity
• principles & responsibilities
• rigour, quality, reliability and validity
• reflexivity
• ethics application and approval
• sampling strategy/recruiting/contacting
• interview process/recording data/analytical process
• outcomes – key themes/corresponding themes
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Findings
Outcomes
• Quality of Life Outcomes
• Change Outcomes
• Process Outcomes
Key themes from
interviews with:
• assessors• frail older service users• informal carers• technology providers
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Key Themes from Interviews
Assessors• falls linked to telehealthcare• the need for a culture change and awareness
raising• prevention of unplanned admission to
hospital/care home/facilitating discharge• peace of mind for service users• barriers/challenges/drivers to implementing
a telehealthcare service• referrals and the gap in the assessment
process
Service Users• feeling safe/worrying less• accepting telehealthcare• the telehealthcare response process• remaining independent and getting out and
about• ongoing face-to-face contact• enabled to remain living at home• benefits• improved confidence/moral• improved health/mobility/support to reduce
symptoms• being listened to/treated with respect• time given to discuss/accept/decline
telehealthcare• response process/reliability
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Key Themes from Interviews/continued
Informal Carers
• improved health and wellbeing / reduced risk
• carer time to work/socialise/undertake hobbies
• coping with the caring process
• enabled to continue caring
• knowing who to contact/involved in the process
• included in the assessment process
• opinion valued, staff flexible and responsive to changing need
Technology Providers
• advice/expertise
• acceptance of telehealthcare
• motivated service users
• Scottish Government policy agenda
• designing telecare equipment to meet assessed need
• Falkirk’s profile in Telehealthcare in Scotland
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Corresponding Key Themes from the 4 Participating Groups
• telehealthcare offers peace of mind, with reduced anxieties for service users/informal carers/families
• falls prevention is linked to telehealthcare. Having technology solutions in place allows frail older people to remain living in their own homes with the knowledge that if they fall, they can summon assistance quickly
• a culture shift is required within health and social services to encourage new ways of working and allow telehealthcare to be further accepted/developed
• awareness raising regarding not only telehealthcare but the reshaping care agenda for frail older people is required within health and social care services and across key stakeholders and the general public
• telehealthcare enables service users to remain living at home independently, while preventing unplanned admission to acute hospital services and it supports speedier discharge
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Key Insights from the Policy Analysis, the Literature Review and the Empirical Work
2 main themes from the policy analysis:1) Changing Lives (2006) emerged as a catalyst for change in the delivery of
health and social care services
2) the emergence of the reshaping care for older people agenda brought funding to support service transformation
2 main themes from the literature review:• assessment of and management of risk have a bearing on the success of
telehealthcare service implementation
• telehealthcare can stand alone or be supported and/or complemented by homecare, falls management, reablement or by equipment and adaptations
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Recommendations
At a Local Level:
• a culture change is necessary within health and social care• an outcomes-focussed SSA for telehealthcare• a dedicated team to assess and prescribe telehealthcare • a reablement approach to care can be complemented by
telehealthcare – raise awareness!• awareness raising regarding telehealthcare across the health and
social care partnership and in the public arena
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Recommendations
At Scottish Government Level:• Support required to enhance and improve communication and
sharing of information within local partnerships and with partnerships across Scotland
• a ‘change management’ approach is required to implement transformational change
• more awareness raising regarding telehealthcare in the public arena is required, to change public perception and to share knowledge
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What Next?
• a culture of evaluation needs to be embedded in all health and social care service delivery
• evaluate telehealthcare in other services (e.g. physically disabled/learning disability/children’s services/dementia)
• use the personal outcomes approach to underpin empirical work
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In Summary
• prior to the publication of health and social care policy in Scotland (2005-2011) there was extensive consultation
• the telehealthcare service in Falkirk meets the personal outcomes required by the frail older people /informal carers interviewed –the outcomes charts
• frail older people and their informal carers feel safe living at home supported by telehealthcare and have peace of mind
• telehealthcare has been used successfully in Housing with Care in Falkirk to support frail older service users to remain living at home
• moving on - Falkirk has already moved forward. My colleague Linda Saunders Team Manager MECS & Telehealthcare will take questions/ have a discussion with you
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References• Bardach, E. 2005, A Practical Guide for Policy Analysis: The Eightfold Path to More Effective Problem
Solving, Second Edition, CQ Press Washington• Ovretveit, J. 1997, “Evaluating Interprofessional Working – a Case Study Example of a Community
Mental Health Team” in: Interprofessional Working for Health and Social Care, ed J. Ovretveit, P. Mathias, T. Thompson, MacMillan: Hampshire, pp. 52-78
• Robson, C. 2003, Real World Research: A Resource for Social Sciences and Practitioner-Researchers 2nd edn, Blackwell Publishing Ltd, Oxford
• Weiner, J. 2005, Health Policy Checklist for the Development, Selection and Assessment of Program Policies Within Health Care Organizations, [online] Available at: http://ocw.jhsph.edu/courses/introhealthpolicy/PDFS/Bardach_Outline_IHP_7b.pdf [Accessed] 14/12/2011
• Miller, E. Cook, A. 2007, Users and Carers Define Effective Partnerships in Health and Social Care [online] Available at: www.jitscotland.org.uk/action-areas/themes/involvement [Accessed 05/10/2011]
• Miller, E. Cook, A. 2009, Talking Points: A Personal Outcomes Approach, Support Pack for Staff, Focusing on the outcomes important to users and carers [online] Available at: http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvemen/staff-development-and-leadership-materials/
• [Accessed 05/01/2010]• Miller, E. Cook, A. 2011, Key Messages, Talking Points: Personal Outcomes Approach [online]
Available at: http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/background-1/ [Accessed 22/12/2011]
