telecare in wales lee davis welsh government 07808 727466 029 2080 1410 [email protected]
TRANSCRIPT
Telecare in WalesLee Davis
Welsh Government07808 727466029 2080 1410
www.ssiacymru.org.uk/telecare
Why is there so little Telehealth
?
Wales
• Population under 3 million• 22 Local Authorities
• 7 LHBs• All Co-Terminus with one or more local authority
So :• Regionalisation• Pooled Budgets
Welsh ‘Call Centres’ In 2006
• 22 (23?) call centres mostly only 5,000 connections
• Only one with over 10,000 connections• Every LA had one• Costs not known• Value not known• Potential not understood
Regionalisation
• North Wales Regional Telecare Service• 6 local authorities and one LHB working through one call
centre (admittedly on two sites)
• South East Wales Improvement Collaborative (SEWIC)• 10 Local Authorities and 3 LHBs• Encompassing Gwent Frailty Project
• Carmarthenshire & Hywell Dda RCT
Sustaining Social Services – A Framework for Action
• Regionalisation• Cost• Integration of Telecare & Telehealth• Links with ICES
Telecare to Manage RiskEnvironmentalAnd Security Social Medical
Nutrition Cognition
Mobility
Fire Flood
GasIntruders
Cardiac arrest
Medication
Asthma attack
A Robust Business Case !?
A telecare enhanced care package is on average cheaper to social services than residential care only if the package is less than about 20 hours
per week…
A Robust Business Case !?
Random Sampling:
Where institutional care is avoided social care costs were on average reduced by £216 per
weekWhere telecare can mean a reduced care package
at home the cost avoidance is on average £257 per week
A Robust Business Case !?
In one county studied:
Weekly cost of providing telecare service is under £9 per user per week – elsewhere probably £12-£15
Across Wales:
On average 3.29 hospital bed days per year per client – a weekly saving of £14.12 per client
John Bolton’s Work for SSIA
• List of 31 things that local authorities should do to save money
• Telecare is Number 2 on that list
• After Re-ablement ( – which it can support)
A Robust Business Case !?
Conclusion
The potential for a well targeted telecare service to reduce costs for social services is
substantial
A Robust Business Case !?
Conclusion
Telecare is not a cost saving panaceaTelecare was developed to manage the risks associated
with independent living, to contribute to people’s health, mobility, social well-being and security, and
ultimately to provide choice
This should remain its primary goal
People Receiving Telecare at midnight on 31December 2009
17,946
Total Telecare Service Delivery = 19,699
Community Alarm users = 100,000 approxHome Care Service Users in any given week = 23-24,000
Would you describe your telecare service as mainstreamed?
Yes = 20 (17) (15)
No = 2 (5) (7)
Telehealth
• We don’t Know how many – counting them now
But
Carmarthenshire RCT = 240
• Main supplier of Telehealth packages in Wales say that through the Telecare Capital Grant they sold ....
86 !!
Existing Social Alarm Monitoring
Personal Contacts
Emergency ServicesMonitoring
Centre
Community Alarms
They used :POTS (plain old telephone system) systems
Personal Contacts
Emergency Services
Monitoring Centre
Passive/Reactive Telecare
It is still :POTS (plain old telephone system) systemsPassive Sensors in the home..
AdvancedLifeline
Unit
Response Team
Contact &Coordination centre
Wireless alarm
Alarms – A Reactive Telecare System
Smart Sensors
Rapid Response Team
Liftingservice
24 Hour --Nurse
24 hr. Home Care
Relatives& friends
Mobile Warden
Duty Social Worker
Community Alarm Centre
Out-of-hoursGP
Fireservice
Ambulance
Police
Emergency plumber
24 hour Gas fitter
Community Alarm Centre
Elderlyliving independently
Home AutomationSecurity Wireless Network• Lights• Doors windows• Motion / Activity• Bed• Drawers• Kitchen• Bathroom
GlucoseSensor
Scales
Blood-pressure
Cuff
Cholesterol Monitor
MedicationTracking
Pulse Oximeter
Separate Health & Social Care Systems
Home HubAppliance
Coordination Required
Family, friends and volunteers
Care Response Service, Warden etc
Emergency Services
Community Alarm Centre
Social Worker
NHS Direct
Healthcare Professionals
Telehealth Care Record
Contact & Coordination Centres
Potential Roles:• Hospital Discharge• Preventing Admission – co-ordinating services to support at home• Real Time updating and communication of care plan • Changing the care package – Responsive.
