Telecare in the UK home: general directions and commercial aspects for

service delivery

Paul Garner, BT

22/10/04

Telecare definition

The use of Information and Communication Technology (ICT) to support independent living for older,

frail and disabled people

UK Population Projections by Age Group

0

10000

20000

30000

40000

50000

60000

70000

2001 2006 2011 2016 2021 2026

Po

pu

lati

on

(00

0s) 75+

60-74

45-59

30-44

15-29

0-14

8 million over 65s 12 million over 65s

The changing population

40% of NHS expenditure and 50% of social services expenditure is spent on

people aged over 65

Type of care No of recipients

Amount purchased in 2001-02

Average cost per client per year

Total cost

Nursing care 85,960 3,580,186

weeks

£19,136 £1,317 million

Residential care 163,300 11,557,035 weeks

£15,836 £2,861 million

Community based care

925,000 150,000,000 hours

£1,956 £1,810 million

Assessment & management

1,088,300 N/A £457 £498 million

Total 1,088,300 N/A £5,960 £6,487 million

Over £7.5B by 2026, without inflation!

The Cost of Care

Less carers available

2.0

2.5

3.0

3.5

4.0

4.5

1995 2005 2015 2025 2035 2045 2055Year

Rat

io P

erso

ns

Ag

ed 1

6-64

to

65+

10

15

20

25

30

35

40

45

50

UK

Lo

ng

Ter

m H

ealt

hca

re C

ost

(£B

)

Support Ratio 1 UK Long TermHealthcare Cost 2

1. Office for National Statistics, 2002.2. Royal Commission Report into Long Term Care, 1999.

Predictions for the demand and supply of residential care home places for people aged over 65

200000

210000

220000

230000

240000

250000

260000

270000

280000

290000

20

03

20

05

20

07

20

09

20

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13

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15

20

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20

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20

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20

23

20

25

No

of

pla

ce

s

Supply

Demand @population over65 grow th rate

Demand @ onefifth populationgrow th rate

Supply @ 2003levels

Residential Care

• National Service Framework for Older People:

“by 2006, an extra 100,000 people should be looked after at home”

• Patient centric care – single assessment process

• Bed-blocking – over 65s cost the NHS 1.3 million bed-days each year

• £80M for Telecare pump priming in English LAs from 2006 (plus extra £1bn for social services)

Political Drivers

There are now 1.5 million alarm support systems in the UK which use simple technology to provide support to vulnerable people ...

… but systems using new technology could provide much better support.

1st Generation Telecare Solutions

2nd Generation: Telecare PilotAn automated intelligent supportive home care system using an array of environmental sensors and a broadband gateway

Works with the occupant to help

maintaintheir independence

and safety.

0 2 4 6 8 10 12 14

0.0

0.2

0.4

0.6

0.8

1.0

Inter-event Time (ln[seconds-10])

Pro

ba

bili

ty D

en

sity

Ref Client: 23s3BHKLT.txt

Event Count: 134285

ExponentialLog-GammaLognormalGammaWeibull

End-to-end service

Monitored residence

Carer

Voice call(PSTN)

Liverpool Direct

call centre

Alert messagin

g

BroadbandEncrypted

Voice call

(PSTN)Monitoring

data

Internet

Back office

Management

interface

Data serve

r

Telecare platform

Firewall Messaging server

Voice serve

r

Monitored residence

RMU

Automated Voice Call (PSTN)

BroadbandEncrypted

Existing/recent Telecare pilots

• Medway Council (Kent)– Phase 1 basic set of 7 sensors, now moving to phase 2 with fall, bed occupancy, X10

light control, bogus caller on TV plus panic link, wandering, gas shut off. Uses Tunstall kit including “869 Wireless sensors”

• FOLD (N.Ireland)– 1st gen = basic service linking family/friends 24/7. NI have 20,000 clients and 60,000

carers. 2nd Gen = auto critical alerts, 24/7, warden/carer link. 3rd Gen = pre-alerts, 24/7, care plan review and delivery is critical. Uses Tunstall kit as above at multiple sites.

• Sandwell (West Midlands)– Same equipment as above plus auto pill dispenser. Not appropriate for everyone, must

be needs led, not equipment led. Now evaluation and consolidation.

• Kent County Council– One stop shop call centre to coordinate assistive technology packages including

Tunstall kit.

• North Surrey and Woking PCT– Respiratory Disease telemedicine trial

Existing/recent Telecare pilots

• Carlisle PCT & Housing– Intermediate care pilot. Support independent living At home – rehabilitation, recovery

and monitoring. Feb 02 – Mar 03 = 420 services users, 60% support early discharge, 20% prevent admissions, 20% monitor risk of falls. Average cost = £205 per week (6 weeks in hospital at £850 per week = £5.1k)

• Northamptonshire “Safe at Home”– Small pilot focused on dementia care.

