the mainstreaming of telehealthcare services will release substantial resources

© 2008 Tunstall Group Ltd Confidential

The mainstreaming of telehealthcare services will release substantial resources

– how do you make it happen?

Doing More With Less !!

2© 2008 Tunstall Group Ltd

Presentation Team

• Kevin Alderson– Public Sector Policy Director

• Andrew Bailey– Account Director - Wales and the West Country


Areas to Cover

• Taking stock– the Welsh Telecare programme has delivered a good

infrastructure, it now needs building upon• Facing challenges

– finances will be tight for the foreseeable future whilst demand for services continues to grow through demographic trends

• Maximising opportunities– this existing infrastructure can deliver big savings for

redeployment if it is fully utilised

• Key Objectives:-– Highlight the opportunity, through case studies– Illustrate the route to mainstream services, based on best practice

in Wales and elsewhere– Discuss how to make this happen across Wales


Telehealthcare


Flexible telehealthcare solutions

Monitoring Centre can support: Administration duties, Emergency response coordinationLifestyle monitoringQuantify results,Coordinate installation and removal,Equipment inventory Valuable communication hub for the whole service

Monitoring Centre

Telecare units and Sensors in clients’homes

Response in the Community

Based in client homesExtra care housingResidential housing

Nursing homes etc.

Free phonetelephonenumber


Flexible telehealthcare solutions

Monitoring Centre can support: Administration duties, Non clinical triageQuantify results,Coordinate installation and removal,Infection control Equipment inventory Valuable communication hub for the whole service

Clinicians perform daily triage of patient caseload

Monitoring Centre

Telehealth monitorsin patients’ homes

Clinicians, Community andTrust based

Based in patient homesExtra care housingResidential housing

Nursing homes etc.

Free phonetelephonenumber


How does Telehealthcare work?

Telehealthcare delivery model

Managed Response

Social Care, Housing, Community Nursing, Friends, Family, Therapy, Meals, Voluntary Services…

EmergencyResponse

Response Centre

Alerts andReassurance

Social care health care housing education


NURSINGSECURITY

MEDICALPERSONAL

SOCIAL

ENVIRON-MENTAL

SAFETY

fire, floods,high temps,low temps,air quality,noise,hygiene

wandering,falls, CO gas,scalds,unburnt CH4,tampering,cooker/µwave misuse

incontinence,pressure areas,chronic disease symptoms,medication compliance

Intruders,bogus callersdoor status

use of bed, little movement,bath monitor,lack of contact, poor nutrition

cardiac arrhythmia,asthma attack,hypoglycemia epileptic seizure, blocked catheter, apnoea

Continuum of Telehealthcare Services


Evidence of the positive impacts

Citizens & PatientsCarersFinances


What has been happening in Scotland?

“JIT” (Joint Improvement Team) – Telecare Development Programme


Quality of life of users of telecare services

Telecare’s impact on specific aspects likely to affect users’ quality of life?:

• Over half (55.2%) of the respondents felt that their health had not changed, whilst slightly more than half of the other respondents (comprising 27.1% of the total) thought that their health had improved;

• Almost all (93.3%) respondents felt safer;• Over two-thirds (69.7%) felt more independent;• Very few (3.5%) felt lonelier;• Four-fifths (82.3%) either “disagreed” or “strongly disagreed” that they felt

more anxious and stressed;• Most (87.2%) thought that their families now worried less about them;• About two-fifths (40.8%) felt that their equipment had not affected the amount

of help they needed from their family, whilst about one-third (32.8%) felt that they needed less help.

York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/


Reduced pressure on informal carers

• Three-quarters (74.3%) of the respondents felt that telecare equipment has reduced the pressures on them by reducing their stress levels

• Fewer than one-in-twenty (4.3%) felt that their stress levels had increased;

• Carers generally felt that the equipment gave them peace of mind as they worried less (e.g. about falls);

• They felt that people with learning disabilities could enjoy greater independence and that the equipment could enable people with dementia to remain living in the community for longer;

• Even if stress levels had fallen, several respondents highlighted that caring can still be very demanding and stressful (especially if the client will not use their equipment);

• However, many carers were very positive about the telecare service and also very grateful for it.



Telecare in Scotland – prevention and efficiency!!

