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A HEALTHy VIEW OF SOCIAL CARE IN SURREY INTEGRATING HEALTH AND SOCIAL CARE TO DELIVER TELECARE SOLUT

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Day Resource Unit. Pt with PD. Neurologist. Geriatrician. Primary Care Team ... Audit Commission, Assistive Technology: Independence and Well-being 4, February 2004 ... – PowerPoint PPT presentation

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Title: A HEALTHy VIEW OF SOCIAL CARE IN SURREY INTEGRATING HEALTH AND SOCIAL CARE TO DELIVER TELECARE SOLUT


1
A HEALTH(y) VIEW OF SOCIAL CARE IN SURREY
INTEGRATING HEALTH AND SOCIAL CARE TO DELIVER
TELECARE SOLUTIONS
  • Dr Beverly Castleton
  • Consultant Physician Care of the Elderly
    Specialist in Movement Disorders
  • Surrey Primary Care Trust
  • 15 November 2007

2
  • Introduction
  • Model of Care CDM Out of Hospital
  • Pilot to Practice Mainstream Telecare
  • Evaluation and Commissioning
  • Conclusion

3
MODEL OF DELIVERY FOR CHRONIC DISEASE
  • Out of Hospital
  • Single Assessment Process Delivery
  • Common Assessment Framework
  • Risk Management
  • Reshaping Patient-Centred Care
  • White Paper Our health, our care, our say
  • A New Ambition for Old Age
  • Our NHS Our Future

4
Future Health Care Trends - Burden of Disease
A TRANSFORMATION IN THE MODEL OF CARE
Source KPCMI 166
5
Across the whole triangle
Case Management
Level 3
Complex co-morbidity
Level 2
Disease/Care Management
Poorly controlled single disease
Professional Care
Self Care
Level 1
Supported Self Care
Well controlled (70-80 of LTC population)
Population Wide Prevention
6
TELECARE DEFINITION
  • Telecare is the delivery of health and social
    care services to people usually in their own
    homes using a combination of sensor and
    information and communication technologies (ICT).

7
TELECARE
Prevention
Safety security monitoring, e.g. bath
overflowing, gas left on, door unlocked
Mitigating risk
Personal Monitoring Physiological signs
Activities of daily living
Information Communication, e.g. health advice,
triage, access to self-help groups
The individual in their home or wider environment
Prevention
Improving functionality
Electronic assistive technology,
e.g. Environmental controls, doors
opening/closing, control of beds
8
THE EMERGING INFRASTRUCTURE
  • Assessment referral
  • Equipment
  • Monitoring
  • Response
  • Review

The individual in their home
NCRS
Alarm !
Record event
Response protocol
Response home visit, emergency services, remote
change
Check status
Check
Response provider neighbour, relative,
ambulance, HCA, fire, police
Call centre
9
LOGISTIC INFORMATION PATHWAY OF A TELECARE
SERVICE
Entry (Re) Assessment of Need (SAP)
Care Package Development
Review
Telecare Prescription and a Response Protocol
Community Response
Home survey
Call Handling
Equipment Provision
Monitoring
Installation and Maintenance
10
PARTNERS IN PROVISION
  • Dementia Care
  • Falls Services
  • Primary Care GP/DN/Out of Hours
  • Community Alarm Service
  • Ambulance Service
  • ANPs (Advanced Nurse Practitioners)
  • Community Matrons
  • SWOPs (Specialist Workers for Older People)
  • Specialist Nurses in Chronic Disease Management
  • Patients, Carers and Relatives
  • Care Managers
  • Home Care
  • Intermediate Care/Older Peoples Services
  • Nursing Residential home staff

11
PARTNERS IN PROVISION
  • Flexible Systems
  • Quality
  • Not necessarily hours

12
TELECARE IS AN ADJUNCT TO THE SYSTEM NOT A
SUBSTITUTE FOR CARE AND HANDS-ON DELIVERY
13
3 MIGRATION PATHWAYSREDESIGN
  • IT Asst
    Interagency
  • Skills
    Work
  • Integration
  • Clinical Networks
  • Whole System Delivery

14
TRUSTED ASSESSOR
15
CONTEXT
  • At least 12 major government reports since 1998
    have called for telecare
  • Delivering 21st century IT support for the NHS
    home telemonitoring to be available in 100 of
    homes requiring it by Dec 2010
  • 80m in Comprehensive Spending Review for
    developing telecare and social alarm services
  • The elements of a telecare framework are in place
    social alarm service,
  • Numerous trials shed light on implementation
    problems and individual outcomes

