use of resources mini-summit
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Use of Resources Mini-Summit. Workshop “a” – Assistive Technology. Presentation What is the opportunity? Questions What are the challenges that need to be overcome to succeed? What support & core skills does the workforce need to take this forward? - PowerPoint PPT PresentationTRANSCRIPT
© 2009 Tunstall Group Ltd 1
Use of Resources Mini-Summit
Workshop “a” – Assistive Technology
© 2009 Tunstall Healthcare Group Ltd
Agenda
• Presentation– What is the opportunity?
• Questions– What are the challenges that need to be
overcome to succeed?– What support & core skills does the workforce
need to take this forward?– What kind of support is required from the
regional infrastructure?
© 2009 Tunstall Group Ltd 3
“Assistive Technology” in the context of the Use of Resources
Telecare and Telehealth
© 2009 Tunstall Healthcare Group Ltd
1st Generation - Responding to emergency situations• Social Alarms - Giving 1.5m UK elderly and frail people the
confidence to live at home
Response Centre
Response NetworkUser at home
calls for help
Evolution of Telecare
© 2009 Tunstall Healthcare Group Ltd
ResponseCentre Intruder
Inactivity
Telecare solutions – Home Risks
Lifeline
Temp Extremes
Gas
Smoke
COFall
Bed Sensor
Flood
Neighbours, Carers...
Voluntaryservices
SocialServices
HousingServices
Managed response
Escalation
GP
Reassurance
© 2009 Tunstall Healthcare Group Ltd
Long Term Conditions where ‘vital signs monitoring’ offers limited help: Dementia Physically/Sensory Impaired Arthritis Mental illness Ageing
Self Care Support / Management
Home-Based Monitoring
Healthy and Well
Undiagnosed
Pre-LTC
Undiagnosed
Self Care Support / Management
Specialist Disease/Core Management
Specialist Disease/Care Management
CaseManagement
Falls
SecurityInactivity
Environmentmonitoring
Lifestyle Monitoring – Preventative Telecare monitoring using ADLife
© 2009 Tunstall Healthcare Group Ltd
Telehealth Service
Clinical User
Monitoring Centre
Blood Pressure
Breathing Rate
Temperature
Pulse Oxymetry
ECG
Body Weight
Spirometry
Glucometry
• Early discharge monitoring• Outreach service• Real-time alarms after transmission
Patientat Home
© 2009 Tunstall Healthcare Group Ltd
People in the UK living with a chronic condition* People in the UK living with a chronic condition*
1 in 3 in the UK live with a Long Term Condition
Source: *Chronic disease management”, Dept of Health, May 2004**HSE web-site
Current health interventions can control chronic
conditions not cure
DIABETES2.2 million diagnosed and 1 million
undiagnosed
ASTHMA3.7 million and 1.5 million children
HEART FAILURE0.5 million
Conditions where remote biometric monitoring solutions
can help
COPD1+ million**
Conditions where remote biometric monitoring devices can not help
ARTHRITIS8.5 million
MENTAL ILLNESS 10 million
DEMENTIA 1 in 5 aged 80+
LEARNING DISABILITIES1.5 million
PHYSICAL DISABILITIES10+ million
© 2009 Tunstall Healthcare Group Ltd
Telehealthcare Delivery Model
Managed Response
Social Care, Housing, Community Nursing, Friends, Family, Therapy, Meals, Voluntary Services…
EmergencyResponse
Response Centre
Alerts andReassurance
Source: Tunstall
Person CentredServices
© 2009 Tunstall Group Ltd 10
The Business Case
© 2009 Tunstall Healthcare Group Ltd
Evidence leads to mainstreaming service
BACKGROUND • 52% rise in 75+ and 76% rise in 85+ by 2025• Dependency ratio set to fall to 3:1 by 2025 from 4:1 • Significant shortfall in both financial and human resources needed to provide support • CSCI recommend greater use to be made of telecare
OUTCOMES • In May 2006 TeleG (Gloucestershire telecare
project) was launched (using PTG)
• Analysis of the two year project has revealed actual net savings of
– £405,088 across 55 users
• Extrapolating these average savings, the external evaluator shows potential health and social care net savings of
– £4.27 million across 368 users – £11.6 million across 2000 users
• Initial contributions to mainstream the service could be allocated pro rata 79% to Community adult care and 21% to health sector
© 2009 Tunstall Healthcare Group Ltd
Meeting the needs of a growing ageing population Telecare offered free to everyone 80+
