Telecare “enabled” - The future of assistive technology in

commissioning services for people

Jeremy PorteusHousing Network Lead

Change Agent Team

22 February 2005

Designing for Life

Telecare• Included in DH ICES guidance (March 2001)• Telecare Advisory Group and pilot project (2003)• Telecare ‘Getting Started pack’ (revised 2005)• Audit Commission report (Feb 2004)• ICES/Audit Commission/CAT Conferences

(Summer 2004)• DH Green Paper (expected February 2005)• DH Policy Collaborative till March 2005• £80m in Spending Review from 2006

Understanding the language• Assistive Technology: Any equipment or system that assists people who

have difficulties due to age or disability in carrying out everyday activities (source R Curry) or a product or service that enables independence for older and disabled people (source: FAST)

• Telecare: the remote or enhanced delivery of health and social services to people in their own home by means of communications and computerised systems (source: Barnes)

• Telemedicine: the practice of medical care using interactive audio-visual and data communications – this includes the delivery of medical care, diagnosis, consultation and treatment, as well as health education and the transfer of medical data (source: WHO)

• Smart House: A dwelling incorporating a communication network that connects the key electrical appliances and services, and allows them to be remotely controlled, monitored or accesssed (source: Housing LIN factsheet)

•

Information & communication, e.g.health advice, triage, access to self-help groups

Safety and security monitoring, e.g. Bath overflowing, gas left on, door unlocked

Personal monitoring:•Physiological signs•Activities of daily living

Electronic assistive technology, e.g. environmental controls, doors opening/closing, control of beds

Improving functionality

Mitigating risk

The individual in their home or wider environment

Features of a Telecare ServiceFeatures of a Telecare Service

Implementing Telecare• Over 1.4 million users of community alarms in the UK• 150 social services departments, 303 PCTs, 238

district councils, housing associations, alarm service/ independent providers, demonstration facilities

• 138 community equipment services – health/social services (some housing/education links) majority with S31 agreements and pooled funds, single point of contact, equipment tracking, some contracted services etc

• Seven day delivery for most equipment incl telecare (PAF indicator)

• Various forms of funding to date, mostly pilots/projects, £80m for 2006-2008

• Policy Collaborative, Getting Started Pack

Background to Telecare• Community alarms emerged from concern about

isolated older people and availability of cheap technology in 60’s and 70’s

• Driven by local authorities and more recently housing associations

• Were strongly associated with social rented and sheltered housing

• However, there have been huge technological advances – new products, new wireless technologies, assistive technology

• Huge social change too and different ways of considering customer and commissioners’ needs

A case for improved

integrated working

We are sometimes the wrong services providing the wrong service at the

wrong time

We need to review how and where we spend

resouces

The rate of change in health care must link to change in

social care & housing provision

The key providers must coordinate their services

more effectively

We are still driving a reactive approach to care

and housing

We need to develop enhanced preventative

services

33% increase in people needing care in next 10 years

Demand is increasing more quickly than ever before

Not developing the types of care services needed in

the future fast enough

We are far to slow

Govt will no longer tolerate poor performance or slow progress

Cash rewards are available to those willing to change

Low overall expectation

User expectations will increase in both needs and

wants

Assessment including telecare

• Fair Access to Care Services (FACS) – Critical, Substantial, Moderate, Low Risk

• Single Assessment Process (SAP) – assessment tools – Contact, Overview, Specialist, Comprehensive

• Supporting People Support Plans?

• Financial assessment – if charging for services

• Self-assessment

• Direct payment options – social care assessment

• Self-purchase

Telecare and hospital admissions

• Telecare has a potential role in avoiding hospital admissions as well as supporting discharges

• For preventive and admission avoidance approaches you will need to look at the models of supporting long term conditions (eg heart failure, strokes) where there are multiple admissions

• For hospital discharge approaches, you will need to look at intermediate care, step-up/down facilities, extra care housing, link with home improvement or Care & Repair agencies etc

• Reducing unnecessary hospital admissions will maintain independence for users/carers and stabilise costs particularly under the national tariff from April 2005

Making the business case for telecare

• Empowerment of service users – better involvement in the management of health and lifestyle conditions

• Better us of staff time – responding to specific needs, alerts and circumstances in the home

• Quicker diagnosis and referral for care, treatment or other service

• A significant health dividend – prevention, and reduction of hospital admission or home from hospital care

• Support and manage independence in the home• The glue to a coordinated approach to support people

at home

User at home

Heart Disease

Stroke

Falls

COPD

Cancer

MND, MS Long term

conds

Major Phys Dis

Loneliness/ isolation

Dementia

Sensory/ com loss

Ageing/ Senility

Other Phys Dis

LD/MH

Care pathway

Temp Phys Dis

Housing

Integrated services to support independence

Care pathway

Wandering?

Lives alone?

Yes

Yes

Yes

>1 fall per month?

FallsIsolated/lonely

Demetia

3 or more admissions?

FACS

Critical?

Substantial?

Moderate?

Yes

Yes

Yes

No

No

No

No

Yes

SAP

Contact?

Overview?

Specialist?

Yes

Yes

Yes

No

No

No

No

Yes

Comprehen-sive?

Services

Case Management

Nursing/ home care/ specialist dementia care & support

Int care/rehab

Telecare/ telehealth – falls monitor, reminders, wandering, bed occupancy etc

Housing

Low?

Assessment

Specific needsMICRO

MACROGeneral needs

Moving on Staying put

Technology

HomeCare

Acute sector

Primary care

Domiciliary/homecare

Residential/nursingcare

Communityhousing

Ageing-in-place

Sheltered and verysheltered (ECH)

Adapted housing

Aids, adaptationsand equipment

•Eneabling Technology Technology•EEnabling Technology

Telecare – the challenge• No mainstream telecare in England yet, no joint

commissioning -Telecare not provided as a ‘care option’, what happens with practice-based commissioning?

• Single assessment still a vision rather than a reality in many areas – telecare not in CSR

• 150 SSDs, 303 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning via SAP/FACS etc with information sharing

• Impact of Supporting People reviews?• Some processes could be lengthy – project manager, ethics,

charging, procurement, agreements, training, information-sharing protocols etc – need to start NOW

• Lack of clarity over what ‘assessed needs’ to address with telecare – do we have the evidence? High or low FACS?

Telecare checklist

• The patient or client group to be supported• The care process to be enhanced through telecare• The care setting• The scale of the proposed service (the number of patients or clients

served)• The scope of the proposed service (the functionality of the service)• The referral process into the service• The equipment installation, maintenance and monitoring service• The response service• The fit with existing care teams• The capacity of existing care teams to provide the response• The training needs of new and existing staff • The distribution of costs and benefits amongst stakeholders• The role of private sector suppliers

Further information

• Housing LIN, Change Agent Team - www.changeagentteam.org.uk/housing

• Audit Commission - http://www.audit-commission.gov.uk

• ICES Team – www.icesdoh.org • Telecare pack - www.icesdoh.org/telecare • Policy Collaborative: http://

www.info.doh.gov.uk/etpc/etpc.nsf

Future perfect?