DELIVERING BETTER OUTCOMES THROUGH BETTER PARTNERSHIPS A CASE OF MUTUAL DEPENDENCY

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DELIVERING BETTER OUTCOMES THROUGH BETTER
PARTNERSHIPSA CASE OF MUTUAL DEPENDENCY

• Mike Martin Director, Joint Improvement Team,
  Health Directorate
• Scottish Centre for Telehealth Annual Conference,
  21 Nov 2007

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PERFORMANCE SUPPORT
HEALTH
THIRD SECTOR OTHERS
SOCIAL CARE
HOUSING
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HELPING US TO FOCUS

• Policy Framework (Better Health, Better Care,
  Changing Lives, Firm Foundations Sheltered
  Housing Review)
• National Outcomes Agenda and SOAs
• Outcomes for Community Care
• Measuring quality
• Strategic Joint Commissioning
• Shifting the Balance of Care
• National Telecare Programme

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Policy Drivers

• The Common Themes
• Person/Patient Centred
• Community based, non institutional
• Easy, equitable access
• Focus on import
• Optimise choice
• Common Approaches
• Partnership across statutory agencies
• between commissioners/providers/users
• across professional/clinical disciplines
• Efficiency

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National Outcomes Framework

• Spending Review provides context
• Economic strategy provides over-view (7
  objectives)
• Government strategic objectives provide framework
  (5 objectives)
• High level outcomes provide purpose (15
  outcomes)
• Indicators/measures provide the focus (45
  indicators)
• Single Outcome Agreements
• National concordant between Scottish Government
  and COSLA
• 32 SOAs with each local authority
• HEAT will remain for NHS

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Outcomes for Community Care

• Need to fit into SOA and HEAT
• 4 outcomes Improved Health
• Improved Wellbeing
• Improved Social inclusion
• Improved independence and responsibility
• 16 measures user satisfaction x 3
• Faster access x 3
• Support for carers x 1
• Quality of assessment and care planning x 3
• Anticipatory/at risk focus x 3
• Services closer to patients/users x 3

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Outcomes user experiences of Partnerships
(DoH Research project 2006)
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I feel lonely?Could useBefriendersSupported/
sheltered housingCommunity activitiesAssistive
technologyTransport to activitiesGood neighbour
supportHousing support
I want more independence ? Could use A home of
your own Adaptations to the house Special
equipment A different house/location A move
closer to carers Care at home Better transport
services Direct payments Housing support
I cant afford my home ? Could use Benefits
advice Better, cheaper heating Equity
release Move to cheaper housing Handy-person
service
I dont feel well ? Could use GP visit Medical
treatment-in/out patient Intensive home
support Rapid response Carer support GP/Nurse
visit
I dont feel safe ? Could use Better home
security Care and repair Community safety
action Adaptations/ equipment Assistive
technology ASBO Handy-person service Housing
support
My problems are overwhelming ? Could
use Specialist assessment/key worker Rapid
response Respite Intensive home
support Supported/sheltered housing
?
?
?
?
?
?
Happy, Well and Independent
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MEASURING QUALITYUDSET user defined self
evaluation tool

• Based on Department of Health research
• Developed to create a measuring tool
• Single shared assessment and service reviews
• 3 levels of information
• Individual
• Partnership
• National

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PARTNERSHIP WORKING essential but elusive

• Experience
• Slower, poorer decisions
• Protecting and defending resources
• Demarcation disputes
• Confused access
• Abdication of responsibility

• Aim
• Faster, better decisions
• Optimise shared resources
• Combining skills and experience
• Easier access
• Collective responsibility

Infrastructures too often frustrate rather than
facilitate achieving good objectives!
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Never, ever think outside the box!
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Shifting the Balance of Care

• Key objective in Delivering for Health and Better
  Health, Better Care
• Shifting from institutional to home based care
• Significant shifts already
• Learning Disability
• Older People
• Mental Health
• 91 of 65yrs live in their own home
• But we can and should do more!

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Shifting the Balance of Care The Approach

• Strategic Partnership Group
• Resource models
• Professional engagement
• Integrated community teams
• Workforce development
• Strategic Joint Commissioning
• - more housing based models of care
• - more local diagnostic and treatment centres
• - more integrated response services
• - more intermediate care
• - more outcomes based commissioning
• In a complex, partnership world communication
  is key

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THE ART AND IMPORTANCE OF COMMUNICATION

• Language is what separates us from animals
• a shoal of a million fish can change direction
  in the blink of an eye
• a team leader can give an instruction to 6 team
  members and have it interpreted in 6 completely
  different ways
• Talk noise in search of a thought!
• Listening waiting for you to stop talking
• Conversation 2 dove-tailed monologues

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Care at Home

• Home Care the cinderella service probably the
  single most important service!