Telehealth:• Installation, Maintenance, Administration• Traffic Light System means clinical involvement only at last point of process
• This is Mainstreaming Technology !!!
County 4
County 2 County 1
County 3
TELECAREMONITORING
CENTRE24/7
ResponseResponseTeam 1
ResponseTeam 2
ResponseTeam 3
ResponseTeam 4
Coordination & Contact
centre 8am–6pm Mon
- Fri
Home
Clinic
Coordination & Contact
centre 8am–6pm Mon
- Fri
Coordination & Contact
centre 8am–6pm Mon
- Fri
Coordination & Contact
centre 8am–6pm Mon
- Fri
Integration of Services Cost-effectively
Telehealth on a Telecare Platform
• We are ready• Seize the moment with the LHBs & Regional
partnerships• The technology enables us to provide
telehealth monitoring services and telecare alarm services alongside.
• We need to be proactive and not miss this opportunity to provide truly integrated services
Cottage Industry Thinking• How far away are we from turning ‘Community Alarm Services’ in to
‘Contact & Co-ordination Centres‘ which can co-ordinate the delivery of integrated health and social care services
• We are so far away that Care Line’ services are not being informed when service users are in care homes or hospital. Many have no idea where users are unless an alarm goes off
• Does all the required service user information go in to the service?• Does all the call centre’s knowledge of service users’ needs & history
inform how you can maintain people’s independence.• Are the ‘Call Centres’ really full players in the delivery of health &
social services• Are they really part of the mainstream?• Or are they are still a ‘one-trick-pony’ re-active service?
What We Know & What We Need
Communication Hubs
3 Functions 3 Contexts
Library Function NationalCall Handling RegionalCare Coordination Local
Framework of Services for Older People – 2011
• The focus of this ‘Framework of Services for Older People’ will be upon how these public services work together to promote the independence of frail older people either in their own homes or in other homely settings. It will contribute to the achievement of modern, accessible and responsive services capable of meeting people’s needs and of being delivered flexibly, consistently and sustainably across organisational boundaries. In addition to enabling people to live as independently as possible, services must assist them to recover independence where this has been threatened, must promote and protect their dignity, must promote social inclusion, must support them at times of difficulty and protect them from harm.
Framework of Services for Older People – 2011
The word ‘Telecare’ appears 51 times
Framework for Telecare
• Within the next few months the Welsh Government will be publishing updated guidance that will build upon lessons learned over the past five years and will continue to promote the strategic development of this service. The guidance will be directed towards ensuring that we make the best use of telecare and realise the benefits of closer integration with other services such as telehealth, community equipment, adaptations, etc. We also need to exploit the potential of the communications centre at the heart of telecare to provide more effective services.
The Social Care Battleground
Question:What will prevail? -Short term survivalism or
long term sustainability.Answer:
Organisations will need to work together in partnership and with innovation if we are going
to meet the challenge to demonstrate that preventative services are more efficient in the
long run
What We Know & What We Need
The Sustainability & Mainstreaming of Telecare depends upon the development of a national
comprehensive care strategy that embeds telecare into health, housing and social care
services
What We Know & What We Need
Pooled Health & Local Authority Budgets to
• Purchase telecare and telehealth equipment• Integrated data collection & management• Co-supervision of telecare and telehealth
What We Know & What We Need
National/Regional purchasing strategies with clear specifications to secure better products
from suppliers
A full-time professional in charge of Telecare / Telehealth regionally. With a level of authority
and skills
What We Know & What We Need
Better and more consistent training for users, referrers and assessors
Fully dedicated assessors
Charging policies that remove perverse incentives – public/private funding strategy ?
A Robust Business Case
Why is Telehealth Delivery so low ?• This presentation has concentrated on the supply side• And the received wisdom is that we need get clinical involvement (esp.
GPs) to work through telehealth
• Why aren’t clinicians flocking to it?• Is it because health care is still too Hospital based>
• But is there a nightmare scenario that service user (patient) demand is low ?? – have we measured it?
• Is it that telecare is still too ‘cottage industry’ to help?• Is it that Health & Social care are still not able to work together?• Or is it just the stage we are at?
Telecare in WalesLee Davis
Welsh Government07808 727466029 2080 1410
www.ssiacymru.org.uk/telecare