Implementing telehealth and telecare a better future for all

1
Implementing telehealth and telecare a better
future for all
30 November 2007
Mike Clark CSIP Networks
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Telecare Commissioning - Agenda

• Our health, our care, our say and key policy
  initiatives across health, housing and social
  care
• Building Telecare in England (July 2005)
• Preventative Technology Grant and other funding
  streams (incl. Supporting People, Partnerships
  for Older People (POPP), extra care as well as
  mainstream funding in health, housing and social
  care) PTG carry over 2008/9
• White Paper LTC demonstrators Cornwall, Newham,
  Kent
• Integrated and partnership working including
  pooled funds
• Demographic factors and demand forecasting
• Strategic and joint commissioning, whole systems
  approaches
• Better procurement, performance management and
  value for money
• Telecare and telehealth as mainstream service
  options
• User choice and independence through direct
  payments, individual budgets, self care and
  self-assessment, preventative services
• Predictive models
• Standards interoperability, connectivity, ALIP

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Telecare Commissioning the challenges

• Human contact and technology, ethical and consent
  issues eg organisations are used to
  commissioning intensive home care but not linked
  with telecare, extra care or LTC management
• Savings may accrue in health from a local
  authority investment
• Local authorities and their partners fail to plan
  for telecare and telehealth beyond March 2008
  when the grant funding ends
• Poor engagement with users, carers, GPs, third
  sector and other key stakeholders decisions are
  made beyond the influence of main beneficiaries
• Inconclusive benefits for investments made,
  charging
• Funding leakage and diversion with fragmented
  services and poor uptake of the PT Grant
• Product and service innovation, too much focus on
  inputs/outputs
• Questions about the evidence base
• Lack of a culture of joint/integrated/strategic
  commissioning across service organisations leads
  to poor decisions made in isolation which are not
  linked to best outcomes

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Telecare Commissioning the best outcomes

• Independence a priority issue for health,
  housing and social care
• Individuals users, tenants, patients and carers
  benefit in terms of quality of life and better
  outcomes
• Involvement key stakeholders are involved at all
  stages
• Integrated whole systems mapping and capacity
  building
• Implementation more coordinated implementation
  across services, appropriate training for staff,
  better value for money
• Indicators reduced admissions, higher service
  satisfaction
• Improvements continuous improvement in health
  and other outcomes, improved evidence base
• Intelligence better intelligence provides a
  balance between meeting complex needs for
  individual users and providing preventative
  services
• Innovation different approaches and fresh
  solutions to old problems and new trends,
  developing outcomes
• Impact all stakeholders see a significant change
  for the better

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Telecare Commissioning Current position

• CSCI survey information now available with CSIP
  follow up currently working with organisations
  who may not have met their local targets
• Link to Transforming Community Equipment (TCE)
  where organisations are considering this for
  telecare
• Continuation of CSIP newsletters, factsheets,
  events, masterclasses and briefings etc through
  2007/8
• 150 Telecare profiles being updated
• NHS PASA framework review now 2900 lines (April
  2007)
• NHC procurement/mini-competition July 2007
• White Paper LTC Demonstrator Sites commence in
  2008
• Innovation support eg other user groups, self
  care and choice
• Final opportunities within PT Grant funding to
  establish local business case for telecare and
  telehealth Winter 2007
• PT Grant carry over into 2008/9 (subject to local
  arrangements)
• Comprehensive Spending Review CSR07 October
  2007
• End of PT Grant - March 2008 with mainstream
  services

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Telecare Commissioning Implementation issues

• Joint workinggtpartnershipsgtintegrated services
• Long start up periods, recruitment
• Year one carry over of grant funding
• Awareness raising, high level champions
• Procurement of monitoring and response
• Managing change and organisational culture issues
  not yet a care option
• Poor referral rates, low referral rates,
  rejections
• FACS versus preventative versus targeted
  approaches versus self care eligibility issues
• Links to other initiatives From JSNA, LAAs to
  learning disabilities to individual budgets and
  self care
• Business planning and business case for
  mainstreaming
• Evidence base
• Charging
• Paperwork, bureaucracy involved
• Evaluation

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Telecare Performance background

•  
• The (Preventative Technology) grant should be
  used to increase the numbers of people who
  benefit from telecare, by at least 160,000 older
  people nationally.
•  
• .Through the grant, the Department expects
  councils to invest in telecare to help support
  individuals in the community. This aims to help
  an additional 160,000 older people to live at
  home with safety and security and reduce the
  number of avoidable admissions to
  residential/nursing care and hospital.
• Building Telecare in England, Department of
  Health, 2005 Additional users benefiting from
  telecare