Background • The demographic trend is acute in Essex (Tendring area has
highest level of over 65s per capita in Europe)• 17,300 people have dementia rising to 27,800 by 2025 • This demand will require spend budgets to rise by a factor
of three over next 10 yrs just to maintain services at current level. This is obviously not sustainable
Outcomes • £87m worth of Public Pledges 2009-10 of which £4m is
dedicated to telecare equipment and support.• Essex strategy offers telecare free to everyone 80+• Currently 31,337 service users (Aug 09) across 9 District /
Borough Carelines • 475 people issued equipment per month on average• Major marketing campaign to advertise the offer to potential
users and families
© 2009 Tunstall Healthcare Group Ltd
Costs and Benefits• Commissioning based comparison of support costs, 10% sample of
2,400 cases referred for assessment– For all sample users
– £1 on Telecare is £3.58 saved in traditional care– For all sample users with savings
– £1 on Telecare is £12.60 saved• Savings accrue to following years• 08-09 total costs £317 per user for 5,662 users
No: of Service Users
No: with Careline
Connection
Cost of Equipment
Careline Support
SavingsSaving Ratio
Overall Summary
240 143 £38,293.29 £14,928.00 £190,578.39 3.58
Children - - - - - -
Adults 18 5 £3,294.01 £532.00 £6,059.04 1.58
Older People 222 138 £34,999.28 £14,396.00 £184,519.35 3.74
© 2009 Tunstall Healthcare Group Ltd
North Yorkshire’s mainstreamed telecare approach
Background• By 2020 there will be 50% more people over 65,
54% more people with dementia• If the general model of social care service provision
remains the same, by 2020 NYCC will need 3,420 more domiciliary care packages and 1,817 additional places in care homes at a cost increase of £43m per annum in real terms by 2020
Outcome• Today, telecare is available for all individuals needing Adult
and Community Services support as part of the range of mainstream personalised solutions to suit their individual circumstances
• In the first year of the programme NYCC has saved over £1 million
• Finance department has audited findings and approved future budget reflecting these gains
© 2009 Tunstall Healthcare Group Ltd
Scrutiny Committee gives Telecare mainstreaming the green light – 2007
In 2006/7 Care and Independence Overview and Scrutiny Committee examined the Implementation of Telecare in North Yorkshire. The report of the Chair of the Assistive Technology and Telecare Working Group 01/02/07 concluded that:-
• When Telecare has been implemented by authorities in a “big way” the evidence is the results can be quite startling, notably in terms of releasing hard pressed resources.
• Telecare must not seen as an alternative to human contact, nor is it seen as an opportunity to police people. It is about supporting and managing risk, not about controlling behaviour.
• Members concluded, to gain the greatest efficiencies with resources that preventative use prior to the service user becoming critical will derive the maximum gains for organisations, users and carers.
© 2009 Tunstall Healthcare Group Ltd
Satisfaction survey
• A Directorate survey carried out in Spring 2008 which had 96 respondents indicated the following outcomes.
– 86% - Telecare has helped me to carry on living at home– 90% - Telecare equipment has given me more confidence/peace of
mind – 95% - Telecare equipment has helped me to feel safer – 92% - Rated Telecare excellent or very good overall – 86% - Rated the assessment excellent or very good – 92% - Were happy with the installation
– Of the respondents, 80% lived alone and 45% were owner occupiers.
© 2009 Tunstall Healthcare Group Ltd
Cost Benefit Analysis – 200838% saving in care packages
• The last 138 people assessed for telecare during the period of Sept 2008 were analysed. Some people were new to ACS and some were pre-existing with traditional support
• 7 cases were disregarded as outliers as it was felt they skewed the data too favourably thus final total is 131 people analysed
• Traditional packages were either the support that had previously been received (if pre-existing case) or for support to new people was based on care manager’s professional assessment of need if Telecare had not been available.
