Use of Resources Mini-Summit

© 2009 Tunstall Group Ltd 1

Use of Resources Mini-Summit

Workshop “a” – Assistive Technology

© 2009 Tunstall Healthcare Group Ltd

Agenda

• Presentation– What is the opportunity?

• Questions– What are the challenges that need to be

overcome to succeed?– What support & core skills does the workforce

need to take this forward?– What kind of support is required from the

regional infrastructure?


“Assistive Technology” in the context of the Use of Resources

Telecare and Telehealth


1st Generation - Responding to emergency situations• Social Alarms - Giving 1.5m UK elderly and frail people the

confidence to live at home

Response Centre

Response NetworkUser at home

calls for help

Evolution of Telecare


ResponseCentre Intruder

Inactivity

Telecare solutions – Home Risks

Lifeline

Temp Extremes

Gas

Smoke

COFall

Bed Sensor

Flood

Neighbours, Carers...

Voluntaryservices

SocialServices

HousingServices

Managed response

Escalation

GP

Reassurance


Long Term Conditions where ‘vital signs monitoring’ offers limited help: Dementia Physically/Sensory Impaired Arthritis Mental illness Ageing

Self Care Support / Management

Home-Based Monitoring

Healthy and Well

Undiagnosed

Pre-LTC

Undiagnosed

Self Care Support / Management

Specialist Disease/Core Management

Specialist Disease/Care Management

CaseManagement

Falls

SecurityInactivity

Environmentmonitoring

Lifestyle Monitoring – Preventative Telecare monitoring using ADLife


Telehealth Service

Clinical User

Monitoring Centre

Blood Pressure

Breathing Rate

Temperature

Pulse Oxymetry

ECG

Body Weight

Spirometry

Glucometry

• Early discharge monitoring• Outreach service• Real-time alarms after transmission

Patientat Home


People in the UK living with a chronic condition* People in the UK living with a chronic condition*

1 in 3 in the UK live with a Long Term Condition

Source: *Chronic disease management”, Dept of Health, May 2004**HSE web-site

Current health interventions can control chronic

conditions not cure

DIABETES2.2 million diagnosed and 1 million

undiagnosed

ASTHMA3.7 million and 1.5 million children

HEART FAILURE0.5 million

Conditions where remote biometric monitoring solutions

can help

COPD1+ million**

Conditions where remote biometric monitoring devices can not help

ARTHRITIS8.5 million

MENTAL ILLNESS 10 million

DEMENTIA 1 in 5 aged 80+

LEARNING DISABILITIES1.5 million

PHYSICAL DISABILITIES10+ million


Telehealthcare Delivery Model

Managed Response

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

EmergencyResponse

Response Centre

Alerts andReassurance

Source: Tunstall

Person CentredServices


The Business Case


Evidence leads to mainstreaming service

BACKGROUND • 52% rise in 75+ and 76% rise in 85+ by 2025• Dependency ratio set to fall to 3:1 by 2025 from 4:1 • Significant shortfall in both financial and human resources needed to provide support • CSCI recommend greater use to be made of telecare

OUTCOMES • In May 2006 TeleG (Gloucestershire telecare

project) was launched (using PTG)

• Analysis of the two year project has revealed actual net savings of

– £405,088 across 55 users

• Extrapolating these average savings, the external evaluator shows potential health and social care net savings of

– £4.27 million across 368 users – £11.6 million across 2000 users

• Initial contributions to mainstream the service could be allocated pro rata 79% to Community adult care and 21% to health sector


Meeting the needs of a growing ageing population Telecare offered free to everyone 80+

Background • The demographic trend is acute in Essex (Tendring area has

highest level of over 65s per capita in Europe)• 17,300 people have dementia rising to 27,800 by 2025 • This demand will require spend budgets to rise by a factor

of three over next 10 yrs just to maintain services at current level. This is obviously not sustainable

Outcomes • £87m worth of Public Pledges 2009-10 of which £4m is

dedicated to telecare equipment and support.• Essex strategy offers telecare free to everyone 80+• Currently 31,337 service users (Aug 09) across 9 District /

Borough Carelines • 475 people issued equipment per month on average• Major marketing campaign to advertise the offer to potential

users and families


Costs and Benefits• Commissioning based comparison of support costs, 10% sample of