• West Lothian “Opening Doors”– 1900 people supported. 1200 home installations. 3364 NHS bed days saved.

• Warrington “Housing with care”– Telecare to monitor activity levels, includes flood, smoke and wandering.

• Columba Project (Surrey)– Linked with Imperial College and Tunstall. A re-enablement and skills gain environment

for 65+ age group. 25 clients over 1 year. Telecare in a 4 bedroom housing unit and the client home. Tunstall extended kit as above plus fridge door sensor. “Lifestyle monitoring and indicators of change in health and social status”. Created Telecare checklist.

Existing/recent Telecare pilots

• Millennium Homes– Sensors and interactive voice/screens around the home. Only calls for help are

transmitted outside the home. Now established the Huntleigh Research Institute at Brunel University to conduct Telecare R&D. Huntleigh have also launched the Huntleigh Insight solution.

• IST Vivago Wristcare– Wrist based wearable wireless monitor and alarm. Measures movement, temperature

and skin conductivity. 5000 units in use across Finland, Sweden, UK, Germany, Japan, France, Ireland, Spain. 50% institutional, 50% used at home.

• WYMAS Respiratory Service – call centre support for asthmatics with condition control problems

• Salford CareCall Service – call centre support for type II diabetics with condition control problems

• Hanover extracare pilot – Based on Tunstall equipment.

DoH: Integrating Community Equipment Services

• Typical time to set up a Telecare project = 18 months – have produced “getting started pack” aim to reduce to 6 months.

• Pack includes statements on cost/benefits and advantages/disadvantages from audit commission

• Preventative Technology Grant - £80M to be made available from 2006 targeted at 160,000 vulnerable people.

• Move Telecare services from pilots and trials to mainstream delivery. E-Health and Telecare are required “additional services” under NHS LSP contracts NOW

• A showcase for emerging good practice and innovation:

www.icesdoh.org

Local authority market – Telecare as a substitute for residential care

Benefits to LAReduces care costs – more services can be offeredPromotes independence and client satisfaction

NowResidential care costs Local Authorities on average £15,800 per client per annumTotal cost - £2.8bn

With telecareOne third of residential care clients could become telecare clientsSaving £12k per client per annum, £700m in total

No of Potential Telecare Clients

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10,000

20,000

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40,000

50,000

60,000

70,000

80,000

90,000

2003

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2007

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2017

2019

2021

2023

2025

No

of

clien

ts

Private clients

Local authorityfunded clients

Consumer market

• Reassurance market – typically adult children concerned about elderly parents

• 20% of UK population aged over 60 in 2001, rising to 30% in 2026

• There is an opportunity to offer a consumer version of Telecare building on the home security and home entertainment markets

• 3.1 million single pensioner households • 1.4 million single pensioners have no panic alarm and ABC1 children Consumer monitoring market alone worth

> £150m per annum

Research - 3rd Generation:Longitudinal trend analysis...

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4 April 1998

FALSE TRUE

AWAKE ASLEEP

ON OFF

IN OUT

Temp (Lounge)

22.0

24.0

PIR (Bedroom)257

PIR (Lounge)231

PIR (Kitchen)324

PIR (Hall)21

PIR (Bathroom)10

Closedoor (Entrance Door)8

Closedoor (Fridge Door)15

Activity (CDEFGI)865

Sense

Analyse

Display

…combining a multiplicity of instrumented data with known human intervention to generate a sophisticated well-being indicator and assessment aid…..

Other user knowledge

Centre for Care in Community

Led by BT this Centre, by focusing on Telecare, aims to design and prove a system for continuous monitoring of client health and social well-being

in the home.

Av Err: 12%

38 39 40 41 42 43 44 45 46 47 48 49 50 51 52PERIOD

TODAY

2nd FALLMEDICATION

CHANGE

1st FALL

PREDICTIVE REGION

Well-being INDEX:

100

80

50

10

00

20

04

(Without Intervention)

HISTORY REGION

STAIR LIFTINSTALLED

CAREINTERVENTION

STARTS

MajorModerateMildNoneINTERVENTION

LEVEL:

Accommodation Change Medication ChangeWithout InterventionPREDICTION

TYPE:X

Care Well-being IndexCALCULATEOPTIMISATION:

XCost (£ per Week)X

Preventative rather than reactive

Smart Homes for wellbeing

Many questions still to be answered:• Low cost ubiquitous sensor devices• Scalable intelligent data analysis• Seamless links to care records (ICRS)• Privacy, ethics, usability/interfaces• Standards: sensors, systems, messaging

Opportunity for continuous objective measurement and support:

• Peace of mind for clients and carers• Optimisation of home care services• Timely intervention ahead of crises• Government and consumer market

Georgia Tech Digital Family Portrait