Outcome Minimum target for 2007-2010

Actual achieved Apr 07-Sep 07

Actual savings achieved Apr 07-Mar 08 Est monetary saving

Hospital bed days saved by facilitating speedier hospital discharge

46,500 1,800 5,668 days 517 discharges

£1.7m 15.5%

Reduced unplanned hospital admissions - bed days saved

Info not avail Info not avail 13,870 days1220 admis

£3.34m 30%

Care home bed days saved by delaying people to enter care homes

225,000 6,900 61,993 days 518 admis

£3.42m 30.7%

Nights of sleepover care saved 46,000 1,250 Info not avail £0.55m 5%

Home check visits saved 905,000 107,000 Info not avail £1.79m 6.1%

Locally identified savings eg reduced waking nights

Info not avail Info not avail £0.30m 2.7%

No. of TDP funded telecare users 13,505 6,005 7,902

Estimated verifiable savings as a result of Scotland Telecare Dev Prog

£43m £2.9m £11.15m



Key English Telecare Case Studies

North Yorkshire


North Yorkshire Cost Benefit Analysis Average 38% 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


Evaluation Outcomes“Traditional” v “Telecare enhanced”

• 46% of the traditional packages would have been residential, EMI or nursing and 54% at home

• Those who would have had more than 10 hours home care saw a reduction in the number of hours needed

• The trend for those who would have received 7 hours or less was a reduction in the number of hours with some people needing no further support

• Analysis indicated a net average annual efficiency per person £3,654 countywide

• 38% reduction in care package costs.

• Average of the sample (131) and grossing up for all those clients utilising Telecare for over a year (330) gives net figure £1,108,609.


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.


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.


Key English Telecare Case Studies

Stockton


Evidence ensures mainstreaming of service

BACKGROUND • number of over 65s will increase by 46% by 2021 • 20% of the population report having a limiting long term condition

OUTCOMES• A draft evaluation was taken to the Adult Care Partnership Board which showed

that overall savings were estimated to be £600,000 pa gross and £220,954 pa net

• The 13 month pilot directly supported the mainstreaming of telecare services in Stockton

• £400k funding over 2 years secured, £300k from PCT (local delivery plan arrangement) and 100k social services (adult social care fund)

• 270 people using telecare (defined as 2 or more pieces of equipment). In addition there are 4500 community alarm service users


Reduction of care home/domiciliary care hours

Each telecare client receives a six week joint review and at the time of this report (May 2008), 90 reviews had been completed with social work professionals stating that:

• 42 Telecare installations will delay care/residential care admission and eventually lead to a reduction in care home admissions. (47%)

• 26 Telecare installations have resulted in stopping a care home admission. (29%)

• 11 Telecare installations have resulted in no economic benefits. (12%)• 7 Telecare installations have resulted in reduced domiciliary care hours.

(8%)• 4 Telecare installations have resulted in stopping nursing care home

admissions. (4%)


Hospital A&E attendance avoided/bed days saved

The key statistics when looking at this is the sensors detecting incidents early and making the service aware that there may be a problem.

• This is highlighted by the main key incidents of sensor activity.– 64 Clients found on the floor.– 31 “Client Walking” activations where clients were found and returned safely to their

property.– Of these 95 incidents only 7 of the “clients on the floor” category led to

ambulances called and attending the hospitals accident and emergency services.

• With Telecare staff attending the remaining call outs within an average of 14 ½ minutes from the time the incident has occurred it could be assumed due to the nature of the incidents the service has saved the local PCT:

– 88 Ambulance call outs, in the region of £13,904 at an average £158 per call out. £158 is average cost of an ambulance call out.

– £6,424 saving in A&E admission based on £73 per call average standard cost of A&E admission. (PCT average Standard A&E admission)

– £66,528 in bed days saved if each case had resulted in a 2 day hospital stay. Based on £378 per day hospital bed. (PCT average cost per day of hospital bed 2008).


Key English Telehealth Case Studies


NHS Blackpool and Vitaline

• Delivering telehealth for over 3 years

• COPD, HF, Diabetes, Partnership with Community Matrons

• 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 and expansion


NHS Blackpool and Vitaline – 12 month study


NHS Blackpool and Vitaline – 12 month study

• 100% Equipment is easy to use

• 80% Since having telehealth I understand my condition better

• 80% I have less anxiety

• 70% managing my condition at home through telehealth has enhanced my quality of life


Orchard Medical Centre – PbC project

• Primary care (GP Practice) based (Orchard Medical Centre)

• Led by GP’s, operationally run by district nursing and practice staff -Heart failure focussed - Started March 07

• PbC service change business case (Key outcomes and benefits trialled trialled)

• Quality of life for patients improved• Increased knowledge and understanding of health promotion issues relating to heart

failure, both by nursing staff and patients to troubleshoot problems and make small changes that will impact on long term health.