2,400 cases referred for assessment– For all sample users

– £1 on Telecare is £3.58 saved in traditional care– For all sample users with savings

– £1 on Telecare is £12.60 saved• Savings accrue to following years• 08-09 total costs £317 per user for 5,662 users

No: of Service Users

No: with Careline

Connection

Cost of Equipment

Careline Support

SavingsSaving Ratio

Overall Summary

240 143 £38,293.29 £14,928.00 £190,578.39 3.58

Children - - - - - -

Adults 18 5 £3,294.01 £532.00 £6,059.04 1.58

Older People 222 138 £34,999.28 £14,396.00 £184,519.35 3.74


North Yorkshire’s mainstreamed telecare approach

Background• By 2020 there will be 50% more people over 65,

54% more people with dementia• If the general model of social care service provision

remains the same, by 2020 NYCC will need 3,420 more domiciliary care packages and 1,817 additional places in care homes at a cost increase of £43m per annum in real terms by 2020

Outcome• Today, telecare is available for all individuals needing Adult

and Community Services support as part of the range of mainstream personalised solutions to suit their individual circumstances

• In the first year of the programme NYCC has saved over £1 million

• Finance department has audited findings and approved future budget reflecting these gains


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.


Cost Benefit Analysis – 200838% 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


Additional detail• The comparison was made between what a traditional care package

would have looked like and what actual packages of care were including a Telecare solution.

– In 64 out of 138 (46%), traditional package would have been residential, EMI or

nursing care

– In 74 out of 138, (54%), traditional package would have been care in the home.

– Preliminary financial analysis is indicating

• a gross average efficiency per person on an annual basis of between £1,756

and £12,246 per area, averaging out at £3,654 countywide

• a 38% reduction in care package costs.

• The range is between a 90% reduction in package costs and in some cases an

increase if telecare added onto a residential package


North Yorkshire County Council Success Factors

• Strong leadership/vision • Clear 15 year commissioning plan• 60+ case studies available• Over 5,000 professionals and partners trained• Embedded in performance management structure

– “Telecare enhanced care package” numbers performance managed on a monthly basis

– Disciplinary offence not to mention Telecare in an assessment process

• 12,265 telecare users (Aug 09)“Here in North Yorkshire we have proven the case for telecare. It will

continue to be a critical part in our commissioning strategy and our investment plans.”

Seamus Breen, Assistant Director – Commissioning and Partnerships

“Here in North Yorkshire we have proven the case for telecare. It will continue to be a critical part in our commissioning strategy and our

investment plans.” Seamus Breen, Assistant Director – Commissioning and Partnerships


Blackpool PCT and “Vitalline”

• They have run telehealth for over a year now, initially small scale 13 monitors

• 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• Now 30 monitors



NHS Leeds – invest now to save in the long-term

Background• Leeds PCT has 12,500 registered COPD patients just above the national

average.• 8 telehealth monitors were rotated around 43 COPD patients• 18 month trial funded by the Preventative Technology Grant

Outcome• Benefits to the patient

– 98% of patients found the telehealth monitors simple to use & very easy to understand

– The patients felt more empowered about their health• Benefits to the NHS

– During the trial, 67% of COPD patients did not access hospital– Speciality respiratory nurse home visits were reduced by 20-25%

with peak periods of 50% – With 8 telehealth monitors it was calculated that 172 home visits per

year would be saved.– With 50 telehealth monitors this would increase to 1078 saved visits

• Benefits to the Nurses– More efficient visits to patients as nurses have triaged patients stats

to give quicker diagnosis– More COPD patients can be treated with the reduction in nurse home

visits


Large Scale Telehealth Projects

• The trials go on, but some are not waiting• Kent, Cornwall, Newham – (WSD participants)

• North Yorkshire & York• Nottingham City• South Tyne & Wear

“…..industrial scale…..”


Agenda

• Presentation– What is the opportunity?– North Yorkshire – over £1 million of projected savings

• Questions– What are the challenges that need to be overcome to

succeed?– What support & core skills does the workforce need to

take this forward?– What kind of support is required from the regional

infrastructure?


Telehealthcare Service Development Plan Template

• 6 point plan– Business case– Leadership challenge– Local services – “fit for purpose”?– Winning over the front line– Partner plan– Self funder plan


We are ready to help

• [email protected]– 07740 578000

• [email protected]– 07725 041008

Documents

Use of Resources Mini-Summit