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Telecare Performance outturns for 2006/7
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Telecare Performance projections for 2007/8
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Telecare Performance expenditure
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Telecare Performance expenditure
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Telecare Performance preparing for April 2008
In early 2008, CSIP will be running a series of
events to identify up to 200 outcomes from the
two years of the Preventative Technology Grant.
Locations London, Birmingham, Manchester,
Leeds, Taunton   We will be looking for examples
of how telecare has been implemented across the
country. In particular, we will be interested in
examples where telecare and telehealth have
provided positive outcomes for users, carers,
staff and other key stakeholders using innovative
and integrated approaches. In addition, CSIP
will be looking at how local authorities and
their partners are mainstreaming their services
to ensure sustainability from 2008 onwards.
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Performance and support
HEALTH
Third sector and others
Social Care
Housing
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In your area, how many people
Have dementia?
Fell last night?
Have a long term neurological condition?
Have angina, heart failure, diabetes?
Live alone with poor housing at risk of crime?
Have intensive home care, COPD and depression?
Attend AE regularly?
Could be in a care home in the next year?
Could benefit from preventative support?
Could benefit from integrated telecare/health
services?
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Strategic commissioning
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Strategic commissioning some key points
1 Shared overall vision, integrated
2 Map existing services, forecast future demand,
analyse trends
7 Service, financial and performance monitoring
and review
Stakeholder involvement
3 Whole system planning, defining outcomes,
building capacity
6 Governance, marketing and implementation
4 Service and process design based on outcomes,
budget alignment
5 Outcome-based specifications, agreements,
contracts and procurement
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Social Care Only
Referral

• Single Assessment
• Contact
• Overview
• Specialist
• Comprehensive

• FACs levels
• Annual published arrangements
• Critical/Substantial/Moderate/Low
• SAP/e-SAP

• Information
• Better Care, Higher Standards
• Leaflets
• FACs

• Referral standards and targets
• Key Performance Indicators
• RAP

??Telecare as preventative services when not
FACS-eligible??

• Customer Service
• Information in other languages
• Translation services
• Services for people with sensory or communication
  needs
• Charter Mark
• Investors in People
• Skills for Care, Workforce Development, Training
• Approved and Trusted Assessors

No

• FACS Level not met
• Information
• Advice
• Self-assessment
• Self-purchase

Care Plan?
Review of Care Plan
Yes
Care Options include telecare direct service,
DP, Ind budget

• Regulations and Guidance on Direct Payments
• Individual Budgets Pilots

Care Pathways
Financial assessment

• Local Financial Assessment
• Fairer Charging Policies

Self-assessment/Self-purchase

• Standards for Review
• Key Performance Indicators
• RAP

Service Commenced
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Care Options include telecare direct service,
DP, Ind budget

• Best practice/local standards
• Sensor types eg base unit, wandering/GPS,
  PIR/activity, door contacts See equipment and
  installation

• Ethics
• Consent, dignity
• NSF for Older People
• Care plan requirements

Yes
Dementia/ Cognitive?
No

• Best practice/local standards
• Sensor types eg base unit, PIR/activity, lighting
  controller, falls monitor
• See equipment and installation

Yes

• Falls programme eligibility
• NSF for Older People
• Consent, dignity
• Care plan requirements

Falls?
No

• Best practice/local standards
• Sensor types eg lifestyle/PIR, medication and
  other prompts and reminders
• See equipment and installation

Yes
Activity/ Prompts/ Reminders?

• Medicines management
• Pharmacists involvement
• Consent, dignity
• Care plan requirements

No

• Best practice/local standards
• Sensor types eg base unit, fire, smoke, CO,
  flood, Shut-off, bogus callers
• See equipment and installation

Yes
Personal/ Home Safety?

• Care plan requirements

No
Care Pathways

• Best practice/local standards
• Range of sensors with pager, link to mobile phone
  etc
• See equipment and installation

Yes
Carer Support?

• Telecom arrangements

No
Installation
Self-assessment/Self-purchase
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LTC model and social care provision
FACS
Discharges prevent reimbursements
Critical
Dementia
COPD
Substantial
Social care (vulnerable)
Health care (vulnerable)
Moderate
Falls
Volunteers
More complex cases
Low
Accessible Health social care Information/advice
Examples of current pilots in telecare
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LTC model and social care provision
FACS
Critical
Substantial
Single assessment Contact Overview Specialist Comp
rehensive
Social care (vulnerable)
Health care (vulnerable)
Moderate
More complex cases
Low
Accessible Health social care Information/advice
Commissioning Approach - reactive, responsive to
highest needs?
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LTC model and social care provision
FACS
Critical
Substantial
Single assessment Contact Overview Specialist Comp
rehensive
Social care (vulnerable)
Health care (vulnerable)
Moderate
More complex cases
Low
Accessible Health social care Information/advice
Commissioning approach preventative and self
care stops people moving into critical/substantial
?
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LTC model and social care provision
FACS
Critical
Substantial
Single assessment Contact Overview Specialist Comp
rehensive
Social care (vulnerable)
Health care (vulnerable)
Moderate
More complex cases
Low
Accessible Health social care Information/advice
Commissioning approach - all users where needs
could be met by telecare? Cost?
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Monitoring progress

• 160,000 new users supported
• 200 outcomes and lessons learned across the
  country
• First 20m through NHS PASA framework and second
  annual review
• Demonstrators underway by Spring 2008
• Telehealth programmes being established
• Assisted Living Innovation Platform/Technology
  Strategy Board underway
• CSR07 decisions/Lord Darzi Report - 2008
• Dementia Strategy/Social Care Green Paper
• Joint Strategic Needs Assessment/LAAs

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Contact details
Housing Telecare Networks Care Services
Improvement Partnership Department of
Health Wellington House 135-155 Waterloo
Road London SE1 8UG e-mail telecare_at_csip.org.uk
Website www.icn.csip.org.uk/telecare