11 June 2010

Telecare and Telehealth Support from DH

Care Networks and WSDAN

Mike ClarkDH Care Networks Telecare Lead

WSD Action Network Co-project Lead

Telecare Telehealth eHealth, mHealth,

pHealth, telemedicine

Community Alarm

USA, Canada, UK, Parts

of Europe, (Italy,

Germany, Netherlands)

some parts of Asia

Vital signs monitoring

and trend analysis for

long term conditions –

heart, respiratory,

diabetes

USA, Canada, UK, Parts

of Europe, (Italy,

Germany, Netherlands)

some parts of Asia

Vital signs monitoring

and trend analysis for

long term conditions –

heart, respiratory,

diabetes

UK, Some parts of

Europe, Australia,

gaining ground in North

America and parts of

Asia

Personal and

environmental sensors

– falls, flood, fire,

temperature, carbon

monoxide, bed

occupancy, medication

UK, Some parts of

Europe, Australia,

gaining ground in North

America and parts of

Asia

Personal and

environmental sensors

– falls, flood, fire,

temperature, carbon

monoxide, bed

occupancy, medication

Telemedicine – USA,

Europe, India, Africa,

parts of Asia

Videoconferencing,

Information and

telephone support,

smartphone and games

applications

Telemedicine – USA,

Europe, India, Africa,

parts of Asia

Videoconferencing,

Information and

telephone support,

smartphone and games

applications

UK, Some parts of

Europe and Asia,

Australia, gaining

ground in North

America and Canada

Also known as pendant

alarms, social alarms –

generally linked to a

monitoring centre

UK, Some parts of

Europe and Asia,

Australia, gaining

ground in North

America and Canada

Also known as pendant

alarms, social alarms –

generally linked to a

monitoring centre

Illustrative only – DH Care Networks does not endorse individual suppliers or their products

Understanding the developing global picture

2004 2005 2006 2007 2008 2009 2010 2011

Shaping the future

•WSD Outcomes (10/11)

•Connectivity to record

systems

• Telecare Framework

•Mobile health/games

Outcomes

•PTG outcomes

•+175,000 users

•WSD and ALIP

commences

•£521m TSC/SP

PTG Yr 1

•+£30m allocated

•Aim for +60,000

users

•White Paper –

“Our health….”

Funding

•Announcement

of £80m grant

funding

BTiE

•Building

Telecare in

England (BTiE)

•Preventative

Technology

Grant (PTG)

•1.4m users

•Aim for +160,000

older people

PTG Yr 2

•+£50m allocated

•Aim for

+100,000 users

•Putting People

First – ‘Telecare

is integral…’

Mainstream

•Telecare

moving into

‘mainstream’

•50-100 PCTs

with telehealth

programmes/

plans

•Interoperability

Innovation

•Ambient and

wearable sensors

•Hub and

interoperability

developments

•Impact on price

•ALIP outcomes

Funding and outcomes

The story so far - England

WSD – Whole system Demonstrator programme

ALIP – Assisted Living Innovation Platform

SP – Supporting People fundingTSC – Transforming Social Care funding

Making sense of the technology and services

Recent trends from the ATA Conference (May 2010)•Mobile•Broadband•Connected, social networking•Self install, consumer purchases•Services not products•More device intelligence•Lifestyle and well-being as well as long term conditions•Competitive prices

Illustrative only – DH Care Networks does not endorse individual suppliers or their products

Evidence

Activity

� Improving carers’ lives� Other LTCs

Understanding who could benefit

� Support for CHD

� Palliative care

� Support for People living alone

� Overnight care

� Supporting dementia (social care)

� COPD

� Falls

� Heart failure

� Diabetes

� Handling home emergencies � Reducing anxiety� Reducing care

home admissions

� Reducing hospital/A&E

admissions

� Intermediate care,

re-ablement

� Obesity/Diet � Medication

� Extra care, sheltered housing� Hypertension

� Outside

the home

•Use of PT Grant funding

•Different evidence

thresholds for health, social

care, housing

Evidence versus Activity

NICE and other guidance

VHA Evidence from USA

Long Term Conditions

Complexity, risk, high cost

Adult Social Care

Understanding who could benefit

TelehealthTelecare

FACS critical and

substantial, co-

morbidities,

exacerbations

Could support

people at home but

some people may be

too ill or too frail to

benefit from

technology

?