• Reduction in hospital admissions leading to a reduction in bed days demanded. • Reduction in hospital acquired infections and their complications by this frail and

vulnerable group• Improved safety during complex medication alteration• Increased skills in the community and practice team• Increased skill mix in the combined team, with a further opportunity to work seamlessly

in the primary care team

• Pilot successful - now expanded and embedded into standard care within the practice


Impact on Doctors Time

Doctor Use

0

1

2

3

4

5

6

Month

co

nta

cts

pe

r u

se

r

Doctor Tel Calls

Doctor visits

Doctor in surgery

total doctor demand


“I’d be lost without telehealth”

• Margaret has severe heart failure and would often forget to take medication leading to regular visits to A&E

• She has not used out of hours health services at all in the last year

• Telehealth gave Margaret increased reassurance leading to improved medication compliance and less visits to the hospital

Case study – OMC


Example large scale telehealth services

Whole System Demonstrator • Tunstall is involved in all three WSD sites - Kent, Newham, Cornwall –

covering 6,000 people

• Cornwall: Major milestone achieved Aug 09 – over 2000 people taking part:– 1,100 telehealth patients– 1,100 telecare clients– Currently 1,100 in the control trial group

Successes• Now mainstream funded for 1,100 patients year on year (Expanding

into Stroke, Hypertension and UTI) • Effective internal service set up and project management• Dedicated administration and technical team• High awareness level and full clinical engagement

– GP, Community Matrons, Medical physics, clinical team, and installation/de-installation team

• Formal evaluation is currently underway with research institutes.


Example large scale telehealth services

NHS North Yorkshire & York: • Mainstream funded – 2000 units (COPD, CHF, Diabetes, Stroke)

• ROI based on reducing acute sector demand and improving operational efficiencies in primary care

• Full service & care pathway redesign – embedding “care at home” services into standard service provision.

• GP, Case management and specialist clinical team critical to success - clinical champions in all key areas (geographical and specialist)

• Full supporting service provision provided by Tunstall– Service desk (referral, commissioning, assessment and contact)– Single access sign on – Clinical consultancy – Project management – Outcomes evaluation


Large scale Telehealth deployment & service redesign delivers a net ROI of 1.9

• Indicative PCT of population 800,000

• Total net savings of £9.1 million over 3 years

• Annual net savings £5.1 million year 4 onwards

• Net return on investment first three years 1.9

• 2,000 patients (Heart Failure, COPD, Diabetes)

– Telehealth technology supply: equipment packages, triage software, communication fees, warranty/maintenance, consumables

– Managed services: installations/de-installations, service desk, training

– Care at Home Service redesign, LTC care pathway redesign and project support


Overview of integrated telehealthcare service

ICP

Integrated Care Platform


ICPIntegrated Care Platform

IdentifyPatients & condition

ServiceManagement

Self Care &Monitoring

Data Capture& Processing

Clinical Decision Support Coaching &

Education

patient


Managed Services that support care delivery transformation

IdentifyPatients & condition

ServiceManagement

Self Care &Monitoring

Data Capture& Processing

ClinicalDecisionSupport

patient

Coaching &Education

Transforming Care Delivery

Service and Pathway re-design


36

ICP: Provide the building blocks….

IdentifyPatient

& Needs

ServiceManagementSelf Care &

Monitoring

Data Capture& Validation

ClinicalDecisionSupport

Coaching &Education

TelecoachingHealth information

Patient Portal

Video Conference

patient

Health Surveys

SecureCommunications

N3 HostingTechnical Triage

Clinical Triage

Riskstratification

Healthcare portal

Patient Referral

Service Desk


Tunstall Service DeskPlatform

Tunstall telehealth platform 2 way flow of patient details

Patients/Carers Servicesupport staff

Online Referral Form

Referring clinicians Multiple referral sources

Communication coordination

Trust staff

Other H&SC platforms

System Integration

SLA ReportsTunstall telecare platform

Integrated telehealthcare delivery……joining up health & social care

N3

e

nv

iro

nm

en

t

Locally hosted


How does Telehealthcare work?

Telehealthcare delivery model

Managed Response

Social Care, Housing, Community Nursing, Friends, Family, Therapy, Meals, Voluntary Services…

EmergencyResponse

Response Centre

Alerts andReassurance

Social care health care housing education


What are the barriers to making this happen?How do we make “mainstream” happen?

Discussion session


Thank you for listening

[email protected]

07740 578000

the mainstreaming of telehealthcare services will release substantial resources

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