16
TECHNOLOGY IMPACT
  • Reduces patient journeys, hospital visits and
    hospital admissions
  • Saves the time of healthcare professionals
  • Supports individuals living at home to look after
    themselves
  • Improves the quality or effectiveness of the care
    or treatment that is delivered
  • Helps to manage the risk

17
TELECARE The ChallengeMainstreaming
  • Creating the organisational structure for
    implementation
  • Retraining staff
  • Apportioning costs
  • Deciding eligibility
  • NEEDS IT BACK UP TO IMPROVE INFORMATION FLOW

18
SINGLE ASSESSMENT PROCESS
  • Common Assessment Framework
  • Who Leads?
  • What Criteria?
  • All Levels of Need

19
There is the tantalising possibility for public
policy to meet more peoples desire to remain
independent for longer, while at the same time
saving money overall
  • Source Assistive Technology Independence and
    Well-being 4 Audit Commission, Feb. 2004

20
CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT
  • Involve the patient and customise for their needs
  • Easy access
  • Manage populations through integrated databases
    screen and risk manage
  • Develop robust networks between
  • - patients (support groups)
  • - patients and professionals
    (communities of care)
  • - professionals (communities of
    practice)

21
CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT
  • Training and development for patients and
    professionals
  • Develop expert systems
  • - expert patients
  • - expert professionals
  • - expert ICT with protocols, guidelines etc
    that develops shared knowledge
  • Clinical governance that depends on good
    evaluation and the ability to track the patient
    in the system

22
MAJOR SWOP/STOP NETWORKS
AE MAU
Wards
Specialist based assessment
SWOP System
Rehabilitation
Community
Social Services
Information, skills flow
23
PARKINSONS DISEASE MANAGEMENT
Primary Care Team
PD Society
Day Resource Unit
Pt with PD
Geriatrician
Neurologist
EPICS/Comm. Matron
PDLN
Home Care?
Arrows indicate flows of information, skills and
care
24
THE PARKINSONS DISEASE SUPPORT NETWORKNew
Electronic Support Network for People with
Parkinsons Disease
  • A collection of linked websites, or virtual
    communities to help patients, their families and
    healthcare professionals to support sufferers of
    Parkinsons Disease
  • Medixine/North Surrey PCT

25
KEY ISSUES
  • Who is offered Telecare?
  • What levels of sophistication of equipment?
  • Do we need national criteria?
  • Should the equipment be free?
  • Should the revenue cost be means tested?
  • Should it be disease led?

26
WANLESS Social Care ReviewImpact of Telecare on
the need for Domiciliary Care,2005/6 to 2014/5
Hours of care (thousands)
Potential impact of the 2006-08 Preventative
Technology Grant investment on the estimated
number of hours of domiciliary care needed in
Telecare Valley (excluding care homes).
27
  • The provision of telecare has an immediate impact
    on total staffing levels. When assessing
    staffing, it is not only formal carers who need
    to be included, but also the call centre staff
    and response teams on which telecare networks
    crucially depend. The demand for staff is
    particularly high at the beginning of a telecare
    investment project when this human infrastructure
    needs to be set up, the telecare equipment
    installed and everyone trained to use it.

28
CONCLUSIONS
  • Major Service Redesign
  • Whole System Integrated Approach
  • Use the IT Agenda as a catalyst for change
  • Single Assessment Process to mainstream Telecare
  • Cross Organisational Workflow and Workforce
    required
  • Managing the Risk is essential
  • Patient and Carers need to be part of the team
  • Accuracy of Data essential
  • Win Win

29
  • Research
  • Evaluation Commissioning

30
PAYOR
DATA
PATIENT ( CARER)
PROVIDER
31
REFERENCES
  • Audit Commission, Assistive Technology
    Independence and Well-being 4, February 2004
  • Audit Commission, Older people implementing
    telecare, July 2004
  • Department of Health, Building Telecare in
    England, July 2005
  • Department of Health Health and Social Care
    Change Agent Team (CAT), Housing LIN Factsheet no
    5 Assistive Technology in Extra Care Housing,
    August 2004

32
REFERENCES
  • Department of Health ICES (Integrating Community
    Equipment Services, Telecare Implementation Guide
    and numerous fact sheets, July 2005 onwards
  • Health Select Committee, The Use of New Medical
    Technologies within the NHS, Fifth Report of
    Session 2004-05, April 2005
  • Department of Health Application of Telecare and
    Long Term Care
  • Telecare Alliance, Website address
    www.telecarealliance.co.uk
  • Wanless Social Care Review, Kings Fund, 2006
  • Our NHS Our Future October 2007
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