Community Matron

caseloads,

emergency

admissions –

COPD, HF

Intensive

home care,

day services,

intermediate

care, falls

management

Complexity, risk, high cost

FACS moderate/low

and one long term

condition, relatively

stable

Larger numbers, more

preventative, higher costs,

possibly lower impact on

admissions, some self-

management

Known to

community

matrons

Known to

social care

but may not

be receiving

a service

£?

TelehealthTelecare

Generally not

known to

community

matrons,

undiagnosed

LTCs,

prevalence

for obesity,

smoking

Generally not

known to social

care but often

live alone

sometimes with

poor social

networks -

potential future

social care

users

Facebook

Tyze

Twitter

MMS

SMSBluetooth

USB

NHS Healthspace

SmartphoneseMail

eHealth NHS Choices

3G/4G

Very large

numbers, longer

term investment,

higher costs,

possibly lower

impact on

admissions, more

self-management

and self-purchase

Wii/DS

Making connections to policy references for telecare and telehealth (2009/10)

•Living well with dementia: A National Dementia Strategy and Implementation Plan•Building Britain’s Future•Social Care Green Paper - consultation•Building a Society for All Ages•Working Together for Older People in Rural Areas•Consultation on FACS•A year of Progress Towards High Quality Care for All•Transforming Community Services (LTCs and Care Closer to Home)•Prevention Strategy•Use of Resources in Adult Social Care

Telehealth

Telecare

� Kent� Cornwall

� Newham

Illustrative only – not too scale. Local services (does not include NHS Choices/NHS Direct)

Telehealth versus Telecare

� Sunderland

� Lincs

� Birmingham (BEN PCT)

� Sheffield

� Nottingham

� Swindon

� Essex

Main Group

� Leeds

� Durham

� Northants

� Sandwell

� Hull

� Southampton

� Barnsley

� Lancs

� Norfolk� North Yorks/York

Final CQC figures – (as at 2 Nov 2009)

Additional users

The minimum additional user figure over three

years is now 295115 for 2006/7/8/9. This is

based on social care alone together with social

care and partner agencies (the first two CQC

categories).

This can be increased if we include all other

agencies (eg district councils, housing

associations). The 2006/7/8/9 figure is 452,897

if these other agencies are included.

The additional user projections for 2009/10 are

143,031 (first two categories) and 186,503 (all

categories). There are now 152 social care

authorities.

Expenditure

Outturn expenditure for 2008/9 was £74,191,000

around £5m below previous projection.

Projections for 2009/10 total £79,664,000

Tracking performance

LAs and additional

users (65 and over)

LAs and expenditure

Comparing 2009/10 information with 2008/9

3% or

more

growth in 2009/2010

5% or

more

growth in 2009/2010

20% or

more

growth in 2009/2010

3% or

more

decline in 2009/2010

5% or

more

decline in 2009/2010

20% or

more

decline in 2009/2010

No

change

– within

+/-3%

New

authority

101 92 39 30 28 11 17 4

3% or

more

growth in

2009/2010

5% or

more

growth in

2009/2010

20% or

more

growth in

2009/2010

3% or

more

decline in

2009/2010

5% or

more

decline in

2009/2010

20% or

more

decline in

2009/2010

No

change

–within

+/-3%

New Missing

75 70 41 44 38 20 28 4 1

Benchmarking

EU contracting limits for local authorities and health

trusts

Buying Solutions National Framework (2010):