Service typeCount of users
Annualised cost £
Traditional Ave cost £
annualised cost £
Telecare enhanced package Ave cost £ Variance £
% reduction in traditional package £
Ave efficiency £
Residential care 60 784775.16 13079.59 417511.19 6958.52 355053.06 45% 5917.55Community Support 71 480024.46 6760.91 356336.33 5018.82 123688.13 26% 1742.09All packages 131 1264799.6 9654.96 773847.52 5907.23 478741.19 38% 3654.51
Traditional package Actual package of care used including Telecare
© 2009 Tunstall Healthcare Group Ltd
Additional detail• The comparison was made between what a traditional care package
would have looked like and what actual packages of care were including a Telecare solution.
– In 64 out of 138 (46%), traditional package would have been residential, EMI or
nursing care
– In 74 out of 138, (54%), traditional package would have been care in the home.
– Preliminary financial analysis is indicating
• a gross average efficiency per person on an annual basis of between £1,756
and £12,246 per area, averaging out at £3,654 countywide
• a 38% reduction in care package costs.
• The range is between a 90% reduction in package costs and in some cases an
increase if telecare added onto a residential package
© 2009 Tunstall Healthcare Group Ltd
North Yorkshire County Council Success Factors
• Strong leadership/vision • Clear 15 year commissioning plan• 60+ case studies available• Over 5,000 professionals and partners trained• Embedded in performance management structure
– “Telecare enhanced care package” numbers performance managed on a monthly basis
– Disciplinary offence not to mention Telecare in an assessment process
• 12,265 telecare users (Aug 09)“Here in North Yorkshire we have proven the case for telecare. It will
continue to be a critical part in our commissioning strategy and our investment plans.”
Seamus Breen, Assistant Director – Commissioning and Partnerships
“Here in North Yorkshire we have proven the case for telecare. It will continue to be a critical part in our commissioning strategy and our
investment plans.” Seamus Breen, Assistant Director – Commissioning and Partnerships
© 2009 Tunstall Healthcare Group Ltd
Blackpool PCT and “Vitalline”
• They have run telehealth for over a year now, initially small scale 13 monitors
• The PCT and Social services wrote up their findings and they have had a:
• 75% reduction in hospital admissions, • 48% reduction in home visits by community matrons,• 85% reduction in GP contacts.
• Mainstream progression• Now 30 monitors
© 2009 Tunstall Healthcare Group Ltd
© 2009 Tunstall Healthcare Group Ltd
NHS Leeds – invest now to save in the long-term
Background• Leeds PCT has 12,500 registered COPD patients just above the national
average.• 8 telehealth monitors were rotated around 43 COPD patients• 18 month trial funded by the Preventative Technology Grant
Outcome• Benefits to the patient
– 98% of patients found the telehealth monitors simple to use & very easy to understand
– The patients felt more empowered about their health• Benefits to the NHS
– During the trial, 67% of COPD patients did not access hospital– Speciality respiratory nurse home visits were reduced by 20-25%
with peak periods of 50% – With 8 telehealth monitors it was calculated that 172 home visits per
year would be saved.– With 50 telehealth monitors this would increase to 1078 saved visits
• Benefits to the Nurses– More efficient visits to patients as nurses have triaged patients stats
to give quicker diagnosis– More COPD patients can be treated with the reduction in nurse home
visits
© 2009 Tunstall Healthcare Group Ltd
Large Scale Telehealth Projects
• The trials go on, but some are not waiting• Kent, Cornwall, Newham – (WSD participants)
• North Yorkshire & York• Nottingham City• South Tyne & Wear
“…..industrial scale…..”
© 2009 Tunstall Healthcare Group Ltd
Agenda
• Presentation– What is the opportunity?– North Yorkshire – over £1 million of projected savings
• Questions– What are the challenges that need to be overcome to
succeed?– What support & core skills does the workforce need to
take this forward?– What kind of support is required from the regional
infrastructure?
© 2009 Tunstall Healthcare Group Ltd
Telehealthcare Service Development Plan Template
• 6 point plan– Business case– Leadership challenge– Local services – “fit for purpose”?– Winning over the front line– Partner plan– Self funder plan
© 2009 Tunstall Healthcare Group Ltd
We are ready to help
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