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• A good quality home is at the heart of the
  Scottish Executive policy of optimising
  independence. It is the provision of a good
  quality home together with appropriate care and
  support services that enable independence to be
  achieved.
• Essential Connections JIT Feb 2005

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• Adequate and appropriate housing is widely
  acknowledged to be a crucial underpinning of
  health and wellbeing .. it has all too often
  been peripheral to the framing of policy at the
  interface between health and social care.
• Connecting Housing to the Health and Social Care
  Agenda CSIP Sept 2007

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The Health and Social Care Rombus
More complex cases

• Critical
• Substantial
• Moderate
• Low
• Common policies opposite drivers

Self care
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NATIONAL TELECARE PROGRAMME(2006-2008)

• Developed and managed by Joint Improvement Team
  impact across local care and health system
• 8.350 million ring-fenced capital
• Funding dependent on time release savings being
  generated and reinvested participation in a
  national evaluation
• 30 out of 32 partnerships currently in receipt of
  funding

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ANTICIPATED BENEFITS

• An additional 19,000 people to live at home
  longer with safety and security
• 75,000 people to be in receipt of telecare
  services by 2010 (including 9,000 people with
  dementia)
• Reduced need for care home places
• Reduce acute hospital admissions swifter
  discharge
• Less pressure on informal carers
• Less need for more expensive interventions
• Improved quality of life for a range of
  beneficiaries

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CORE OUTCOMES EFFICIENCIES

• Outcome 1 Reduce the number of delayed
  discharges from hospital by 437
• Outcome 2 Reduce the number of unplanned
  hospital admissions for community care based
  clients by 1,704
• Outcome 3 Remove need for 391 care home
  admissions for community care based clients
• Outcome 4 Increase the number of persons able
  to maintain themselves at home with telecare
  support service by 3,848

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EFFICIENCIES?

• Best guestimatesso far
• 43m net efficiencies
• Benefits anticipated to exceed cost by ratio of
  51

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CHALLENGES

• Data Sharing
• Charging
• Motivation/Acceptability/Ethics
• Reliability
• Open Platform
• Creating the response services

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Alerts, measurements in the home bells, sirens,
screen readout
Other AT devices
Home Sensors CO, PIR, pressure mat etc - Spec
11.1.1, 11.1.2 and 11.1.3
Alerts to users, carers etc eg pagers
Alerts, info to mobile phones, home PCS etc
Integrated Telecare
Monitoring (including parameters), response/call
handling
Installation, maintenance
Autodiallers, phone line, 3g/GPRS transmission
modules, broadband
Home visits, users/carers, emergency services,
clinician response etc
Cameraphones - Spec 11.1.2
Community alarm handset/pendant Spec 11.1.4
and 11.1.3
Standalone glucose monitors Spec 11.1.6
Autodiallers, phone line, 3g/GPRS transmission
modules, broadband
Cameras Spec - 11.1.2
Lots of Equipment!....
Autodiallers, phone line, 3g/GPRS transmission
modules, broadband
Housing systems, door entry, bogus caller - Spec
11.1.2 and 11.1.3
Sensors worn by users, falls, wristcare,
wandering etc Spec 11.1.1, 11.1.2 and 11.13
Telehealth units Spec 11.1.3
Telehealth peripherals glucose, peak flow,
weight etc Spec 11.1.2 and 11.1.3 also 11.1.5,
11.1.6, 11.1.7
Medication monitoring Spec 11.1.11
Environmental controls Spec 11.1.3
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..TO SUPPORT LOTS OF LOCAL SERVICES

• Intermediate Care/Transitional Living 50 places
• Management of Long Term Conditions 295 people
• Expansion of Core Telecare Packages 10,536
  people
• Provision of enhanced Telecare Packages 1,060
  people
• Telecare Service targeted to 805 people living in
  sheltered housing

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DIFFERENT LOCAL FLAVOURS

• Dementia focus for Islands Councils
• Rural Virtual Clinics
• High Risk targeting
• Large number of small projects
• Strategic development of telecare platform
  support infrastructure
• Focus on reshaping specific part of wider system
  e.g. intermediate care, sheltered

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STRATEGIC PRIORITIES

• Telehealth/Telecare Convergence
• Best use/further development of Call Centres
• Integration of Telecare with Care Planning
• Demonstrator for Older Peoples Housing
• Performance Standards Regulation
• Innovation and development
• National Evaluation

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The drug itself has no side effects but the
number of health economists needed to prove its
value may cause dizziness and nausea.