•Telecare products/services

•Telehealth products/services

•Telecoaching

•Managed services

Supporting efficient procurement

Housing Local authorities Independent,

commercial, third sectorHealth

•Social care

authorities for

purchase of

community alarm

equipment, telecare

sensors,

installation, control

centre monitoring,

response

•Some district

councils provide

similar services in

county areas

•Some social care

authorities have

purchased and

installed telehealth

equipment

•Social care

authorities for

purchase of

community alarm

equipment, telecare

sensors,

installation, control

centre monitoring,

response

•Some district

councils provide

similar services in

county areas

•Some social care

authorities have

purchased and

installed telehealth

equipment

•Housing

organisations for

purchase of

community alarm

equipment, telecare

sensors,

installation,

monitoring,

response

•Handyperson, care

and repair schemes

for installation

•Provision of

services in sheltered

housing, extra care

•Purchase of

telehealth

equipment and

initial monitoring

•Some out of area

contracts

•Housing

organisations for

purchase of

community alarm

equipment, telecare

sensors,

installation,

monitoring,

response

•Handyperson, care

and repair schemes

for installation

•Provision of

services in sheltered

housing, extra care

•Purchase of

telehealth

equipment and

initial monitoring

•Some out of area

contracts

•Suppliers and

manufacturers of

equipment

•Suppliers of

installation, control

centres, monitoring

and response

•Provision of

nursing services,

therapy and other

services through

commercial

organisations and

social enterprises

•Specialist

installation eg

registered engineers

for gas safety

•Suppliers and

manufacturers of

equipment

•Suppliers of

installation, control

centres, monitoring

and response

•Provision of

nursing services,

therapy and other

services through

commercial

organisations and

social enterprises

•Specialist

installation eg

registered engineers

for gas safety

•Primary care trusts

for purchase of

telehealth

equipment,

installation, data

handling

•Case management

for LTCS

(community

matrons, specialist

nurses etc)

•Some hospital

based activity eg

heart failure.

•Some

commissioning of

out of hours

services to provide

support

•Primary care trusts

for purchase of

telehealth

equipment,

installation, data

handling

•Case management

for LTCS

(community

matrons, specialist

nurses etc)

•Some hospital

based activity eg

heart failure.

•Some

commissioning of

out of hours

services to provide

support

Service providers Mapping services and progress

PCT Telehealth Map:

http://maps.google.co.uk/maps/ms?hl=en&ie=UTF8&msa=0&msid=100406857045032193451.00047bfad6341183c8523&ll=54.329338,-1.604004&spn=8.052625,18.676758&z=6

Telecare and Telehealth Evaluation Map:

http://maps.google.co.uk/maps/ms?hl=en&ie=UTF8&msa=0&msid=100406857045032193451.000481bfda3b6cc58babe&ll=52.66972,-

1.955566&spn=8.373034,18.676758&z=6

Telecare Services Map:

http://maps.google.co.uk/maps/ms?hl=en&ie=UTF8&msa=0&msid=100406857045032193451.0004540c223f16f2d1c9d&ll=52.842595,-1.867676&spn=8.339986,18.676758&z=6

Phased implementationPhased implementation

Risk: infrastructure not in place to work at scale, resistance to change, programme stallsRisk: infrastructure not in place to work at scale, resistance to change, programme stalls

Stay with controlled pilots and projectsStay with controlled pilots and projects

Risk: No organisational transformation to handle scale, inconclusive local evidenceRisk: No organisational transformation to handle scale, inconclusive local evidence

Wait for the moneyWait for the money

Risk: No identified external funding, difficult to build a local business caseRisk: No identified external funding, difficult to build a local business case

Wait for the evidenceWait for the evidence

Risk: Some findings not conclusive, difficult to build a local business case, missed opportunitiesRisk: Some findings not conclusive, difficult to build a local business case, missed opportunities

Do nothing – ‘its not a priority’Do nothing – ‘its not a priority’

Risk: Unable to meet known/unidentified demand with existing services, demographic timebomb Risk: Unable to meet known/unidentified demand with existing services, demographic timebomb

‘Go for it’ – initiate major programme‘Go for it’ – initiate major programme

Risk: infrastructure not in place, overwhelmed with data, unexpected outcomesRisk: infrastructure not in place, overwhelmed with data, unexpected outcomes

Reviewing business case decisions that commissioners are making

News, features and evidence, answering queries, preparing briefing papers

Evidence database:

http://kingsfundlibrary.co.uk/wsdan/

Daily Journal News:

www.wsdactionnetwork.org.uk

Monthly newsletters/features (register for updates) – over 10,000 recipients a month:

www.wsdactionnetwork.org.uk

� High Quality Care for All – references to technology

� Strong leadership and local champions

� Successful outcomes and evaluations

� Body of local knowledge on what works

� Some degree of integrated and partnership working promoted through technology support, pooled funds

� Some well developed care pathways and case management approaches

� Motivated, involved and trained workforce

� Innovative commissioners and providers

� Prevention, personalisation and care closer to home strategies

� Links to JSNA, LAA, World Class Commissioning and key performance indicators

� Health metrics and outcomes easier to monitor, users involved in their care plans

StrengthsWeaknesses

Opportunities Threats

Reviewing the barriers and challenges - SWOT

Weaknesses

ThreatsOpportunities

Strengths

� Leaders and decision makers sceptical

� Local and wider evidence base is not convincing

� ‘Traditional’ commissioning approaches, no decommissioning of ineffective services

� Difficulties with mainstreaming and sustainability of projects and pilots

� Fair Access to Care Services criteria or health priorities prohibit widespread adoption

� Poor infrastructure and data management makes it difficult to identify beneficiaries and improved outcomes

� No vision or entrepreneurial approaches

� Resistance to change and innovation

� Difficulties in building a business case

� Services not fully costed for personal budgets

� Organisational readiness – eg workforce

Reviewing the barriers and challenges - SWOT

Opportunities

Strengths Weaknesses

Threats

� Focus on outcomes, self care and management of long term conditions

� Services and support for the wider population with stakeholder involvement

� Transformation and service integration (£)

� Innovation during difficult economic times

� Personalised services with budget options, choice and control

� Learning lessons from swine flu impacts on funding and services

� Innovation responsibilities, QIPP

� Alignment with other priorities eg LTC management, individual care plans, vascular screening

� Predictive modelling, risk stratification and evidence for who benefits

� World Class Commissioning requirements

� Interoperability, caseload management

� Carbon footprint, digital inclusion, broadband

Reviewing the barriers and challenges - SWOT

Strengths Weaknesses

Opportunities

� No additional funding – more from less

� Swine flu – impact on services, business continuity

� Rapid rate of technology adoption –difficult to scope out future investment

� Disruptive technologies threaten traditional models of care

� Consumer market develops at pace and services are left behind

� Poor data management, data loss, unable to cope with amount of data

� Technology investment with no improvement in outcomes

� Stakeholder rejection

� Consent, confidentiality and privacy issues not addressed

� Technology causes social isolation

Threats

Reviewing the barriers and challenges - SWOT

Events and presentations

Presentation slides are available at

http://www.wsdactionnetwork.org.uk/past_events/index.html

London, Birmingham, Leeds, Bristol, Manchester, Stansted…Newcastle (30 June 2010)

Sharing the learning

Newham telecare and telehealth videos:

http://www.newhamwsdtrial.org/case-studies

Presentation slides are available at http://www.wsdactionnetwork.org.uk/past_events/index.html

Thank youwww.dhcarenetworks.org.uk/telecaretelecare@dhcarenetworks.org.uk

www.wsdactionnetwork.org.ukwsdnetwork@kingsfund.org.uk

Mike Clark